Health Reform Made Simple

Reduces the deficit by $30 billion over first 10 years without CLASS Act and $103 billion over first 10 years with CLASS Act. Continues to reduce the deficit over second 10 years.

Provides that Institute of Medicine, through two studies, will make recommendations on how to fix the Medicare payment system, regarding geographic variations as well as changing the system to reward value and quality. CMS will implement IOM recommendations unless disapproved by Congress.

Includes more extensive provisions on lowering costs over the long-term, such as requiring HHS to set specific benchmarks for expansion of the Accountable Care Organization, Payment Bundling, and Medical Home pilot programs. If pilots prove successful, HHS is directed to expand them on a large-scale basis. Promotes quality not quantity with financial incentives for collaborative care, primary care, and prevention and wellness.

Establishes a Center for Medicare Innovation to empower the Centers for Medicare and Medicaid Services (CMS) to pursue additional payment and delivery system reforms.

Creates a Prevention and Wellness Trust Fund, providing $34 billion in mandatory funding over the next 10 years, for such programs as community-based prevention programs and a child obesity program. Establishes a grant program to help small employers create or strengthen workplace wellness programs.

Exempts 86% of businesses from requirement--those with payrolls below $500,000; provides only graduated penalty for firms with payrolls between $500,000 and $750,00.

In 2013, firms with up to 25 employees can enter the Exchange; in 2014, firms with up to 50 employees; in 2015, firms with up to 100 employees; in 2015 and beyond, Commissioner can allow larger employers as appropriate.

The wealthiest 0.3% of Americans would pay a surcharge on the portion of their income above $500,000 (individuals) and $1 million (couples). This would affect the top 1.2%of those with small business income.

Reduces the donut hole by $500 and institutes a 50% discount for brand-name drugs in the donut hole, effective 2010. Phases out the donut hole by 2019.

Requires the Secretary of HHS to negotiate drug prices on behalf of Medicare beneficiaries.

Establishes a voluntary state incentives grant program to encourage states to implement “certificate of merit” and “early offer” alternatives to traditional medical malpractice litigation.

Ends blanket exemption from anti-trust laws.

Requires health plans to allow young people to remain on their parents’ insurance policy up to their 27th birthday.

To fill the gap before the Exchange is available, creates an insurance program with financial assistance for those uninsured for several months or denied policy due to preexisting conditions.

Allows individuals to keep their COBRA coverage until the Exchange is up and running.

Effective immediately, discourages excessive price increases by insurance companies through review of rate increases.

Creates a long-term care insurance program to be financed by voluntary payroll deductions to purchase community-based services and supports for adults who become functionally disabled.

Reauthorizes the Indian Health Care Improvement Act, whose last authorization expired in 2001, and includes key provisions to better ensure access to quality health care for Native Americans.

Allows for the creation of State Health Insurance Compacts – permitting states to enter into agreements to allow for the sale of insurance across state lines when the state legislatures agree.

Childhood Obesity Linked to Heart Risk

In the U.S., 14% of 2-to-5-year-olds are considered overweight, or at the 85th percentile or greater of weight for height in their age group. Obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life, researchers said, in a finding that is likely to further stoke concerns about childhood obesity. The results suggest that obesity-related disease processes may start earlier than previously believed. Nearly 30% of obese 3-to-5-year-olds had elevated blood levels of C-reactive protein—a widely studied marker for inflammation—compared with 17% of healthy-weight kids of the same age. The disparities widened as children aged, according to the study, which is being published Monday in the journal Pediatrics.

C-reactive protein, or CRP, has been shown to help predict risk of heart disease, stroke and death under certain conditions, according to the American Heart Association. Previous studies have found that overweight and obese adults show elevated levels of CRP, but less has been known about CRP in children.

The study examined three markers that measure different aspects of inflammation, including CRP, in more than 16,000 children nationwide between the ages of 1 and 17. By ages 15 to 17, CRP was elevated in about 60% of obese teens, compared with 18% of teens of healthy weight. The increase was even more pronounced for very obese kids, with nearly 43% of young children and 83% of teens showing CRP elevation. A similar pattern of elevation was observed for the other two inflammatory markers, though one of the markers wasn't elevated in obese children until the age of 6.

The concern of finding CRP elevation in such young children is that its effects could be cumulative. Future research is needed to investigate whether that is the case, and also whether losing weight could reduce CRP response in kids, according to Dr. Skinner. This study was funded by the National Institutes of Health.

Anthem Blue Cross sued over rate increases

A consumer group filed a lawsuit against Anthem Blue Cross, accusing the insurer of raising rates to force members into policies with higher deductibles and lower benefits. Consumer Watchdog accuses Anthem of violating state law by failing to offer policyholders comparable coverage and minimize rate hikes after the company directs customers to alternative plans when closing out existing plans.

San Rafael resident Mary McNamara Feller, a plaintiff in the suit, which was filed in Ventura County, said she had to do something after Anthem last month proposed raising rates on the policy covering her and her husband nearly 39 percent to $1,658 a month. She said the company offered her the option of switching to a policy with a higher deductible and skimpier benefits by a specific deadline, but also told her she could stay in her current policy. The company notified her of the enormous premium increases in her plan after the deadline had passed.

Anthem, which is owned by WellPoint Inc., has come under state and federal scrutiny for hiking the rates of its 800,000 individual policyholders, or those not covered through a group plan, by as much as 39 percent. The increases were scheduled to take effect sooner, but the company agreed to delay them until May 1 to allow the state time to investigate.

California authorities have little power over rates, but Consumer Watchdog's lawsuit relies on a 1993 state law that requires an insurer to offer enrollees a comparable alternative plan. The suit accuses Anthem of forcing older and sicker members, who are unable to switch carriers, to pay higher and higher premiums until they accept inferior coverage or drop coverage altogether.

Studies confirm treatment may help peanut allergy

A daily dose of peanut powder could help some children who are allergic to peanuts, according to a pair of U.S. studies that confirm earlier findings, offering hope that a treatment could come soon. In one study, teams at Duke University in North Carolina and the University of Arkansas for Medical Sciences gave 15 children tiny, but increasing, doses of peanut powder and compared them with eight children who got a placebo.

At the end of the year-long study, children given the treatment were on average able to tolerate 15 peanuts before having an allergic reaction.When you take the daily dose it changes your immune system in a certain way and it raises the threshold of how much food it takes to cause a reaction.

In the second study, 12 children treated with peanut powder from age 32 months to 5 years old were monitored to see whether they could safely eat peanuts after the daily treatment stopped. The children were off the treatment for a month before they were given peanuts.

Nine of the 12 now have peanuts in their diets, the researchers reported at a meeting of the American Academy of Allergy, Asthma & Immunology in New Orleans.

The research builds on previous studies, in which children were able to tolerate the treatment for more than two years and four appeared to be freed of their peanut allergies.The results are encouraging but more research is needed before an effective treatment can be developed.