Health Report from DC: March 5, 2017
Written by Editor   
Monday, March 06, 2017 01:28 PM

News bite:  In Washington, D.C., a congressional committee has voted to impose a nationwide cap on medical malpractice “pain and suffering damages.”  Robert Kennedy Jr. reports that plans for a vaccine safety commission continue in play.  By 2025 nearly 20% of of the total US economy will be for “health spending.”  Because of recent changes in administrative implementation of rules at the IRS the Obamacare insurance mandate and penalty are effectively dead.  Seema Verma, head the Centers for Medicare & Medicaid Services (CMS), concurs with many physicians about electronic health record (EHR) systems.


  • The House Judiciary Committee voted 18-17 to approve legislation imposing a nationwide cap on “pain and suffering" damages that patients can receive in medical malpractice lawsuits. The bill would apply, however, only to patients served through a federal program, subsidy, or benefit, such as Medicare or Medicaid.

The “Protecting Access to Care Act” would cap non-economic damages at $250,000 and curb attorneys' contingency fees.  Defensive medicine is a huge driver of health spending and that unnecessary care accounts for $650 billion in costs each year.

 

  • In Mid-February, Robert F. Kennedy Jr, who believes the vaccine preservative thimerosal has led to an uptick in neurodevelopmental and other disorders in children, says the Trump administration still plans to assemble a vaccine safety commission to explore potential links between vaccinations and a host of disorders, including autism.
Kennedy told reporters attending a Washington, DC, press briefing that he is still in discussion with the administration regarding the assembling of a vaccine commission.

Kennedy said he was first approached by the Trump transition team in early December and met with President-elect Donald Trump in New York City in mid-January. He told the press he was being considered as chair of the potential commission, but that at that time, the administration said it was merely exploring the idea.

More recently, President Trump said he “knew that the pharmaceutical industry was going to cause an uproar about this," but he promised he would not back down. “We need a debate on this,” said Kennedy.  The more than $3 billion that the National Vaccine Injury Compensation Program has paid out is evidence of vaccines' potential for harms, he said.

The Centers for Disease Control and Prevention (CDC), physicians, journalists, and the pharmaceutical industry are involved in what Kennedy sees as a conspiracy to keep the truth about vaccine injury from the public.

Kennedy said reporters have merely parroted the CDC's claims over the years and have not bothered to examine the evidence. He said his organization had found 240 studies on PubMed that demonstrated that mercury was a neurotoxin. The vaccine preservative thimerosal, which contains trace amounts of ethyl mercury, was linked to autism in 81 of those studies, said Kennedy.

Currently, all routinely recommended vaccines for infants are thimerosal-free or contain only trace amounts of thimerosal, with the exception of inactivated influenza vaccine, according to the US Food and Drug Administration.

He also said the CDC should not be trusted, calling it "a vaccine company," and he accused its top decision makers of having ties to the pharmaceutical industry — an industry he said had undue influence over broadcast networks owing to the size of its advertising expenditures on those networks.

"What CDC says is not science. What your doctor says is not science. What the NIH [National Institutes of Health] says is not science. Science is what appears on PubMed,” Kennedy said.
  • Overall health spending is expected to account for 19.9% of the total U.S. economy by 2025 versus a 17.8% share in 2015, according to a report from the Centers for Medicare and Medicaid Services (CMS).

Health spending is projected to grow annually at a rate of 5.6% on average from 2016 to 2025.  For comparison, health spending growth averaged 5.5% in 2014 and 2015 when significant coverage expansion occurred following implementation of the Affordable Care Act (ACA).

The report also made the following projections:

    • The insured population will see an uptick from 90.9% in 2015 to 91.5% in 2025
    • Federal, state, and local governments will account for 47% of national health spending versus 46% in 2015
    • In 2016, national health spending is forecast to rise to $3.4 trillion versus $3.2 trillion in 2015
    • In 2017, health spending is expected to rise 5.4% because of a rise in spending in private health insurance

But the projections do not account for any potential changes in healthcare law in the future.  

  • As the Trump administration begins to grapple in earnest with the nitty-gritty of health insurance regulation, it appears responsive to insurers’ concerns.  An early step by the administration came with issuance of draft regulations seemingly aimed at bringing more certainty to insurance markets and stopping companies from dropping out of the Affordable Care Act’s exchanges.

The core challenge is that the individual mandate was never strong enough to attract healthy people and insurers lost billions in unpaid risk corridor monies.  The latest actions by the IRS, planning to ease its enforcement of the individual mandate, saying now that it will process returns that don’t indicate whether the individual had coverage or not.  The IRS’s actions are in keeping with the executive order President Trump signed on inauguration day encouraging government agencies to "change, delay, or waive provisions" they perceived as too costly. The mandate is effectively gone.

  • Seema Verma, MPH, President Donald Trump’s choice to head the Centers for Medicare & Medicaid Services (CMS), concurs with many physicians about electronic health record (EHR) systems.  When question about the future of the CMS incentive program for meaningful use of EHRs, much criticized by physicians for turning them into data entry clerks. She noted “We need to make sure [EHR technology] is fulfilling its promise and not being more burdensome.” 

Verma, as a lieutenant of US Department of Health & Human Services Secretary Tom Price, MD, wants the federal government to ease up on physicians in a number of ways:

Regulations: “Patients and their physicians should be making decisions about their healthcare, not the federal government," Verma said. "We want to identify regulations that might motivate providers not to participate [in Medicare and Medicaid]."

Mandatory Medicare pilot projects: Congressional Republicans and medical societies have complained about Medicare experiments in healthcare delivery and payment that make physician participation required instead of voluntary. Verma said she was on their side. Innovation is important but "we need to make sure we're not mandating individuals to participate."

Medicare financial risk: The new reimbursement system established by the Medicare Access and CHIP Reauthorization Act holds the most rewards for physicians who assume significant financial risk, however, some medical societies argue that the government’s financial-risk requirements are unrealistically high for some medical practices. Verma agrees.


Sources:  http://www.medscape.com/viewarticle/875992