Mary Ellen Schneider

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS.

More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. The proposed rule also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing health insurance.

Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS.

More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. The proposed rule also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing health insurance.

Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced during a teleconference Aug. 12 that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS.

More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Department, also issued three proposed rules aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. The proposed rule also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing health insurance.

Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

Few Ob.Gyns. Perform Abortions

While nearly all ob.gyns. see patients seeking abortions, only about 14% report performing abortions themselves, according to a new survey. The self-administered survey of more than 1,000 practicing ob.gyns. across the United States showed that female physicians were more likely to perform abortions than were their male counterparts, with 19% of women providing the procedure compared with 11% of men. The findings were published in the September issue of Obstetrics & Gynecology (2011;118:609-14). Age was also a factor. The survey indicated that ob.gyns. aged 35 and younger were the most likely to perform abortions (22%), followed by doctors aged 56-65 years (15%). Physicians were also more likely to perform abortions if they lived in the Northeast, practiced in an urban area, and did not have strong religious beliefs, according to the survey, which was conducted by researchers at the University of Chicago and Duke University in Durham, N.C. The researchers did not ask whether those ob.gyns. who do not perform abortions provide referrals for abortion. The researchers were supported by grants from the Greenwall Foundation, the John Templeton Foundation, and the National Institutes of Health.

Pregnancy Rate Disparities 'Troubling'

The rate of unintended pregnancies among poor women in the United States is rising dramatically, even as nationally that figure remains about the same. An analysis by the Guttmacher Institute found that between 2001 and 2006, the unintended pregnancy rate nationally rose from 50 per 1,000 women aged 15-44 years to 52 per 1,000 women. But among women below the federal poverty line, it rose from 120 to 132 per 1,000 women between 2001 and 2006. The rate of unintended pregnancies actually dropped among higher-income women. For women whose incomes were at or above 200% of federal poverty, the rate fell from 28 to 24 per 1,000 women during the same time period. The analysts at the Guttmacher Institute also found that poor women tended to have higher rates of unintended pregnancies regardless of their education, race and ethnicity, marital status, or age. “The growing disparity in unplanned pregnancy rates between poor and higher-income women – which reflects persistent, similar disparities across a range of health and social indicators – is deeply troubling,” Sharon Camp, president and CEO of the Guttmacher Institute, said in a statement. “Addressing them requires not only improved access to reproductive health care, but also looking to broader social and economic inequalities.” The Guttmacher Institute researchers relied on federal government data such as the National Survey of Family Growth, the Center for Disease Control and Prevention's abortion surveillance figures, and their own data on abortion in putting together the analysis.

SF Circumcisions Remain Legal

A well-publicized effort to ban male circumcision in San Francisco was blocked by the courts this summer. Opponents of circumcision had collected enough signatures to place a proposed ban of the procedure on the city's November ballot. If successful, the ballot measure would have prohibited the circumcision of boys under age 18 unless it was deemed medically necessary. The referendum did not include an exception based on religious beliefs. But in late July, San Francisco Superior Court Judge Loretta M. Giorgi tossed out the ballot measure, saying that the regulation of medical procedures can be done only by the state, not the city.

Know the Law on Expedited Partner Tx

Officials at the American College of Obstetricians and Gynecologists are urging ob.gyns. who work in states where the prescription of antibiotics to the male sex partners of female patients with a sexually transmitted infection is prohibited to work to change the law. In new committee opinion #506 published in the September issue of Obstetrics & Gynecology, ACOG said its members should lobby for legalization of expedited partner therapy and work with their local health departments to develop protocols for its use. While statutes explicitly allowing expedited partner therapy are preferable, ACOG wrote that it may be easier to get a ruling from the state medical and pharmacy boards that the practice is not unprofessional conduct. Expedited partner therapy is currently allowed in 27 states, potentially allowable in an additional 15 states, and prohibited in 8 states.

Identify Human Trafficking Victims

ACOG is asking ob.gyns. to be aware of the problem of human trafficking of women and girls in the United States. In new committee opinion #507, ACOG offers tips that could help ob.gyns. recognize when patients are possible victims of human trafficking. For example, they may lack official identification such as a driver license or passport, offer inconsistent information, avoid eye contact, display signs of physical abuse, and have someone else with them who controls their money and pays for their visit. ACOG recommends asking open-ended questions and finding a way to speak with the patient in the presence of a chaperone away from the patient's partner. The policy statement was published in the September issue of Obstetrics & Gynecology.

Few Ob.Gyns. Perform Abortions

While nearly all ob.gyns. see patients seeking abortions, only about 14% report performing abortions themselves, according to a new survey. The self-administered survey of more than 1,000 practicing ob.gyns. across the United States showed that female physicians were more likely to perform abortions than were their male counterparts, with 19% of women providing the procedure compared with 11% of men. The findings were published in the September issue of Obstetrics & Gynecology (2011;118:609-14). Age was also a factor. The survey indicated that ob.gyns. aged 35 and younger were the most likely to perform abortions (22%), followed by doctors aged 56-65 years (15%). Physicians were also more likely to perform abortions if they lived in the Northeast, practiced in an urban area, and did not have strong religious beliefs, according to the survey, which was conducted by researchers at the University of Chicago and Duke University in Durham, N.C. The researchers did not ask whether those ob.gyns. who do not perform abortions provide referrals for abortion. The researchers were supported by grants from the Greenwall Foundation, the John Templeton Foundation, and the National Institutes of Health.

Pregnancy Rate Disparities 'Troubling'

The rate of unintended pregnancies among poor women in the United States is rising dramatically, even as nationally that figure remains about the same. An analysis by the Guttmacher Institute found that between 2001 and 2006, the unintended pregnancy rate nationally rose from 50 per 1,000 women aged 15-44 years to 52 per 1,000 women. But among women below the federal poverty line, it rose from 120 to 132 per 1,000 women between 2001 and 2006. The rate of unintended pregnancies actually dropped among higher-income women. For women whose incomes were at or above 200% of federal poverty, the rate fell from 28 to 24 per 1,000 women during the same time period. The analysts at the Guttmacher Institute also found that poor women tended to have higher rates of unintended pregnancies regardless of their education, race and ethnicity, marital status, or age. “The growing disparity in unplanned pregnancy rates between poor and higher-income women – which reflects persistent, similar disparities across a range of health and social indicators – is deeply troubling,” Sharon Camp, president and CEO of the Guttmacher Institute, said in a statement. “Addressing them requires not only improved access to reproductive health care, but also looking to broader social and economic inequalities.” The Guttmacher Institute researchers relied on federal government data such as the National Survey of Family Growth, the Center for Disease Control and Prevention's abortion surveillance figures, and their own data on abortion in putting together the analysis.

SF Circumcisions Remain Legal

A well-publicized effort to ban male circumcision in San Francisco was blocked by the courts this summer. Opponents of circumcision had collected enough signatures to place a proposed ban of the procedure on the city's November ballot. If successful, the ballot measure would have prohibited the circumcision of boys under age 18 unless it was deemed medically necessary. The referendum did not include an exception based on religious beliefs. But in late July, San Francisco Superior Court Judge Loretta M. Giorgi tossed out the ballot measure, saying that the regulation of medical procedures can be done only by the state, not the city.

Know the Law on Expedited Partner Tx

Officials at the American College of Obstetricians and Gynecologists are urging ob.gyns. who work in states where the prescription of antibiotics to the male sex partners of female patients with a sexually transmitted infection is prohibited to work to change the law. In new committee opinion #506 published in the September issue of Obstetrics & Gynecology, ACOG said its members should lobby for legalization of expedited partner therapy and work with their local health departments to develop protocols for its use. While statutes explicitly allowing expedited partner therapy are preferable, ACOG wrote that it may be easier to get a ruling from the state medical and pharmacy boards that the practice is not unprofessional conduct. Expedited partner therapy is currently allowed in 27 states, potentially allowable in an additional 15 states, and prohibited in 8 states.

Identify Human Trafficking Victims

ACOG is asking ob.gyns. to be aware of the problem of human trafficking of women and girls in the United States. In new committee opinion #507, ACOG offers tips that could help ob.gyns. recognize when patients are possible victims of human trafficking. For example, they may lack official identification such as a driver license or passport, offer inconsistent information, avoid eye contact, display signs of physical abuse, and have someone else with them who controls their money and pays for their visit. ACOG recommends asking open-ended questions and finding a way to speak with the patient in the presence of a chaperone away from the patient's partner. The policy statement was published in the September issue of Obstetrics & Gynecology.

Few Ob.Gyns. Perform Abortions

While nearly all ob.gyns. see patients seeking abortions, only about 14% report performing abortions themselves, according to a new survey. The self-administered survey of more than 1,000 practicing ob.gyns. across the United States showed that female physicians were more likely to perform abortions than were their male counterparts, with 19% of women providing the procedure compared with 11% of men. The findings were published in the September issue of Obstetrics & Gynecology (2011;118:609-14). Age was also a factor. The survey indicated that ob.gyns. aged 35 and younger were the most likely to perform abortions (22%), followed by doctors aged 56-65 years (15%). Physicians were also more likely to perform abortions if they lived in the Northeast, practiced in an urban area, and did not have strong religious beliefs, according to the survey, which was conducted by researchers at the University of Chicago and Duke University in Durham, N.C. The researchers did not ask whether those ob.gyns. who do not perform abortions provide referrals for abortion. The researchers were supported by grants from the Greenwall Foundation, the John Templeton Foundation, and the National Institutes of Health.

Pregnancy Rate Disparities 'Troubling'

The rate of unintended pregnancies among poor women in the United States is rising dramatically, even as nationally that figure remains about the same. An analysis by the Guttmacher Institute found that between 2001 and 2006, the unintended pregnancy rate nationally rose from 50 per 1,000 women aged 15-44 years to 52 per 1,000 women. But among women below the federal poverty line, it rose from 120 to 132 per 1,000 women between 2001 and 2006. The rate of unintended pregnancies actually dropped among higher-income women. For women whose incomes were at or above 200% of federal poverty, the rate fell from 28 to 24 per 1,000 women during the same time period. The analysts at the Guttmacher Institute also found that poor women tended to have higher rates of unintended pregnancies regardless of their education, race and ethnicity, marital status, or age. “The growing disparity in unplanned pregnancy rates between poor and higher-income women – which reflects persistent, similar disparities across a range of health and social indicators – is deeply troubling,” Sharon Camp, president and CEO of the Guttmacher Institute, said in a statement. “Addressing them requires not only improved access to reproductive health care, but also looking to broader social and economic inequalities.” The Guttmacher Institute researchers relied on federal government data such as the National Survey of Family Growth, the Center for Disease Control and Prevention's abortion surveillance figures, and their own data on abortion in putting together the analysis.

SF Circumcisions Remain Legal

A well-publicized effort to ban male circumcision in San Francisco was blocked by the courts this summer. Opponents of circumcision had collected enough signatures to place a proposed ban of the procedure on the city's November ballot. If successful, the ballot measure would have prohibited the circumcision of boys under age 18 unless it was deemed medically necessary. The referendum did not include an exception based on religious beliefs. But in late July, San Francisco Superior Court Judge Loretta M. Giorgi tossed out the ballot measure, saying that the regulation of medical procedures can be done only by the state, not the city.

Know the Law on Expedited Partner Tx

Officials at the American College of Obstetricians and Gynecologists are urging ob.gyns. who work in states where the prescription of antibiotics to the male sex partners of female patients with a sexually transmitted infection is prohibited to work to change the law. In new committee opinion #506 published in the September issue of Obstetrics & Gynecology, ACOG said its members should lobby for legalization of expedited partner therapy and work with their local health departments to develop protocols for its use. While statutes explicitly allowing expedited partner therapy are preferable, ACOG wrote that it may be easier to get a ruling from the state medical and pharmacy boards that the practice is not unprofessional conduct. Expedited partner therapy is currently allowed in 27 states, potentially allowable in an additional 15 states, and prohibited in 8 states.

Identify Human Trafficking Victims

ACOG is asking ob.gyns. to be aware of the problem of human trafficking of women and girls in the United States. In new committee opinion #507, ACOG offers tips that could help ob.gyns. recognize when patients are possible victims of human trafficking. For example, they may lack official identification such as a driver license or passport, offer inconsistent information, avoid eye contact, display signs of physical abuse, and have someone else with them who controls their money and pays for their visit. ACOG recommends asking open-ended questions and finding a way to speak with the patient in the presence of a chaperone away from the patient's partner. The policy statement was published in the September issue of Obstetrics & Gynecology.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Dept., also issued three proposed rules aimed at creating a system that's easy to navigate. The first proposal, from HHS, outlines standards and processes for consumers to enroll in a health plan and seek financial assistance. It also explains the standards for small employers to participate in exchanges. Another HHS proposal attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges so individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how, under the Affordable Care Act, taxpayers with incomes at 100%-400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Dept., also issued three proposed rules aimed at creating a system that's easy to navigate. The first proposal, from HHS, outlines standards and processes for consumers to enroll in a health plan and seek financial assistance. It also explains the standards for small employers to participate in exchanges. Another HHS proposal attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges so individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how, under the Affordable Care Act, taxpayers with incomes at 100%-400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The Health and Human Services department announced that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges. These grants follow planning grants awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to HHS.

HHS, along with the Treasury Dept., also issued three proposed rules aimed at creating a system that's easy to navigate. The first proposal, from HHS, outlines standards and processes for consumers to enroll in a health plan and seek financial assistance. It also explains the standards for small employers to participate in exchanges. Another HHS proposal attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges so individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how, under the Affordable Care Act, taxpayers with incomes at 100%-400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member.

A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to more than 4,500%.

On average, drugs are being marked up 650% on the gray market, according to Premier Healthcare Alliance, which analyzed 636 unsolicited sales offers received by acute care facilities in its network. Ahe drugs were either back-ordered or unavailable through the manufacturer. The top 10 highest markups, seen in cardiology, sedation, critical care, and oncology drugs, were more than 1,000% over base contract prices:. labetalol (4,533%); cytarabine (3,980%); dexamethasone 4- mg injection (3,857%); leucovorin (3,170%); propofol (3,161%); papaverine (2,979%); protamine sulfate (2,752%); [levophed (2,642%); [sodium chloride concentrate (2,350%); and [furosemide injection (1,721%).

Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as “we only have 20 [units] of this drug left and quantities are going fast.”

The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.

Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price, but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.

Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.

Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.

A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to more than 4,500%.

On average, drugs are being marked up 650% on the gray market, according to Premier Healthcare Alliance, which analyzed 636 unsolicited sales offers received by acute care facilities in its network. Ahe drugs were either back-ordered or unavailable through the manufacturer. The top 10 highest markups, seen in cardiology, sedation, critical care, and oncology drugs, were more than 1,000% over base contract prices:. labetalol (4,533%); cytarabine (3,980%); dexamethasone 4- mg injection (3,857%); leucovorin (3,170%); propofol (3,161%); papaverine (2,979%); protamine sulfate (2,752%); [levophed (2,642%); [sodium chloride concentrate (2,350%); and [furosemide injection (1,721%).

Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as “we only have 20 [units] of this drug left and quantities are going fast.”

The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.

Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price, but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.

Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.

Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.

A gray market of secondary pharmaceutical suppliers is driving up the price of lifesaving drugs that are in short supply, with markups ranging from 100% to more than 4,500%.

On average, drugs are being marked up 650% on the gray market, according to Premier Healthcare Alliance, which analyzed 636 unsolicited sales offers received by acute care facilities in its network. Ahe drugs were either back-ordered or unavailable through the manufacturer. The top 10 highest markups, seen in cardiology, sedation, critical care, and oncology drugs, were more than 1,000% over base contract prices:. labetalol (4,533%); cytarabine (3,980%); dexamethasone 4- mg injection (3,857%); leucovorin (3,170%); propofol (3,161%); papaverine (2,979%); protamine sulfate (2,752%); [levophed (2,642%); [sodium chloride concentrate (2,350%); and [furosemide injection (1,721%).

Gray market vendors generally advertise drugs through e-mails and faxes that tout the shortage of the products, Premier officials said, with language such as “we only have 20 [units] of this drug left and quantities are going fast.”

The reported price gouging comes as the country faces an unprecedented shortage of drugs. By the end of 2011, there could be more than 360 drugs in short supply, according to projections by Premier.

Hospitals and pharmacies must beware when purchasing drugs on the gray market, not just because of the inflated price, but also because of safety risks, Premier officials warned. Products sold on the gray market may have been mishandled, rendering them ineffective or harmful; they also could be counterfeit or diluted.

Stolen, counterfeit, and mishandled drugs are also difficult to recognize. Even the original manufacturers may not be able to spot fake drugs, according to analysts for Premier. And hospitals that try to avoid gray market vendors may encounter problems because these vendors have sophisticated methods of impersonating legitimate, licensed distributors, according to Premier.

Drug shortages are also getting increased attention in Washington, where a bipartisan group of senators has been urging the Food and Drug Administration to do more to address these shortages. The FDA will hold a public meeting on the issue on Sept. 26.

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.

“The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency,” said Dr. Ann S. O'Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician's office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians may improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that integration across all of a patient's medical needs requires more time and effort.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.

“The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency,” said Dr. Ann S. O'Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician's office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians may improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that integration across all of a patient's medical needs requires more time and effort.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians who are employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities (Findings From HSC 2011 August [Issue Brief No. 13]). The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

In one area, at least two cardiologists said they declined job offers from a local hospital because they believed the pressure to drive up volume would be stronger there than in their independent cardiology practice, according to the report.

“The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency,” said Dr. Ann S. O'Malley, a senior health researcher at the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals employing more physicians can also drive up costs for the health system because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician's office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians may improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital. Interview respondents from the 12 communities said that integration across all of a patient's medical needs requires more time and effort.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Fighting for Arthritis Funding

More than 3,500 people have signed on to a petition started by the Arthritis Foundation to maintain federal funding for arthritis research. The online petition urges members of Congress to fund the National Institutes of Health at $35 billion in fiscal year 2012, the minimum amount needed to maintain current research and account for inflation, according to the Arthritis Foundation. While 10-year debt negotiations get underway, Congress is considering smaller spending bills for fiscal year 2012. The petition is available at

www.arthritis.org/petition.php

Sex Differences in Knee OA

The Society for Women's Health Research is funding a pilot study looking into whether there are biological differences that account for women being disproportionately affected by knee osteoarthritis. The Centers for Disease Control and Prevention reported last year that the prevalence of knee osteoarthritis in 2005 was 1.2 per 100 in women and 0.4 per 100 in men. To explore the etiology of the disease in the two sexes, the researchers will study tissue samples from patients who have undergone total knee arthroplasty. Dr. Mary O'Connor, chair of the department of orthopedic surgery at the Mayo Clinic in Jacksonville, Fla., will lead the study and be joined by colleagues at Florida State University in Tallahassee, Emory University and the Georgia Institute of Technology in Atlanta, and the University of Calgary in Alberta.

Senators: Stop the Imaging Cuts

A bipartisan group of senators has called on President Obama to reject any further cuts to medical imaging payments under Medicare, saying the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” they wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter were John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Opioid Deaths Increasing

U.S. policy makers need to implement steps such as educational programs for physicians to curb an onslaught of deaths resulting from overdoses of prescription opioids, according to an analysis published in the British Medical Journal (2011;343:d5142 [doi: 10.1136/bmj.d5142]). Such deaths tripled in the United States from 1999 to 2007, reaching more than 14,400 a year. Other countries, such as the United Kingdom, are also seeing such increases, the researchers reported. To curb deaths from the prescription drugs, policy makers should consider new physician-education programs and creation of electronic prescription systems that will prevent people from obtaining opioids from multiple doctors or pharmacies, the authors suggested. In addition, they said that drug companies should end commissions for sales of prescription opioid drugs.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary widely by state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

Fighting for Arthritis Funding

More than 3,500 people have signed on to a petition started by the Arthritis Foundation to maintain federal funding for arthritis research. The online petition urges members of Congress to fund the National Institutes of Health at $35 billion in fiscal year 2012, the minimum amount needed to maintain current research and account for inflation, according to the Arthritis Foundation. While 10-year debt negotiations get underway, Congress is considering smaller spending bills for fiscal year 2012. The petition is available at

www.arthritis.org/petition.php

Sex Differences in Knee OA

The Society for Women's Health Research is funding a pilot study looking into whether there are biological differences that account for women being disproportionately affected by knee osteoarthritis. The Centers for Disease Control and Prevention reported last year that the prevalence of knee osteoarthritis in 2005 was 1.2 per 100 in women and 0.4 per 100 in men. To explore the etiology of the disease in the two sexes, the researchers will study tissue samples from patients who have undergone total knee arthroplasty. Dr. Mary O'Connor, chair of the department of orthopedic surgery at the Mayo Clinic in Jacksonville, Fla., will lead the study and be joined by colleagues at Florida State University in Tallahassee, Emory University and the Georgia Institute of Technology in Atlanta, and the University of Calgary in Alberta.

Senators: Stop the Imaging Cuts

A bipartisan group of senators has called on President Obama to reject any further cuts to medical imaging payments under Medicare, saying the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” they wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter were John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Opioid Deaths Increasing

U.S. policy makers need to implement steps such as educational programs for physicians to curb an onslaught of deaths resulting from overdoses of prescription opioids, according to an analysis published in the British Medical Journal (2011;343:d5142 [doi: 10.1136/bmj.d5142]). Such deaths tripled in the United States from 1999 to 2007, reaching more than 14,400 a year. Other countries, such as the United Kingdom, are also seeing such increases, the researchers reported. To curb deaths from the prescription drugs, policy makers should consider new physician-education programs and creation of electronic prescription systems that will prevent people from obtaining opioids from multiple doctors or pharmacies, the authors suggested. In addition, they said that drug companies should end commissions for sales of prescription opioid drugs.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary widely by state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

Fighting for Arthritis Funding

More than 3,500 people have signed on to a petition started by the Arthritis Foundation to maintain federal funding for arthritis research. The online petition urges members of Congress to fund the National Institutes of Health at $35 billion in fiscal year 2012, the minimum amount needed to maintain current research and account for inflation, according to the Arthritis Foundation. While 10-year debt negotiations get underway, Congress is considering smaller spending bills for fiscal year 2012. The petition is available at

www.arthritis.org/petition.php

Sex Differences in Knee OA

The Society for Women's Health Research is funding a pilot study looking into whether there are biological differences that account for women being disproportionately affected by knee osteoarthritis. The Centers for Disease Control and Prevention reported last year that the prevalence of knee osteoarthritis in 2005 was 1.2 per 100 in women and 0.4 per 100 in men. To explore the etiology of the disease in the two sexes, the researchers will study tissue samples from patients who have undergone total knee arthroplasty. Dr. Mary O'Connor, chair of the department of orthopedic surgery at the Mayo Clinic in Jacksonville, Fla., will lead the study and be joined by colleagues at Florida State University in Tallahassee, Emory University and the Georgia Institute of Technology in Atlanta, and the University of Calgary in Alberta.

Senators: Stop the Imaging Cuts

A bipartisan group of senators has called on President Obama to reject any further cuts to medical imaging payments under Medicare, saying the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” they wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter were John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Opioid Deaths Increasing

U.S. policy makers need to implement steps such as educational programs for physicians to curb an onslaught of deaths resulting from overdoses of prescription opioids, according to an analysis published in the British Medical Journal (2011;343:d5142 [doi: 10.1136/bmj.d5142]). Such deaths tripled in the United States from 1999 to 2007, reaching more than 14,400 a year. Other countries, such as the United Kingdom, are also seeing such increases, the researchers reported. To curb deaths from the prescription drugs, policy makers should consider new physician-education programs and creation of electronic prescription systems that will prevent people from obtaining opioids from multiple doctors or pharmacies, the authors suggested. In addition, they said that drug companies should end commissions for sales of prescription opioid drugs.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary widely by state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

Enacting comprehensive state laws that ban smoking in workplaces and restaurants as well as raising the cigarette tax by $1 per pack across the country could bring in billions in revenue for cash-strapped states, while also saving nearly 2 million lives.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $1 per pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., CEO of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all. But when the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start, and smoking-related deaths would fall by 624,000.

On the economic side, those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. And the researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $1 per pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States also could benefit from both decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Enacting comprehensive state laws that ban smoking in workplaces and restaurants as well as raising the cigarette tax by $1 per pack across the country could bring in billions in revenue for cash-strapped states, while also saving nearly 2 million lives.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $1 per pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., CEO of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all. But when the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start, and smoking-related deaths would fall by 624,000.

On the economic side, those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. And the researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $1 per pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States also could benefit from both decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Enacting comprehensive state laws that ban smoking in workplaces and restaurants as well as raising the cigarette tax by $1 per pack across the country could bring in billions in revenue for cash-strapped states, while also saving nearly 2 million lives.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $1 per pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., CEO of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all. But when the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start, and smoking-related deaths would fall by 624,000.

On the economic side, those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. And the researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $1 per pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States also could benefit from both decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The U.S. Department of Health and Human Services announced during the teleconference that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges.

These grants follow planning grants that were awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to the department.

HHS, along with the Treasury Department, also issued three proposed rules that are aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The U.S. Department of Health and Human Services announced during the teleconference that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges.

These grants follow planning grants that were awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to the department.

HHS, along with the Treasury Department, also issued three proposed rules that are aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

Federal officials are laying the groundwork for the launch of state-based health insurance exchanges in 2014, handing out millions of dollars in grants to states, designing tools to determine eligibility to buy insurance, and proposing details on how the refundable premium tax credits will work.

The U.S. Department of Health and Human Services announced during the teleconference that it is awarding $185 million in “establishment” grants to 13 states and the District of Columbia to help them build their insurance exchanges.

These grants follow planning grants that were awarded last year by HHS. More than half of the states have already taken some action to begin building their exchanges, according to the department.

HHS, along with the Treasury Department, also issued three proposed rules that are aimed at creating a system that's easy for consumers and small businesses to navigate.

The first proposal, issued by HHS, outlines the standards and processes for consumers to enroll in a health plan and to seek financial assistance. It also explains the standards for small employers to participate in the exchange.

Another proposal from HHS attempts to simplify the process for determining eligibility in Medicaid and the Children's Health Insurance Program and to coordinate these processes with the insurance exchanges, so that individuals can move from Medicaid to another health plan without losing coverage.

Finally, the Treasury Department issued a proposed regulation that explains how individuals and families can receive premium tax credits for purchasing insurance. Under the Affordable Care Act, taxpayers with incomes between 100% and 400% of the federal poverty level will be eligible for premium tax credits if they purchase insurance through the exchange for themselves or a family member. The tax credits are paid in advance to the health plan to reduce the individual's monthly premium.

A federal appeals court in Atlanta has struck down the Affordable Care Act's requirement that individuals purchase health insurance.

In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.

By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson's decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.

Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post on Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.

“The individual responsibility provision – the main part of the law at issue in these cases – is constitutional,” Ms. Cutter wrote. “Those who claim this provision exceeds Congress' power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab.”

The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.

A federal appeals court in Atlanta has struck down the Affordable Care Act's requirement that individuals purchase health insurance.

In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.

By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson's decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.

Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post on Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.

“The individual responsibility provision – the main part of the law at issue in these cases – is constitutional,” Ms. Cutter wrote. “Those who claim this provision exceeds Congress' power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab.”

The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.

A federal appeals court in Atlanta has struck down the Affordable Care Act's requirement that individuals purchase health insurance.

In a 2-1 ruling issued Aug. 12, the court declared that the so-called individual mandate violates the Commerce Clause of the U.S. Constitution and that Congress overstepped its authority in creating the requirement to buy insurance. The lawsuit was brought by a coalition of 26 states that oppose the Affordable Care Act on the grounds that the individual mandate infringes on the constitutional rights of individuals not to purchase insurance, and that the expansion of Medicaid will create an undue burden on state governments.

By ruling the individual mandate is unconstitutional, the appeals court affirms in part a ruling issued by U.S. District Court Judge Roger Vinson of Pensacola, Fla., in January. The appeals court disagreed with Judge Vinson's decision to declare the entire Affordable Care Act unconstitutional, however. The higher court concluded that the individual mandate could be stripped out, allowing the rest of the law to stand.

Stephanie Cutter, a deputy senior adviser to President Obama, wrote in a blog post on Aug. 12 that the White House was disappointed in the ruling but confident that it would be overturned.

“The individual responsibility provision – the main part of the law at issue in these cases – is constitutional,” Ms. Cutter wrote. “Those who claim this provision exceeds Congress' power to regulate interstate commerce are incorrect. Individuals who choose to go without health insurance are making an economic decision that affects all of us – when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab.”

The ruling in Atlanta is one of more than 25 legal challenges to the Affordable Care Act that are happening in courthouses around the country. Legal scholars expect that one of these challenges is likely to be decided by the Supreme Court in the next few years.

Mental health providers and advocates are growing concerned that Medicaid recipients won’t be able to access psychiatrists or certain specialty mental health services even with the massive expansion of Medicaid mandated under the Affordable Care Act.

Low provider payment rates under Medicaid, coupled with financial pressures on states and the federal government, threaten to limit access to mental health treatment just as an additional 16 million Americans gain coverage through the Medicaid program, experts said.

The Affordable Care Act, which was enacted in March 2010, expands the Medicaid program to anyone below 133% of the federal poverty level, which is an annual income of about $29,000 for a family of four. States are required to begin offering coverage to this group by Jan. 1, 2014. (Healthcare.gov offers a timeline.)

The benefits offered to new enrollees do not have to be the same as the ones provided currently under state Medicaid programs. For childless adults in the new coverage population, states must offer "benchmark" or "benchmark equivalent plans," meaning that the benefits for new Medicaid enrollees must be equivalent to benefit packages offered under the Federal Health Benefits Program, by the state’s employee health benefits program, or by the largest commercial HMO plan in the state.

The ACA requires that the benefits package include prescription drug coverage, mental health services, and addiction treatment services that comply with the Mental Health Parity and Addiction Equity Act. And federal regulations say that individuals with disabling mental disorders and those with mental disabilities that prevent them from performing everyday tasks cannot be required to enroll in a benchmark plan. But it’s unclear exactly how all of these requirements will be implemented from state to state when the Medicaid rolls swell in 2014.

That uncertainty has raised concerns. Dr. Anita S. Everett, chairwoman of the Council on Health Systems and Finance for the American Psychiatric Association and director of community mental health services at Johns Hopkins Bayview in Baltimore, said she worries that enrollees in the new Medicaid expansion plans will miss out on some of the supportive services that traditionally have been covered by a number of state Medicaid programs. For example, these new enrollees might not have access to programs that help people with severe mental illness enter or re-enter the workforce or find housing, she said.

While it’s good news that there will be millions more people with coverage for mental health services, Dr. Everett said, it seems unlikely that most of these newly covered people will be eligible for some of the specialty services that are offered under traditional Medicaid programs.

Budget constraints at the state and federal levels also will play a role in what mental health services are available to Medicaid beneficiaries. A report issued by the National Alliance on Mental Illness (NAMI) earlier this year found that from 2009 to 2011, states cut their non-Medicaid mental health spending by nearly $1.6 billion, making cuts to community- and hospital-based psychiatric care, housing, and prescription drug benefits. And states are facing added budgetary pressures because a temporary increase in federal funding for Medicaid from the Recovery Act ended on June 30. And at the national level, the newly formed Joint Select Committee on Deficit Reduction, known as the "super committee," will be considering Medicaid, along with other entitlement programs, for potential cuts this fall.

"The larger concern for us is what the Medicaid program will look like once the political and regulatory processes end," said Michael J. Fitzpatrick, NAMI’s executive director. "Will it be a different Medicaid program? And what services will be covered?"

There’s already wide variation in terms of what is covered from state to state, he said, and NAMI officials are concerned the combination of the flexibility given to states to set up their programs and ongoing financial constraints could result in less robust mental health coverage under Medicaid.

The other problem experts see with the coming Medicaid expansion is the availability of psychiatrists to see the influx of new patients. Low provider reimbursement rates under Medicaid are part of the problem.

"The reality is that you can pass the Affordable Care Act and you can increase the number of people covered under the Medicaid program, but if you don’t have practitioners who are willing to take the Medicaid rate, you really haven’t accomplished anything," Mr. Fitzpatrick said.

Dr. Laurence H. Miller of the University of Arkansas in Little Rock, and medical director of the Arkansas division of behavioral health services, said he knows many psychiatrists who don’t accept Medicaid at all. Not only is the reimbursement low, but Medicaid patients tend to be more complicated, and the program’s red tape can be burdensome for physicians, he said.

Dr. Miller said the general shortage of psychiatrists in many areas of the country and the unwillingness or inability of others to take on Medicaid patients will all combine to create major workforce issues when the Medicaid rolls increase in 2014. It could end up changing the role of the psychiatrist, he said. One possibility is that psychiatrists may begin to take on more of a consultant role, offering advice on patients seen within a primary care group and only directly seeing those more complex patients, said Dr. Miller, who chairs the APA’s Assembly Committee on Public and Community Psychiatry. Physician extenders also might be able to help with the workforce shortage, he said, by performing some of the tasks that physicians don’t need to do themselves.

Mental health providers and advocates are growing concerned that Medicaid recipients won’t be able to access psychiatrists or certain specialty mental health services even with the massive expansion of Medicaid mandated under the Affordable Care Act.

Low provider payment rates under Medicaid, coupled with financial pressures on states and the federal government, threaten to limit access to mental health treatment just as an additional 16 million Americans gain coverage through the Medicaid program, experts said.

The Affordable Care Act, which was enacted in March 2010, expands the Medicaid program to anyone below 133% of the federal poverty level, which is an annual income of about $29,000 for a family of four. States are required to begin offering coverage to this group by Jan. 1, 2014. (Healthcare.gov offers a timeline.)

The benefits offered to new enrollees do not have to be the same as the ones provided currently under state Medicaid programs. For childless adults in the new coverage population, states must offer "benchmark" or "benchmark equivalent plans," meaning that the benefits for new Medicaid enrollees must be equivalent to benefit packages offered under the Federal Health Benefits Program, by the state’s employee health benefits program, or by the largest commercial HMO plan in the state.

The ACA requires that the benefits package include prescription drug coverage, mental health services, and addiction treatment services that comply with the Mental Health Parity and Addiction Equity Act. And federal regulations say that individuals with disabling mental disorders and those with mental disabilities that prevent them from performing everyday tasks cannot be required to enroll in a benchmark plan. But it’s unclear exactly how all of these requirements will be implemented from state to state when the Medicaid rolls swell in 2014.

That uncertainty has raised concerns. Dr. Anita S. Everett, chairwoman of the Council on Health Systems and Finance for the American Psychiatric Association and director of community mental health services at Johns Hopkins Bayview in Baltimore, said she worries that enrollees in the new Medicaid expansion plans will miss out on some of the supportive services that traditionally have been covered by a number of state Medicaid programs. For example, these new enrollees might not have access to programs that help people with severe mental illness enter or re-enter the workforce or find housing, she said.

While it’s good news that there will be millions more people with coverage for mental health services, Dr. Everett said, it seems unlikely that most of these newly covered people will be eligible for some of the specialty services that are offered under traditional Medicaid programs.

Budget constraints at the state and federal levels also will play a role in what mental health services are available to Medicaid beneficiaries. A report issued by the National Alliance on Mental Illness (NAMI) earlier this year found that from 2009 to 2011, states cut their non-Medicaid mental health spending by nearly $1.6 billion, making cuts to community- and hospital-based psychiatric care, housing, and prescription drug benefits. And states are facing added budgetary pressures because a temporary increase in federal funding for Medicaid from the Recovery Act ended on June 30. And at the national level, the newly formed Joint Select Committee on Deficit Reduction, known as the "super committee," will be considering Medicaid, along with other entitlement programs, for potential cuts this fall.

"The larger concern for us is what the Medicaid program will look like once the political and regulatory processes end," said Michael J. Fitzpatrick, NAMI’s executive director. "Will it be a different Medicaid program? And what services will be covered?"

There’s already wide variation in terms of what is covered from state to state, he said, and NAMI officials are concerned the combination of the flexibility given to states to set up their programs and ongoing financial constraints could result in less robust mental health coverage under Medicaid.

The other problem experts see with the coming Medicaid expansion is the availability of psychiatrists to see the influx of new patients. Low provider reimbursement rates under Medicaid are part of the problem.

"The reality is that you can pass the Affordable Care Act and you can increase the number of people covered under the Medicaid program, but if you don’t have practitioners who are willing to take the Medicaid rate, you really haven’t accomplished anything," Mr. Fitzpatrick said.

Dr. Laurence H. Miller of the University of Arkansas in Little Rock, and medical director of the Arkansas division of behavioral health services, said he knows many psychiatrists who don’t accept Medicaid at all. Not only is the reimbursement low, but Medicaid patients tend to be more complicated, and the program’s red tape can be burdensome for physicians, he said.

Dr. Miller said the general shortage of psychiatrists in many areas of the country and the unwillingness or inability of others to take on Medicaid patients will all combine to create major workforce issues when the Medicaid rolls increase in 2014. It could end up changing the role of the psychiatrist, he said. One possibility is that psychiatrists may begin to take on more of a consultant role, offering advice on patients seen within a primary care group and only directly seeing those more complex patients, said Dr. Miller, who chairs the APA’s Assembly Committee on Public and Community Psychiatry. Physician extenders also might be able to help with the workforce shortage, he said, by performing some of the tasks that physicians don’t need to do themselves.

Mental health providers and advocates are growing concerned that Medicaid recipients won’t be able to access psychiatrists or certain specialty mental health services even with the massive expansion of Medicaid mandated under the Affordable Care Act.

Low provider payment rates under Medicaid, coupled with financial pressures on states and the federal government, threaten to limit access to mental health treatment just as an additional 16 million Americans gain coverage through the Medicaid program, experts said.

The Affordable Care Act, which was enacted in March 2010, expands the Medicaid program to anyone below 133% of the federal poverty level, which is an annual income of about $29,000 for a family of four. States are required to begin offering coverage to this group by Jan. 1, 2014. (Healthcare.gov offers a timeline.)

The benefits offered to new enrollees do not have to be the same as the ones provided currently under state Medicaid programs. For childless adults in the new coverage population, states must offer "benchmark" or "benchmark equivalent plans," meaning that the benefits for new Medicaid enrollees must be equivalent to benefit packages offered under the Federal Health Benefits Program, by the state’s employee health benefits program, or by the largest commercial HMO plan in the state.

The ACA requires that the benefits package include prescription drug coverage, mental health services, and addiction treatment services that comply with the Mental Health Parity and Addiction Equity Act. And federal regulations say that individuals with disabling mental disorders and those with mental disabilities that prevent them from performing everyday tasks cannot be required to enroll in a benchmark plan. But it’s unclear exactly how all of these requirements will be implemented from state to state when the Medicaid rolls swell in 2014.

That uncertainty has raised concerns. Dr. Anita S. Everett, chairwoman of the Council on Health Systems and Finance for the American Psychiatric Association and director of community mental health services at Johns Hopkins Bayview in Baltimore, said she worries that enrollees in the new Medicaid expansion plans will miss out on some of the supportive services that traditionally have been covered by a number of state Medicaid programs. For example, these new enrollees might not have access to programs that help people with severe mental illness enter or re-enter the workforce or find housing, she said.

While it’s good news that there will be millions more people with coverage for mental health services, Dr. Everett said, it seems unlikely that most of these newly covered people will be eligible for some of the specialty services that are offered under traditional Medicaid programs.

Budget constraints at the state and federal levels also will play a role in what mental health services are available to Medicaid beneficiaries. A report issued by the National Alliance on Mental Illness (NAMI) earlier this year found that from 2009 to 2011, states cut their non-Medicaid mental health spending by nearly $1.6 billion, making cuts to community- and hospital-based psychiatric care, housing, and prescription drug benefits. And states are facing added budgetary pressures because a temporary increase in federal funding for Medicaid from the Recovery Act ended on June 30. And at the national level, the newly formed Joint Select Committee on Deficit Reduction, known as the "super committee," will be considering Medicaid, along with other entitlement programs, for potential cuts this fall.

"The larger concern for us is what the Medicaid program will look like once the political and regulatory processes end," said Michael J. Fitzpatrick, NAMI’s executive director. "Will it be a different Medicaid program? And what services will be covered?"

There’s already wide variation in terms of what is covered from state to state, he said, and NAMI officials are concerned the combination of the flexibility given to states to set up their programs and ongoing financial constraints could result in less robust mental health coverage under Medicaid.

The other problem experts see with the coming Medicaid expansion is the availability of psychiatrists to see the influx of new patients. Low provider reimbursement rates under Medicaid are part of the problem.

"The reality is that you can pass the Affordable Care Act and you can increase the number of people covered under the Medicaid program, but if you don’t have practitioners who are willing to take the Medicaid rate, you really haven’t accomplished anything," Mr. Fitzpatrick said.

Dr. Laurence H. Miller of the University of Arkansas in Little Rock, and medical director of the Arkansas division of behavioral health services, said he knows many psychiatrists who don’t accept Medicaid at all. Not only is the reimbursement low, but Medicaid patients tend to be more complicated, and the program’s red tape can be burdensome for physicians, he said.

Dr. Miller said the general shortage of psychiatrists in many areas of the country and the unwillingness or inability of others to take on Medicaid patients will all combine to create major workforce issues when the Medicaid rolls increase in 2014. It could end up changing the role of the psychiatrist, he said. One possibility is that psychiatrists may begin to take on more of a consultant role, offering advice on patients seen within a primary care group and only directly seeing those more complex patients, said Dr. Miller, who chairs the APA’s Assembly Committee on Public and Community Psychiatry. Physician extenders also might be able to help with the workforce shortage, he said, by performing some of the tasks that physicians don’t need to do themselves.