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Actually, to find confusion over the new national health insurance law you need to look no further than our own state executive offices. Republican Attorney General Tom Corbett (whose week started off great – see Veon conviction - but is ending badly - see Josh Lock's motion to investigate Corbett) is one of 13 attorneys general around the country suing the federal government to block the new law from taking effect. He argues that it violates the 10th Amendment by unconstitutionally usurping states' and individuals' right by mandating everyone to purchase a product … namely, health insurance. Governor Ed Rendell, a Democrat who’s constitutionally barred from running for a third term, says Corbett’s suit is “political grandstanding,” a waste of taxpayer dollars, and that federal law trumps state law. And, piling on, House Democratic Appropriations chairman Rep. Dwight Evans of Philadelphia warns that he might cut off state funding to the AG's office unless Corbett drops the suit. In the U.S. Senate race, Republican Pat Toomey pledges to vote to repeal the law if he's elected. President Obama says "Be my guest."
While the two sides battle it out with our tax dollars in the courts and under the U.S. and State Capitol domes, we’re left to figure out how the insurance changes will affect the health care insurance we buy and the medical care we receive. Joining us Friday night at 8:30 are Dr. Teresa Burick, WITF's health care consultant, and Carolyn Scanlan, president and CEO of the Hospital & Healthsystem Association of Pennsylvania. Dr. Burick told Radio Smart Talk listeners this week she has concerns that medical malpractice and tort reforms were not included in the law and that the system has too few medical professionals. "Only 2% of all physicians graduating from medical school are going into family practice. And they're anticipating a nationwide shortage, and certainly we actually currently have a shortage of physicians providing primary care, and that includes not only family practice but ob-gyn and internal medicine. I don't see how the government is going to be able to provide the physicians and staff to take care of all of these patients and their issues," she worried.
Sharon Ward, executive director of the Pennsylvania Budget and Policy Center, also appeared on Radio Smart Talk and said the law includes incentives for medical school-loan forgiveness, higher reimbursement rates for primary care physicians, and higher Medicaid payments to create incentives that will counter those shortages. "It maintains the existing employment-based system that we're used to but it improves upon it ... It improves health security and stability. It's going to reduce the number of health-care bankruptcies. It's going to make sure that health insurance coverage that we all have actually does cover what we need. It will make health insurance easier to find and more affordable for individuals but also for small businesses that have really struggled to provide insurance for their employees," Ward said.
Some basics on the new law:
32 million uninsured Americans will be covered beginning in 2014. That’s not everybody. Estimates show anywhere from 13-23 million more uninsured will be left out. It will cost $938 billion over 10 years but the Congressional Budget Office says it will reduce deficits by $143 billion over a decade.
All of us must have health insurance or pay a fine. Big changes are in store for insurers. Starting this year, they cannot place lifetime dollar limits on policies. They can no longer deny coverage to children because of pre-existing conditions. And they cannot cancel policies because someone becomes ill. Parents can keep children on their plan up to age 26. Starting in 2014, insurers will not be able to deny coverage to people with pre-existing conditions nor can they charge them more.
Medicaid gets a big expansion. A family of four earning up to $29,327 will be eligible for the state-federal health coverage. Childless adults will be covered for the first time in 2014. Who pays? Until 2016, the federal government will pay 100 percent of the costs for covering newly eligible individuals. But the new law also applies an increased Medicare payroll tax to investment income and to the wages of folks making more than $200,000 a year or married couples above $250,000. Starting in 2018 there would be a 40 percent tax on high-cost insurance plans worth more than $10,200 for individuals and $27,500 for families.
Businesses in which the government subsidizes health coverage would get hit with a fee of $2000 per employee. Companies with 50 or fewer workers are exempt. Small businesses, those with 25 or fewer employees, will get tax credits if they offer health coverage. The credits start this year and rise to 50% maximum of the cost of the premiums paid by smallest businesses, those with 10 or fewer workers.
Individuals can get subsides on a sliding scale, even earning as much as $88,200 for a family of four. State-based purchasing pools called exchanges will open in 2014. Small businesses, self-employed persons and the uninsured can pick a plan offered through the exchanges. They will offer the same kind of options that employees of big companies get.
Now, the big question: How do they pay for it all? The new laws cuts about $455 billion over the next decade from payment increases to hospitals, insurance companies and others under Medicare and other government health programs. Plus, the revenue from new Medicare taxes, fees on insurance companies, drug-makers and medical-device manufacturers, an excise tax on high-value insurance plans and a tax on indoor tanning services all add to the pot. There is no government-run insurance plan. They will be private plans.
Phew! That’s a lot to absorb and the debate continues, so stay tuned.
Our second segment Friday night centers on the vital work being done through clinical trials at the Penn State Milton S. Hershey Medical Center. The story idea came to us through WITF president and CEO Kathleen Pavelko who is a participant in a clinical trial related to the correlation between breast density and breast cancer. Kathleen wrote to us, “As I've learned from our interactions with the Hershey Medical Center’s Cancer Institute, one of the most important tools in cancer research, prevention and treatment is the clinical trial. Trials require many volunteers, can last many years, and can be vital in many ways. For example, a prevention trial can be run to see what lifestyle changes or drugs have the most impact on cancer rates. Treatment trials test new drugs. These trials are the core way to "prove" the best methods to prevent or treat a disease. Every breakthrough drug goes through it; this is how the very effective breast cancer drug Tamoxifen was tested.”
Hershey Medical Center is part of a consortium of cancer centers that run trials nationwide and the Medical Center also runs trials for its own researchers. Kathleen added, “We don't have to feel helpless about cancer -- we can do something vital, and positive.”
Dr. Andrea Manni is professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism at the Penn State University College of Medicine. He is the principal investigator on the $7.5 million breast-density trial funded by the Susan G. Komen Breast Cancer Foundation. In a video segment for the program, Smart Talkproducer Heather Muha explores the planning, methodology and hopes for the trial with Dr. Manni. “So my hope is that at the end of the two years we’ll be able to show that our particular combination – that is the combination of anti-estrogen and omega-3 fatty acids – will reduce breast density to a larger extent than individual treatment. By reducing breast density, it reduces therefore a risk factor for breast cancer. Ultimately, we will need to show that breast cancer itself is actually reduced. “
Since last December, Kathleen Pavelko has taken fish oil capsules and an osteoporosis medication daily, has a blood test two times a year and an annual mammogram. “Lasts two years. That's it, pretty simple!” she wrote. And Kathleen noted that Dr. Manni is seeking 372 participants for the trial and 98 have been enrolled so far.
“I am very appreciative of their effort. I realize that that is a commitment it’s a commitment because they need to come and be seen every 6 months. They need to provide urine and blood specimens and they need to be very compliant with their follow up,” Dr. Manni explains. “I am very, very much appreciative of all the women that participate in this trial.”
To qualify for the trial, women must be post-menopausal, non-smoking, cancer-free and be diagnosed as having dense breast tissue. The trial lasts two years and each participant will have bi-annual blood tests and annual mammograms. At the end of the trial, Dr. Manni expects to know if the medications tested reduce breast cancer risk sufficiently. If so, then a nationwide trial with 5-10,000 women can begin.
Gregg Schuler is administrator of clinical research quality assurance and compliance at the Penn State Milton S. Hershey Medical Center. He'll join our panel along with Mel Billingsley, PhD, the president and CEO of the Life Sciences Greenhouse of Central Pennsylvania. The LSG is a non-profit corporation that nurtures new and growing life-science and related technology companies in the region. They help university-based researchers, among others, get the seed and pre-seed funding they need to conduct research and refine technologies to advance health. Dr. Billingsley wrote in an email, "According to a 2006 report by Global Business Insights, global spending on OUTSOURCED clinical trials topped $5.9 billion. Factoring in the growth of clinical trials since then and the fact that many large companies still manage clinical trials in-house, it's safe to say that global spending on clinical trials easily approaches $8 billion or more. Pennsylvania attracts its fair share of this spending by virtue of its many well-respected medical centers and proximity to the Northeast Pharmaceutical Company Corridor. Several hospitals, such as Geisinger, Lancaster General, and others participate in clinical trials, as do several larger clinical practices. In addition, academic medical centers such as Penn State Hershey Med clearly have the support structure for more complex clinical trials on more seriously ill people. Certainly, clinical trials provide millions of dollars in support throughout Central PA."
And let's be clear - these are high-value, multi-industry, family-sustaining jobs. "A 2009 survey from "The Scientist" will give you an excellent snapshot of job types and salary ranges. As a general number, the Biotechnology Industry Organization (BIO) suggests that the US average annual wage per employee in bioscience is $70,000, and PA is certainly in this range," Dr. Billingsley added.
However, the life sciences face some serious challenges that Pennsylvania could be prepared to overcome. "The development of new drugs and medical technologies by traditional means (i.e., most of them "home grown" by large U.S. or European pharmaceutical companies) has become so costly and complex that it may not be sustainable," cautioned Dr. Billingsley. "This challenge is encouraging creative thinking from all corners and is opening doors for smaller, innovative companies. Because PA has all of the needed components, such as a strong research base (#4 in National Institutes of Health funding), strong employment and workforce in the life sciences, existing life sciences companies, and access to capital, PA needs to continue to focus on this critical sector. The competition is brisk, with national and international sites vying for leadership positions. It is the goal of the Life Science Greenhouse to promote the growth of life sciences throughout PA. The potential is that innovation in the life sciences can affect both economic development but more importantly, can significantly improve human health."
The Office for Human Research Protections (OHRP) at the U.S. Department of Health and Human Services is the government entity that safeguards the safety and welfare of people enrolled in clinical trials. The Food and Drug Administration (FDA) also at HHS has to approve all study protocols before a sponsor can get approval for the clinical trial to begin. And once all the clinical trial phases are completed for a new drug or treatment, the FDA must grant approval before it can be given to patients.
A critical shortage of volunteers stymies research into diseases and their cures. As the American Cancer Society’s website notes, “The biggest barrier to completing studies is that not enough people take part in them. Fewer than 5% of adults (less than 1 in 20) with cancer will take part in a clinical trial. According to the Pharmaceutical Research and Manufacturers of America (PhRMA), more than 800 cancer medicines were being tested in clinical trials in 2009. Not all of them will prove to be useful, but those that are may be delayed in getting approved because so few adults volunteer.”
Obviously, participating in a medical trial is a major decision that could, in some cases, be life-threatening. One has to weigh carefully the risks and benefits before deciding whether to proceed. Knowing that there are important, potentially life-saving clinical trials underway in our own community is the first step in empowering us to make our lives healthier.
