Governor Issues Public Threat To Veto Health Bills, Other Legislation

On Thursday, Gov. Arnold Schwarzenegger (R) went public with his threat to veto more than 700 bills if legislators fail this week to reach a deal to address water issues this week, the Sacramento Bee reports.

Speaking before the Association of Community College Trustees' Leadership Congress, Schwarzenegger said, "I made it very clear to the legislators and to the leaders that if this does not get done, then I will veto a lot of their legislation" (Sanders, Sacramento Bee, 10/9).

Some of the bills currently on the governor's desk include:

AB 2 by Assembly member Hector De La Torre (D-South Gate), which would require health insurers to undergo a review and demonstrate intentional misrepresentation before rescinding an individual health insurance policy. Schwarzenegger vetoed a similar measure last year;
AB 98 also by De La Torre, which would require health insurance plans to cover maternity services. Some business groups, insurers and Republican legislators oppose the measure;
AB 119 by Assembly member Dave Jones (D-Sacramento), which would prohibit health insurers from charging different premiums based on gender. Some business groups, health plans and Republican legislators oppose the measure;
SB 820 by Sens. Sam Aanestad (R-Grass Valley) and Gloria Negrete McLeod (D-Chino), which would require medical staff peer review committees to report physicians with substance abuse or mental health issues to the Medical Board of California. The board would then follow up and review any corrective action imposed (California Healthline, 9/21); and
AB 1383 also by Jones, which would impose a fee on hospitals in order to draw down increased federal reimbursements for Medi-Cal, California's Medicaid program. Officials say the governor has signaled an inclination to veto the proposal because of concerns raised by anti-tax groups (California Healthline, 10/7).
On Thursday, Schwarzenegger met with legislative leaders from both parties in an effort to strike a water deal. Negotiations are expected to continue in the coming days.

The governor has until midnight Sunday to take action on the bills on his desk.

Senate President Pro Tempore Darrell Steinberg (D-Sacramento) dismissed the veto threat and said he is confident the governor will consider each bill on its merits (Sacramento Bee, 10/9).


New Research Points to Racial, Ethnic Disparities in California Health Care
Black HMO members in California are significantly more likely to seek treatment in hospital emergency departments and delay filling prescriptions than members of other racial or ethnic groups, researchers from the UCLA Center for Health Policy Research found, Payers & Providers reports.

ED Data

The data indicate that 25% of black HMO members visited a hospital ED last year, compared with 18% of white HMO members and 13% of Asian-American HMO members.

In general, members of plans offered by Kaiser Permanente were more likely than members of other plans to seek care in EDs, but black Kaiser members still were 40% more likely than whites to go to an ED for care.

Filling Prescriptions

The study also found that 24.5% of blacks reported putting off filling a prescription, compared with 14.9% of whites, 10.8% of Hispanics and 6.1% of Asian-Americans.

Among members of Kaiser plans, 16.4% of blacks reported delaying filling a prescription, compared with 11.2% of whites, 8.8% of Hispanics and 8.2% of Asian-Americans (Payers & Providers [1], 10/8).

C-Section Data

A separate study by Kaiser's research arm found that black and Asian-American women underwent caesarean sections for first births at significantly higher rates than white or Hispanic women, according to Payers & Providers.

The study was based on data from Kaiser hospitals in Southern California and was published in the October issue of the American Journal of Obstetrics and Gynecology.

The study found that black Kaiser members were 25% more likely than white members to undergo a c-section and Asian-American members were 19% more likely than white members to have a c-section for their first pregnancy (Payers & Providers [2], 10/8).

State Officials Voicing Concerns About Costs of Health Care Overhaul
This week, state officials received an indication of how much a proposal under current health reform bills to expand Medicaid eligibility would affect them, which puts many governors in the uncomfortable position of addressing the rising number of uninsured residents while protecting their states' bottom lines, the Baltimore Sun reports.

The Congressional Budget Office earlier this week estimated that state spending on Medicaid will increase by $33 billion over the next decade under the Senate Finance Committee's health reform bill, which expands Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level (Smitherman, Baltimore Sun, 10/9).

The proposal would have the federal government pick up between 77% and 95% of the cost of the expansion, with states contributing the difference.

Under a deal reached between Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Majority Leader Harry Reid (D-Nev.), the federal government would contribute 100% of the cost of the expansion in Michigan, Nevada, Oregon and Rhode Island for the first five years (California Healthline, 10/5).

Republican governors and some Democrats have expressed concern regarding how their states will pay for the expansion.

Some states have indicated that they could benefit from the proposal.

For example, Maryland leaders believe the move could actually save the state money through reduced pharmaceutical prices and other measures, even though the expansion would mean 150,000 additional Maryland residents could enroll in Medicaid at a cost of tens of millions of dollars to the state annually.

According to the Sun, Maryland officials believe the federal plan would slow the rate at which health care costs increase because fewer uninsured people would be forced to seek treatment at hospitals.

The Sun reports that could result in lower overall health care costs for the state and, in turn, lower insurance premiums for those who are covered (Baltimore Sun, 10/9).

California Hospital News Roundup for the Week of October 9
Arrowhead Regional Medical Center, Colton

Arrowhead Regional Medical Center has been awarded a $245,334 grant from the California HealthCare Foundation, which will allow the facility to fully implement its Palliative Care Service program, the San Bernardino County Sun reports.

CHCF is the publisher of California Healthline.

The two-year grant will allow the program to serve about 144 patients in the first year, and twice that number in the second year, hospital officials said (Sorba, San Bernardino County Sun, 10/6).

El Camino Hospital, Mountain View

On Saturday, El Camino Hospital held a ribbon-cutting ceremony for its new $480 million acute care center, the San Jose Mercury News reports.

The 450,000 square foot expansion adds an additional 241 beds to the hospital, bringing the total number of beds on the campus to 327.

El Camino began the construction on the facility five years ago to meet new state seismic safety standards (Samuels, San Jose Mercury News, 10/3).

Los Alamitos Medical Center

Los Alamitos Medical Center has released a 25-year expansion plan that calls for a new 80,000 square foot medical office building, two new towers with a maximum capacity of 602 beds, parking structures and a central plant for the campus, the Orange County Register reports.

The Los Alamitos City Council is considering serving as the head agency on the facility's environmental report for the expansion plan.

The hospital would give the city $50,000 toward the cost of the study up front and reimburse the city for the remaining cost of the study (Fletcher, Orange County Register, 10/2).

Ojai Valley Community Hospital, Ventura County

Last week, Ojai Valley Community Hospital held a ribbon-cutting ceremony for its renovated emergency department, the Ventura County Star reports. The $2 million project included $1.7 million for the ED and the rest for other repairs.

The ED now has a separate admitting and waiting area and six new treatment areas.

According to Tim Wolfe, chair of the Ojai Valley Community Hospital Foundation, the hospital still needs to make seismic retrofits, renovate the exterior, improve the radiology department and open a new post-anesthesia unit (Kallas, Ventura County Star, 10/1).

St. John's Health Center, Santa Monica

St. John's Health Center in Santa Monica has received $100 million from Abraxis BioScience founder and CEO Patrick Soon-Shiong and his wife, Michele Chan, to develop a state-of-the-art data-sharing network that links physicians and patients to other hospitals and ongoing research being conducted at USC and UCLA, the Los Angeles Times reports.

The donation is the largest individual gift St. John's has ever received and one of the largest given to a community hospital in California (Hennessy-Fiske, Los Angeles Times, 10/1).

Stanford Hospital & Clinics, Palo Alto

Stanford Hospital & Clinics recently invested $3 million on Hill-Rom lifting equipment to help patients get in and out of bed safely and prevent injuries among medical staff, the San Francisco Business Times reports.

Over the summer, Stanford installed eight overhead lifts, 24 mobile lifts, a lift solely for moving exceptionally overweight patients, and 26 air-powered transfer systems for moving patients from a bed to an X-ray table or other treatment sites.

In a statement, Joan Forte, Stanford Hospital & Clinics' interim associate director of nursing, said that the equipment "may eventually pay for itself" by reducing the number of workers' compensation claims due to heavy lifting and other expenses (Rauber, San Francisco Business Journal, 10/2).

UC-Irvine Medical Center, Orange

On Oct. 2, the California Nurses Association protested the closure of a 13-bed geriatric psychiatric unit at UC-Irvine Medical Center, the Register's "Healthy Living" reports.

The unit was closed because it was chronically underused, according to hospital spokesperson John Murray.

The geriatric psychiatric patients and their nurses are expected to be incorporated into the adult psychiatric ward at UCIMC (Perkes, "Healthy Living," Orange County Register, 10/2).

UC-San Francisco, Mission Bay

On Oct. 2, UC-San Francisco opened its new 42,000 square foot Orthopaedic Institute in Mission Bay, the Business Times reports.

The facility has 28 exam rooms, four operating rooms and two procedure rooms. The institute will provide outpatient treatment, research, and training in musculoskeletal conditions, injuries and sports medicine (Leuty, San Francisco Business Times, 10/2).

Valley Health System

On Tuesday, the board of directors for Valley Health System voted 6-1 in favor of the sale of its assets -- including Hemet Valley Medical Center and Menifee Valley Medical Center -- to Physicians for Healthy Hospitals, a group of 132 physicians who practice in the hospital district, the Riverside Press-Enterprise reports.

The $162 million sale covers the hospital district's debt to its bondholders and unsecured creditors, as well as the fair market value of the district's assets, officials said.

The terms of the agreement require PHH to retain almost all of the district's employees and services, including its hospitals' EDs.

The sale has to be approved by district voters before it is finalized. An election will be held Dec. 15 (Hines, Riverside Press-Enterprise, 10/6).

Governor Issues Public Threat To Veto Health Bills, Other Legislation

On Thursday, Gov. Arnold Schwarzenegger (R) went public with his threat to veto more than 700 bills if legislators fail this week to reach a deal to address water issues this week, the Sacramento Bee reports.

Speaking before the Association of Community College Trustees' Leadership Congress, Schwarzenegger said, "I made it very clear to the legislators and to the leaders that if this does not get done, then I will veto a lot of their legislation" (Sanders, Sacramento Bee, 10/9).

Some of the bills currently on the governor's desk include:

AB 2 by Assembly member Hector De La Torre (D-South Gate), which would require health insurers to undergo a review and demonstrate intentional misrepresentation before rescinding an individual health insurance policy. Schwarzenegger vetoed a similar measure last year;
AB 98 also by De La Torre, which would require health insurance plans to cover maternity services. Some business groups, insurers and Republican legislators oppose the measure;
AB 119 by Assembly member Dave Jones (D-Sacramento), which would prohibit health insurers from charging different premiums based on gender. Some business groups, health plans and Republican legislators oppose the measure;
SB 820 by Sens. Sam Aanestad (R-Grass Valley) and Gloria Negrete McLeod (D-Chino), which would require medical staff peer review committees to report physicians with substance abuse or mental health issues to the Medical Board of California. The board would then follow up and review any corrective action imposed (California Healthline, 9/21); and
AB 1383 also by Jones, which would impose a fee on hospitals in order to draw down increased federal reimbursements for Medi-Cal, California's Medicaid program. Officials say the governor has signaled an inclination to veto the proposal because of concerns raised by anti-tax groups (California Healthline, 10/7).
On Thursday, Schwarzenegger met with legislative leaders from both parties in an effort to strike a water deal. Negotiations are expected to continue in the coming days.

The governor has until midnight Sunday to take action on the bills on his desk.

Senate President Pro Tempore Darrell Steinberg (D-Sacramento) dismissed the veto threat and said he is confident the governor will consider each bill on its merits (Sacramento Bee, 10/9).


New Research Points to Racial, Ethnic Disparities in California Health Care
Black HMO members in California are significantly more likely to seek treatment in hospital emergency departments and delay filling prescriptions than members of other racial or ethnic groups, researchers from the UCLA Center for Health Policy Research found, Payers & Providers reports.

ED Data

The data indicate that 25% of black HMO members visited a hospital ED last year, compared with 18% of white HMO members and 13% of Asian-American HMO members.

In general, members of plans offered by Kaiser Permanente were more likely than members of other plans to seek care in EDs, but black Kaiser members still were 40% more likely than whites to go to an ED for care.

Filling Prescriptions

The study also found that 24.5% of blacks reported putting off filling a prescription, compared with 14.9% of whites, 10.8% of Hispanics and 6.1% of Asian-Americans.

Among members of Kaiser plans, 16.4% of blacks reported delaying filling a prescription, compared with 11.2% of whites, 8.8% of Hispanics and 8.2% of Asian-Americans (Payers & Providers [1], 10/8).

C-Section Data

A separate study by Kaiser's research arm found that black and Asian-American women underwent caesarean sections for first births at significantly higher rates than white or Hispanic women, according to Payers & Providers.

The study was based on data from Kaiser hospitals in Southern California and was published in the October issue of the American Journal of Obstetrics and Gynecology.

The study found that black Kaiser members were 25% more likely than white members to undergo a c-section and Asian-American members were 19% more likely than white members to have a c-section for their first pregnancy (Payers & Providers [2], 10/8).

State Officials Voicing Concerns About Costs of Health Care Overhaul
This week, state officials received an indication of how much a proposal under current health reform bills to expand Medicaid eligibility would affect them, which puts many governors in the uncomfortable position of addressing the rising number of uninsured residents while protecting their states' bottom lines, the Baltimore Sun reports.

The Congressional Budget Office earlier this week estimated that state spending on Medicaid will increase by $33 billion over the next decade under the Senate Finance Committee's health reform bill, which expands Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level (Smitherman, Baltimore Sun, 10/9).

The proposal would have the federal government pick up between 77% and 95% of the cost of the expansion, with states contributing the difference.

Under a deal reached between Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Majority Leader Harry Reid (D-Nev.), the federal government would contribute 100% of the cost of the expansion in Michigan, Nevada, Oregon and Rhode Island for the first five years (California Healthline, 10/5).

Republican governors and some Democrats have expressed concern regarding how their states will pay for the expansion.

Some states have indicated that they could benefit from the proposal.

For example, Maryland leaders believe the move could actually save the state money through reduced pharmaceutical prices and other measures, even though the expansion would mean 150,000 additional Maryland residents could enroll in Medicaid at a cost of tens of millions of dollars to the state annually.

According to the Sun, Maryland officials believe the federal plan would slow the rate at which health care costs increase because fewer uninsured people would be forced to seek treatment at hospitals.

The Sun reports that could result in lower overall health care costs for the state and, in turn, lower insurance premiums for those who are covered (Baltimore Sun, 10/9).

California Hospital News Roundup for the Week of October 9
Arrowhead Regional Medical Center, Colton

Arrowhead Regional Medical Center has been awarded a $245,334 grant from the California HealthCare Foundation, which will allow the facility to fully implement its Palliative Care Service program, the San Bernardino County Sun reports.

CHCF is the publisher of California Healthline.

The two-year grant will allow the program to serve about 144 patients in the first year, and twice that number in the second year, hospital officials said (Sorba, San Bernardino County Sun, 10/6).

El Camino Hospital, Mountain View

On Saturday, El Camino Hospital held a ribbon-cutting ceremony for its new $480 million acute care center, the San Jose Mercury News reports.

The 450,000 square foot expansion adds an additional 241 beds to the hospital, bringing the total number of beds on the campus to 327.

El Camino began the construction on the facility five years ago to meet new state seismic safety standards (Samuels, San Jose Mercury News, 10/3).

Los Alamitos Medical Center

Los Alamitos Medical Center has released a 25-year expansion plan that calls for a new 80,000 square foot medical office building, two new towers with a maximum capacity of 602 beds, parking structures and a central plant for the campus, the Orange County Register reports.

The Los Alamitos City Council is considering serving as the head agency on the facility's environmental report for the expansion plan.

The hospital would give the city $50,000 toward the cost of the study up front and reimburse the city for the remaining cost of the study (Fletcher, Orange County Register, 10/2).

Ojai Valley Community Hospital, Ventura County

Last week, Ojai Valley Community Hospital held a ribbon-cutting ceremony for its renovated emergency department, the Ventura County Star reports. The $2 million project included $1.7 million for the ED and the rest for other repairs.

The ED now has a separate admitting and waiting area and six new treatment areas.

According to Tim Wolfe, chair of the Ojai Valley Community Hospital Foundation, the hospital still needs to make seismic retrofits, renovate the exterior, improve the radiology department and open a new post-anesthesia unit (Kallas, Ventura County Star, 10/1).

St. John's Health Center, Santa Monica

St. John's Health Center in Santa Monica has received $100 million from Abraxis BioScience founder and CEO Patrick Soon-Shiong and his wife, Michele Chan, to develop a state-of-the-art data-sharing network that links physicians and patients to other hospitals and ongoing research being conducted at USC and UCLA, the Los Angeles Times reports.

The donation is the largest individual gift St. John's has ever received and one of the largest given to a community hospital in California (Hennessy-Fiske, Los Angeles Times, 10/1).

Stanford Hospital & Clinics, Palo Alto

Stanford Hospital & Clinics recently invested $3 million on Hill-Rom lifting equipment to help patients get in and out of bed safely and prevent injuries among medical staff, the San Francisco Business Times reports.

Over the summer, Stanford installed eight overhead lifts, 24 mobile lifts, a lift solely for moving exceptionally overweight patients, and 26 air-powered transfer systems for moving patients from a bed to an X-ray table or other treatment sites.

In a statement, Joan Forte, Stanford Hospital & Clinics' interim associate director of nursing, said that the equipment "may eventually pay for itself" by reducing the number of workers' compensation claims due to heavy lifting and other expenses (Rauber, San Francisco Business Journal, 10/2).

UC-Irvine Medical Center, Orange

On Oct. 2, the California Nurses Association protested the closure of a 13-bed geriatric psychiatric unit at UC-Irvine Medical Center, the Register's "Healthy Living" reports.

The unit was closed because it was chronically underused, according to hospital spokesperson John Murray.

The geriatric psychiatric patients and their nurses are expected to be incorporated into the adult psychiatric ward at UCIMC (Perkes, "Healthy Living," Orange County Register, 10/2).

UC-San Francisco, Mission Bay

On Oct. 2, UC-San Francisco opened its new 42,000 square foot Orthopaedic Institute in Mission Bay, the Business Times reports.

The facility has 28 exam rooms, four operating rooms and two procedure rooms. The institute will provide outpatient treatment, research, and training in musculoskeletal conditions, injuries and sports medicine (Leuty, San Francisco Business Times, 10/2).

Valley Health System

On Tuesday, the board of directors for Valley Health System voted 6-1 in favor of the sale of its assets -- including Hemet Valley Medical Center and Menifee Valley Medical Center -- to Physicians for Healthy Hospitals, a group of 132 physicians who practice in the hospital district, the Riverside Press-Enterprise reports.

The $162 million sale covers the hospital district's debt to its bondholders and unsecured creditors, as well as the fair market value of the district's assets, officials said.

The terms of the agreement require PHH to retain almost all of the district's employees and services, including its hospitals' EDs.

The sale has to be approved by district voters before it is finalized. An election will be held Dec. 15 (Hines, Riverside Press-Enterprise, 10/6).

Governor Issues Public Threat To Veto Health Bills, Other Legislation

On Thursday, Gov. Arnold Schwarzenegger (R) went public with his threat to veto more than 700 bills if legislators fail this week to reach a deal to address water issues this week, the Sacramento Bee reports.

Speaking before the Association of Community College Trustees' Leadership Congress, Schwarzenegger said, "I made it very clear to the legislators and to the leaders that if this does not get done, then I will veto a lot of their legislation" (Sanders, Sacramento Bee, 10/9).

Some of the bills currently on the governor's desk include:

AB 2 by Assembly member Hector De La Torre (D-South Gate), which would require health insurers to undergo a review and demonstrate intentional misrepresentation before rescinding an individual health insurance policy. Schwarzenegger vetoed a similar measure last year;
AB 98 also by De La Torre, which would require health insurance plans to cover maternity services. Some business groups, insurers and Republican legislators oppose the measure;
AB 119 by Assembly member Dave Jones (D-Sacramento), which would prohibit health insurers from charging different premiums based on gender. Some business groups, health plans and Republican legislators oppose the measure;
SB 820 by Sens. Sam Aanestad (R-Grass Valley) and Gloria Negrete McLeod (D-Chino), which would require medical staff peer review committees to report physicians with substance abuse or mental health issues to the Medical Board of California. The board would then follow up and review any corrective action imposed (California Healthline, 9/21); and
AB 1383 also by Jones, which would impose a fee on hospitals in order to draw down increased federal reimbursements for Medi-Cal, California's Medicaid program. Officials say the governor has signaled an inclination to veto the proposal because of concerns raised by anti-tax groups (California Healthline, 10/7).
On Thursday, Schwarzenegger met with legislative leaders from both parties in an effort to strike a water deal. Negotiations are expected to continue in the coming days.

The governor has until midnight Sunday to take action on the bills on his desk.

Senate President Pro Tempore Darrell Steinberg (D-Sacramento) dismissed the veto threat and said he is confident the governor will consider each bill on its merits (Sacramento Bee, 10/9).


New Research Points to Racial, Ethnic Disparities in California Health Care
Black HMO members in California are significantly more likely to seek treatment in hospital emergency departments and delay filling prescriptions than members of other racial or ethnic groups, researchers from the UCLA Center for Health Policy Research found, Payers & Providers reports.

ED Data

The data indicate that 25% of black HMO members visited a hospital ED last year, compared with 18% of white HMO members and 13% of Asian-American HMO members.

In general, members of plans offered by Kaiser Permanente were more likely than members of other plans to seek care in EDs, but black Kaiser members still were 40% more likely than whites to go to an ED for care.

Filling Prescriptions

The study also found that 24.5% of blacks reported putting off filling a prescription, compared with 14.9% of whites, 10.8% of Hispanics and 6.1% of Asian-Americans.

Among members of Kaiser plans, 16.4% of blacks reported delaying filling a prescription, compared with 11.2% of whites, 8.8% of Hispanics and 8.2% of Asian-Americans (Payers & Providers [1], 10/8).

C-Section Data

A separate study by Kaiser's research arm found that black and Asian-American women underwent caesarean sections for first births at significantly higher rates than white or Hispanic women, according to Payers & Providers.

The study was based on data from Kaiser hospitals in Southern California and was published in the October issue of the American Journal of Obstetrics and Gynecology.

The study found that black Kaiser members were 25% more likely than white members to undergo a c-section and Asian-American members were 19% more likely than white members to have a c-section for their first pregnancy (Payers & Providers [2], 10/8).

State Officials Voicing Concerns About Costs of Health Care Overhaul
This week, state officials received an indication of how much a proposal under current health reform bills to expand Medicaid eligibility would affect them, which puts many governors in the uncomfortable position of addressing the rising number of uninsured residents while protecting their states' bottom lines, the Baltimore Sun reports.

The Congressional Budget Office earlier this week estimated that state spending on Medicaid will increase by $33 billion over the next decade under the Senate Finance Committee's health reform bill, which expands Medicaid eligibility to individuals with incomes up to 133% of the federal poverty level (Smitherman, Baltimore Sun, 10/9).

The proposal would have the federal government pick up between 77% and 95% of the cost of the expansion, with states contributing the difference.

Under a deal reached between Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Majority Leader Harry Reid (D-Nev.), the federal government would contribute 100% of the cost of the expansion in Michigan, Nevada, Oregon and Rhode Island for the first five years (California Healthline, 10/5).

Republican governors and some Democrats have expressed concern regarding how their states will pay for the expansion.

Some states have indicated that they could benefit from the proposal.

For example, Maryland leaders believe the move could actually save the state money through reduced pharmaceutical prices and other measures, even though the expansion would mean 150,000 additional Maryland residents could enroll in Medicaid at a cost of tens of millions of dollars to the state annually.

According to the Sun, Maryland officials believe the federal plan would slow the rate at which health care costs increase because fewer uninsured people would be forced to seek treatment at hospitals.

The Sun reports that could result in lower overall health care costs for the state and, in turn, lower insurance premiums for those who are covered (Baltimore Sun, 10/9).

California Hospital News Roundup for the Week of October 9
Arrowhead Regional Medical Center, Colton

Arrowhead Regional Medical Center has been awarded a $245,334 grant from the California HealthCare Foundation, which will allow the facility to fully implement its Palliative Care Service program, the San Bernardino County Sun reports.

CHCF is the publisher of California Healthline.

The two-year grant will allow the program to serve about 144 patients in the first year, and twice that number in the second year, hospital officials said (Sorba, San Bernardino County Sun, 10/6).

El Camino Hospital, Mountain View

On Saturday, El Camino Hospital held a ribbon-cutting ceremony for its new $480 million acute care center, the San Jose Mercury News reports.

The 450,000 square foot expansion adds an additional 241 beds to the hospital, bringing the total number of beds on the campus to 327.

El Camino began the construction on the facility five years ago to meet new state seismic safety standards (Samuels, San Jose Mercury News, 10/3).

Los Alamitos Medical Center

Los Alamitos Medical Center has released a 25-year expansion plan that calls for a new 80,000 square foot medical office building, two new towers with a maximum capacity of 602 beds, parking structures and a central plant for the campus, the Orange County Register reports.

The Los Alamitos City Council is considering serving as the head agency on the facility's environmental report for the expansion plan.

The hospital would give the city $50,000 toward the cost of the study up front and reimburse the city for the remaining cost of the study (Fletcher, Orange County Register, 10/2).

Ojai Valley Community Hospital, Ventura County

Last week, Ojai Valley Community Hospital held a ribbon-cutting ceremony for its renovated emergency department, the Ventura County Star reports. The $2 million project included $1.7 million for the ED and the rest for other repairs.

The ED now has a separate admitting and waiting area and six new treatment areas.

According to Tim Wolfe, chair of the Ojai Valley Community Hospital Foundation, the hospital still needs to make seismic retrofits, renovate the exterior, improve the radiology department and open a new post-anesthesia unit (Kallas, Ventura County Star, 10/1).

St. John's Health Center, Santa Monica

St. John's Health Center in Santa Monica has received $100 million from Abraxis BioScience founder and CEO Patrick Soon-Shiong and his wife, Michele Chan, to develop a state-of-the-art data-sharing network that links physicians and patients to other hospitals and ongoing research being conducted at USC and UCLA, the Los Angeles Times reports.

The donation is the largest individual gift St. John's has ever received and one of the largest given to a community hospital in California (Hennessy-Fiske, Los Angeles Times, 10/1).

Stanford Hospital & Clinics, Palo Alto

Stanford Hospital & Clinics recently invested $3 million on Hill-Rom lifting equipment to help patients get in and out of bed safely and prevent injuries among medical staff, the San Francisco Business Times reports.

Over the summer, Stanford installed eight overhead lifts, 24 mobile lifts, a lift solely for moving exceptionally overweight patients, and 26 air-powered transfer systems for moving patients from a bed to an X-ray table or other treatment sites.

In a statement, Joan Forte, Stanford Hospital & Clinics' interim associate director of nursing, said that the equipment "may eventually pay for itself" by reducing the number of workers' compensation claims due to heavy lifting and other expenses (Rauber, San Francisco Business Journal, 10/2).

UC-Irvine Medical Center, Orange

On Oct. 2, the California Nurses Association protested the closure of a 13-bed geriatric psychiatric unit at UC-Irvine Medical Center, the Register's "Healthy Living" reports.

The unit was closed because it was chronically underused, according to hospital spokesperson John Murray.

The geriatric psychiatric patients and their nurses are expected to be incorporated into the adult psychiatric ward at UCIMC (Perkes, "Healthy Living," Orange County Register, 10/2).

UC-San Francisco, Mission Bay

On Oct. 2, UC-San Francisco opened its new 42,000 square foot Orthopaedic Institute in Mission Bay, the Business Times reports.

The facility has 28 exam rooms, four operating rooms and two procedure rooms. The institute will provide outpatient treatment, research, and training in musculoskeletal conditions, injuries and sports medicine (Leuty, San Francisco Business Times, 10/2).

Valley Health System

On Tuesday, the board of directors for Valley Health System voted 6-1 in favor of the sale of its assets -- including Hemet Valley Medical Center and Menifee Valley Medical Center -- to Physicians for Healthy Hospitals, a group of 132 physicians who practice in the hospital district, the Riverside Press-Enterprise reports.

The $162 million sale covers the hospital district's debt to its bondholders and unsecured creditors, as well as the fair market value of the district's assets, officials said.

The terms of the agreement require PHH to retain almost all of the district's employees and services, including its hospitals' EDs.

The sale has to be approved by district voters before it is finalized. An election will be held Dec. 15 (Hines, Riverside Press-Enterprise, 10/6).

Swine Flu Vaccine Starting To Arrive Locally

Shipments of the swine flu vaccine are trickling in to local health departments.

The Wheeling-Ohio County Health Department and the Belmont County Heath Department have received their shipments and distributed the vaccine to local hospitals.

Medical professionals will be the first ones to receive the vaccine.

As of Friday, there have been at least four reported deaths in Ohio because of the swine flu. The latest fatality was a 14-year-old Columbus boy.

Stay with NEWS9 and WTOV9.com for continuing coverage.


Previous Stories:
October 8, 2009: Wheeling High School Student Suffering From Swine Flu
October 7, 2009: Swine Flu Vaccine Now Available To General Public
September 30, 2009: Local County Turns Focus To Swine Flu Vaccinations
September 21, 2009: Swine Flu Case Outcome Surprises WJU Officials
September 21, 2009: Swine Flu Confirmed At Wheeling Jesuit
September 16, 2009: Local Health Department Preparing For Swine Flu Vaccine
September 11, 2009: WJU Prepares Swine Flu Outbreak Plan
September 8, 2009: W.Va. Jails Prepared For Possible Swine Flu Outbreak
September 4, 2009: W.Va. Records 1st Swine Flu-Related Death
September 3, 2009: Pregnant Woman In Ohio Dies Of Swine Flu
August 31, 2009: School Nurse Shortage Could Impact Swine Flu Response
August 21, 2009: Local Hospital Prepares For Swine Flu Surge
August 11, 2009: School, Hospital Team Up To Teach Kids Hygiene In Unique Way
August 7, 2009: Ohio No Longer Reporting Individual Swine Flu Cases
August 5, 2009: Swine Flu Warning Sent Out By Bellaire School Officials
August 4, 2009: Back-To-School Swine Flu Precautions
July 28, 2009: Swine Flu, West Nile On The Rise In Ohio County
July 28, 2009: Ohio Prepared To Deal With Swine Flu, Health Officials Say
July 27, 2009: Child Is 2nd Swine Flu Case Confirmed In Jefferson County
June 24, 2009: Swine Flu Cases Prompt Closure Of W.Va. Kids Camp
June 19, 2009: Swine Flu Case Confirmed In Steubenville
June 12, 2009: Swine Flu Declared Global Pandemic
June 5, 2009: Swine Flu Confirmed In Hancock County
June 4, 2009: Swine Flu Still A Danger
May 18, 2009: First Confirmed Swine Flu Death Occurs In New York
May 6, 2009: Residents Warned About Swine Flu Vaccine
May 6, 2009: First American Dies From Swine Flu
May 4, 2009: 2 New Swine Flu Cases In Ohio
May 1, 2009: Swine Flu: Local Employers Encourage Some Workers To Stay Home
May 1, 2009: Ohio County Awaits Swine Flu Test Results From State
April 30, 2009: Tuscarawas County Patient Tests Negative For Swine Flu
April 30, 2009: Wheeling-Ohio County Health Officials Await Swine Flu Confirmation, Drugs
April 29, 2009: Kids & Swine Flu: Parents Urged To Discuss Proper Hygiene
April 28, 2009: Swine Flu Has Valley Residents Concerned
April 28, 2009: Some Valley Residents Approve Of Government's Actions On Swine Flu
April 28, 2009: Local Couple Cancels Honeymoon Because Of Swine Flu Scare
April 27, 2009: Local Travelers Leery Over Swine Flu Outbreak
April 27, 2009: Swine Flu Has Local Health Officials On Alert
April 27, 2009: Ohio Boy Diagnosed With Swine Flu
April 25, 2009: Swine Flu Kills Dozens In Mexico, Spreads Into United States

Kaiser Daily Global Health Policy Report

VOA News examines how the recession will be a factor in U.S. funding decisions about PEPFAR and other global health initiatives. According to VOA, the Obama administration's proposed funding for HIV, tuberculosis and malaria in 2010 is "higher than the current fiscal year. However, the proposed increase is lower than in some years past."

The news service reports that U.S. Global AIDS Coordinator Eric Goosby "says the Obama administration is committed to fighting" HIV. Goosby noted the economic situation is "a reality that continues to reverberate with budgetary discussion within the administration...and how it impacts the deficit. And those conversations have predominated in the thinking as we move into 2010, 2011 in budget discussions." He added, "The trajectory for PEPFAR expansion in the first five years is not going to be reflected for the immediate future. But it does not reflect a change in commitment or emphasis."

The article also includes Goosby's comments on HIV/AIDS treatment and prevention as well as the recent appeal (.pdf) by the International AIDS Society for "sustained political leadership and financing by the G8 and other donors to maintain recent momentum" in HIV/AIDS. Goosby said, "I think that is a reasonable challenge for the International AIDS Society to call upon world leaders to continue to acknowledge…there indeed is a collective responsibility…by resource rich countries…around how resource rich countries relate to resource poor countries in helping to support their response to what is an overwhelming epidemic" (De Capua, 10/8).

Swine Flu Vaccine Starting To Arrive Locally

Shipments of the swine flu vaccine are trickling in to local health departments.

The Wheeling-Ohio County Health Department and the Belmont County Heath Department have received their shipments and distributed the vaccine to local hospitals.

Medical professionals will be the first ones to receive the vaccine.

As of Friday, there have been at least four reported deaths in Ohio because of the swine flu. The latest fatality was a 14-year-old Columbus boy.

Stay with NEWS9 and WTOV9.com for continuing coverage.


Previous Stories:
October 8, 2009: Wheeling High School Student Suffering From Swine Flu
October 7, 2009: Swine Flu Vaccine Now Available To General Public
September 30, 2009: Local County Turns Focus To Swine Flu Vaccinations
September 21, 2009: Swine Flu Case Outcome Surprises WJU Officials
September 21, 2009: Swine Flu Confirmed At Wheeling Jesuit
September 16, 2009: Local Health Department Preparing For Swine Flu Vaccine
September 11, 2009: WJU Prepares Swine Flu Outbreak Plan
September 8, 2009: W.Va. Jails Prepared For Possible Swine Flu Outbreak
September 4, 2009: W.Va. Records 1st Swine Flu-Related Death
September 3, 2009: Pregnant Woman In Ohio Dies Of Swine Flu
August 31, 2009: School Nurse Shortage Could Impact Swine Flu Response
August 21, 2009: Local Hospital Prepares For Swine Flu Surge
August 11, 2009: School, Hospital Team Up To Teach Kids Hygiene In Unique Way
August 7, 2009: Ohio No Longer Reporting Individual Swine Flu Cases
August 5, 2009: Swine Flu Warning Sent Out By Bellaire School Officials
August 4, 2009: Back-To-School Swine Flu Precautions
July 28, 2009: Swine Flu, West Nile On The Rise In Ohio County
July 28, 2009: Ohio Prepared To Deal With Swine Flu, Health Officials Say
July 27, 2009: Child Is 2nd Swine Flu Case Confirmed In Jefferson County
June 24, 2009: Swine Flu Cases Prompt Closure Of W.Va. Kids Camp
June 19, 2009: Swine Flu Case Confirmed In Steubenville
June 12, 2009: Swine Flu Declared Global Pandemic
June 5, 2009: Swine Flu Confirmed In Hancock County
June 4, 2009: Swine Flu Still A Danger
May 18, 2009: First Confirmed Swine Flu Death Occurs In New York
May 6, 2009: Residents Warned About Swine Flu Vaccine
May 6, 2009: First American Dies From Swine Flu
May 4, 2009: 2 New Swine Flu Cases In Ohio
May 1, 2009: Swine Flu: Local Employers Encourage Some Workers To Stay Home
May 1, 2009: Ohio County Awaits Swine Flu Test Results From State
April 30, 2009: Tuscarawas County Patient Tests Negative For Swine Flu
April 30, 2009: Wheeling-Ohio County Health Officials Await Swine Flu Confirmation, Drugs
April 29, 2009: Kids & Swine Flu: Parents Urged To Discuss Proper Hygiene
April 28, 2009: Swine Flu Has Valley Residents Concerned
April 28, 2009: Some Valley Residents Approve Of Government's Actions On Swine Flu
April 28, 2009: Local Couple Cancels Honeymoon Because Of Swine Flu Scare
April 27, 2009: Local Travelers Leery Over Swine Flu Outbreak
April 27, 2009: Swine Flu Has Local Health Officials On Alert
April 27, 2009: Ohio Boy Diagnosed With Swine Flu
April 25, 2009: Swine Flu Kills Dozens In Mexico, Spreads Into United States

Kaiser Daily Global Health Policy Report

VOA News examines how the recession will be a factor in U.S. funding decisions about PEPFAR and other global health initiatives. According to VOA, the Obama administration's proposed funding for HIV, tuberculosis and malaria in 2010 is "higher than the current fiscal year. However, the proposed increase is lower than in some years past."

The news service reports that U.S. Global AIDS Coordinator Eric Goosby "says the Obama administration is committed to fighting" HIV. Goosby noted the economic situation is "a reality that continues to reverberate with budgetary discussion within the administration...and how it impacts the deficit. And those conversations have predominated in the thinking as we move into 2010, 2011 in budget discussions." He added, "The trajectory for PEPFAR expansion in the first five years is not going to be reflected for the immediate future. But it does not reflect a change in commitment or emphasis."

The article also includes Goosby's comments on HIV/AIDS treatment and prevention as well as the recent appeal (.pdf) by the International AIDS Society for "sustained political leadership and financing by the G8 and other donors to maintain recent momentum" in HIV/AIDS. Goosby said, "I think that is a reasonable challenge for the International AIDS Society to call upon world leaders to continue to acknowledge…there indeed is a collective responsibility…by resource rich countries…around how resource rich countries relate to resource poor countries in helping to support their response to what is an overwhelming epidemic" (De Capua, 10/8).

Swine Flu Vaccine Starting To Arrive Locally

Shipments of the swine flu vaccine are trickling in to local health departments.

The Wheeling-Ohio County Health Department and the Belmont County Heath Department have received their shipments and distributed the vaccine to local hospitals.

Medical professionals will be the first ones to receive the vaccine.

As of Friday, there have been at least four reported deaths in Ohio because of the swine flu. The latest fatality was a 14-year-old Columbus boy.

Stay with NEWS9 and WTOV9.com for continuing coverage.


Previous Stories:
October 8, 2009: Wheeling High School Student Suffering From Swine Flu
October 7, 2009: Swine Flu Vaccine Now Available To General Public
September 30, 2009: Local County Turns Focus To Swine Flu Vaccinations
September 21, 2009: Swine Flu Case Outcome Surprises WJU Officials
September 21, 2009: Swine Flu Confirmed At Wheeling Jesuit
September 16, 2009: Local Health Department Preparing For Swine Flu Vaccine
September 11, 2009: WJU Prepares Swine Flu Outbreak Plan
September 8, 2009: W.Va. Jails Prepared For Possible Swine Flu Outbreak
September 4, 2009: W.Va. Records 1st Swine Flu-Related Death
September 3, 2009: Pregnant Woman In Ohio Dies Of Swine Flu
August 31, 2009: School Nurse Shortage Could Impact Swine Flu Response
August 21, 2009: Local Hospital Prepares For Swine Flu Surge
August 11, 2009: School, Hospital Team Up To Teach Kids Hygiene In Unique Way
August 7, 2009: Ohio No Longer Reporting Individual Swine Flu Cases
August 5, 2009: Swine Flu Warning Sent Out By Bellaire School Officials
August 4, 2009: Back-To-School Swine Flu Precautions
July 28, 2009: Swine Flu, West Nile On The Rise In Ohio County
July 28, 2009: Ohio Prepared To Deal With Swine Flu, Health Officials Say
July 27, 2009: Child Is 2nd Swine Flu Case Confirmed In Jefferson County
June 24, 2009: Swine Flu Cases Prompt Closure Of W.Va. Kids Camp
June 19, 2009: Swine Flu Case Confirmed In Steubenville
June 12, 2009: Swine Flu Declared Global Pandemic
June 5, 2009: Swine Flu Confirmed In Hancock County
June 4, 2009: Swine Flu Still A Danger
May 18, 2009: First Confirmed Swine Flu Death Occurs In New York
May 6, 2009: Residents Warned About Swine Flu Vaccine
May 6, 2009: First American Dies From Swine Flu
May 4, 2009: 2 New Swine Flu Cases In Ohio
May 1, 2009: Swine Flu: Local Employers Encourage Some Workers To Stay Home
May 1, 2009: Ohio County Awaits Swine Flu Test Results From State
April 30, 2009: Tuscarawas County Patient Tests Negative For Swine Flu
April 30, 2009: Wheeling-Ohio County Health Officials Await Swine Flu Confirmation, Drugs
April 29, 2009: Kids & Swine Flu: Parents Urged To Discuss Proper Hygiene
April 28, 2009: Swine Flu Has Valley Residents Concerned
April 28, 2009: Some Valley Residents Approve Of Government's Actions On Swine Flu
April 28, 2009: Local Couple Cancels Honeymoon Because Of Swine Flu Scare
April 27, 2009: Local Travelers Leery Over Swine Flu Outbreak
April 27, 2009: Swine Flu Has Local Health Officials On Alert
April 27, 2009: Ohio Boy Diagnosed With Swine Flu
April 25, 2009: Swine Flu Kills Dozens In Mexico, Spreads Into United States

Kaiser Daily Global Health Policy Report

VOA News examines how the recession will be a factor in U.S. funding decisions about PEPFAR and other global health initiatives. According to VOA, the Obama administration's proposed funding for HIV, tuberculosis and malaria in 2010 is "higher than the current fiscal year. However, the proposed increase is lower than in some years past."

The news service reports that U.S. Global AIDS Coordinator Eric Goosby "says the Obama administration is committed to fighting" HIV. Goosby noted the economic situation is "a reality that continues to reverberate with budgetary discussion within the administration...and how it impacts the deficit. And those conversations have predominated in the thinking as we move into 2010, 2011 in budget discussions." He added, "The trajectory for PEPFAR expansion in the first five years is not going to be reflected for the immediate future. But it does not reflect a change in commitment or emphasis."

The article also includes Goosby's comments on HIV/AIDS treatment and prevention as well as the recent appeal (.pdf) by the International AIDS Society for "sustained political leadership and financing by the G8 and other donors to maintain recent momentum" in HIV/AIDS. Goosby said, "I think that is a reasonable challenge for the International AIDS Society to call upon world leaders to continue to acknowledge…there indeed is a collective responsibility…by resource rich countries…around how resource rich countries relate to resource poor countries in helping to support their response to what is an overwhelming epidemic" (De Capua, 10/8).

Health Insurers Threaten Rate Hikes

Industry representatives put Congress and the Obama administration on notice that if health-reform legislation doesn’t send even more new customers the industry’s way or if a windfall profits tax is included, the industry would hit businesses, individuals and the government with higher premiums, effectively defeating one of the initiative’s top goals, reining in ever-rising costs.

The industry’s chief complaint, which was raised in connection with an already-industry-friendly bill cobbled together by Senate Finance Committee chairman Max Baucus, is that the legislation would push 29 million more Americans into the insurance market, but that they might be the sickest and thus costliest people.

The industry wants more of the estimated 25 million still uninsured – especially healthy, young people – to be compelled to buy policies, too. Without more healthy customers added to the mix, the industry says it will have no choice but to raise rates.

"The consequences of this would be an upward spiral; rate shock to everyone who stays in," Karen Ignagni, president of the industry group America's Health Insurance Plans, told the Washington Post. "This legislation will fail the test of affordability for individuals." [Washington Post, Oct. 9, 2009]

The industry’s warning comes after its lobbyists won an important victory in the Senate Finance Committee, defeating amendments that would have added a public option, a government-run program that would compete with private insurers to hold down costs.

Private insurers also bristled at an idea floated by House Speaker Nancy Pelosi, a windfall profits tax on extra money the industry might make from the influx of millions of new customers, many qualifying for government subsidies.

Robert E. Zirkelbach, a spokesman for America’s Health Insurance Plans, told the New York Times that a tax on windfall profits “would lead to higher premiums for families and businesses” because the added expense would be passed through to customers. [NYT, Oct. 9, 2009]

However, it was not clear why insurers would worry about a windfall profits tax if they were also concerned that new customers would be a financial burden.

Still, by the industry throwing its weight around with threats of higher premiums, it may be risking a backlash from Congress, which could still turn to the public option as the only feasible method for constraining ever-rising health insurance costs.

The industry fears the public option because it could piggyback on the existing Medicare bureaucracy and thus save substantial money, which the insurance industry spends on administrative expenses, executive pay and profits.

Those costs eat up 20 percent or more of an average dollar that businesses and individuals spend on health insurance premiums, compared to about 2 percent for Medicare.

The latest threats suggest that industry lobbyists believe they have enough senators lined up to back a Republican filibuster and block the public option.

But Democrats especially have reason to worry, because if they enact a reform package without the public option – and insurers then jack up rates – Democrats could be blamed for the unintended consequence of higher costs and thus pay a steep political price at the polls.

30 Senate Democrats Voice Support for Public Health Plan

On Thursday, 30 Senate Democrats asked Senate Majority Leader Harry Reid (D-Nev.) to include a government-administered public health insurance plan option in the final health reform bill that he delivers to the chamber floor. Next Tuesday, the Senate Finance Committee is scheduled to vote on its health reform bill, which omits the public option in favor of creating a network of not-for-profit health cooperatives.

Health Insurers Threaten Rate Hikes

Industry representatives put Congress and the Obama administration on notice that if health-reform legislation doesn’t send even more new customers the industry’s way or if a windfall profits tax is included, the industry would hit businesses, individuals and the government with higher premiums, effectively defeating one of the initiative’s top goals, reining in ever-rising costs.

The industry’s chief complaint, which was raised in connection with an already-industry-friendly bill cobbled together by Senate Finance Committee chairman Max Baucus, is that the legislation would push 29 million more Americans into the insurance market, but that they might be the sickest and thus costliest people.

The industry wants more of the estimated 25 million still uninsured – especially healthy, young people – to be compelled to buy policies, too. Without more healthy customers added to the mix, the industry says it will have no choice but to raise rates.

"The consequences of this would be an upward spiral; rate shock to everyone who stays in," Karen Ignagni, president of the industry group America's Health Insurance Plans, told the Washington Post. "This legislation will fail the test of affordability for individuals." [Washington Post, Oct. 9, 2009]

The industry’s warning comes after its lobbyists won an important victory in the Senate Finance Committee, defeating amendments that would have added a public option, a government-run program that would compete with private insurers to hold down costs.

Private insurers also bristled at an idea floated by House Speaker Nancy Pelosi, a windfall profits tax on extra money the industry might make from the influx of millions of new customers, many qualifying for government subsidies.

Robert E. Zirkelbach, a spokesman for America’s Health Insurance Plans, told the New York Times that a tax on windfall profits “would lead to higher premiums for families and businesses” because the added expense would be passed through to customers. [NYT, Oct. 9, 2009]

However, it was not clear why insurers would worry about a windfall profits tax if they were also concerned that new customers would be a financial burden.

Still, by the industry throwing its weight around with threats of higher premiums, it may be risking a backlash from Congress, which could still turn to the public option as the only feasible method for constraining ever-rising health insurance costs.

The industry fears the public option because it could piggyback on the existing Medicare bureaucracy and thus save substantial money, which the insurance industry spends on administrative expenses, executive pay and profits.

Those costs eat up 20 percent or more of an average dollar that businesses and individuals spend on health insurance premiums, compared to about 2 percent for Medicare.

The latest threats suggest that industry lobbyists believe they have enough senators lined up to back a Republican filibuster and block the public option.

But Democrats especially have reason to worry, because if they enact a reform package without the public option – and insurers then jack up rates – Democrats could be blamed for the unintended consequence of higher costs and thus pay a steep political price at the polls.

30 Senate Democrats Voice Support for Public Health Plan

On Thursday, 30 Senate Democrats asked Senate Majority Leader Harry Reid (D-Nev.) to include a government-administered public health insurance plan option in the final health reform bill that he delivers to the chamber floor. Next Tuesday, the Senate Finance Committee is scheduled to vote on its health reform bill, which omits the public option in favor of creating a network of not-for-profit health cooperatives.

Health Insurers Threaten Rate Hikes

Industry representatives put Congress and the Obama administration on notice that if health-reform legislation doesn’t send even more new customers the industry’s way or if a windfall profits tax is included, the industry would hit businesses, individuals and the government with higher premiums, effectively defeating one of the initiative’s top goals, reining in ever-rising costs.

The industry’s chief complaint, which was raised in connection with an already-industry-friendly bill cobbled together by Senate Finance Committee chairman Max Baucus, is that the legislation would push 29 million more Americans into the insurance market, but that they might be the sickest and thus costliest people.

The industry wants more of the estimated 25 million still uninsured – especially healthy, young people – to be compelled to buy policies, too. Without more healthy customers added to the mix, the industry says it will have no choice but to raise rates.

"The consequences of this would be an upward spiral; rate shock to everyone who stays in," Karen Ignagni, president of the industry group America's Health Insurance Plans, told the Washington Post. "This legislation will fail the test of affordability for individuals." [Washington Post, Oct. 9, 2009]

The industry’s warning comes after its lobbyists won an important victory in the Senate Finance Committee, defeating amendments that would have added a public option, a government-run program that would compete with private insurers to hold down costs.

Private insurers also bristled at an idea floated by House Speaker Nancy Pelosi, a windfall profits tax on extra money the industry might make from the influx of millions of new customers, many qualifying for government subsidies.

Robert E. Zirkelbach, a spokesman for America’s Health Insurance Plans, told the New York Times that a tax on windfall profits “would lead to higher premiums for families and businesses” because the added expense would be passed through to customers. [NYT, Oct. 9, 2009]

However, it was not clear why insurers would worry about a windfall profits tax if they were also concerned that new customers would be a financial burden.

Still, by the industry throwing its weight around with threats of higher premiums, it may be risking a backlash from Congress, which could still turn to the public option as the only feasible method for constraining ever-rising health insurance costs.

The industry fears the public option because it could piggyback on the existing Medicare bureaucracy and thus save substantial money, which the insurance industry spends on administrative expenses, executive pay and profits.

Those costs eat up 20 percent or more of an average dollar that businesses and individuals spend on health insurance premiums, compared to about 2 percent for Medicare.

The latest threats suggest that industry lobbyists believe they have enough senators lined up to back a Republican filibuster and block the public option.

But Democrats especially have reason to worry, because if they enact a reform package without the public option – and insurers then jack up rates – Democrats could be blamed for the unintended consequence of higher costs and thus pay a steep political price at the polls.

30 Senate Democrats Voice Support for Public Health Plan

On Thursday, 30 Senate Democrats asked Senate Majority Leader Harry Reid (D-Nev.) to include a government-administered public health insurance plan option in the final health reform bill that he delivers to the chamber floor. Next Tuesday, the Senate Finance Committee is scheduled to vote on its health reform bill, which omits the public option in favor of creating a network of not-for-profit health cooperatives.

Nations no longer counting pandemic flu cases; last US estimate in July, stuck at 1 million

ATLANTA (AP) — U.S. health officials have lost track of how many illnesses and deaths have been caused by the first global flu epidemic in 40 years.

And they did it on purpose.

Government doctors stopped counting swine flu cases in July, when they estimated more than 1 million were infected in this country. The number of deaths has been sitting at more than 600 since early September. Health officials had previously counted lab-confirmed cases, though the tally was skewed because many people who got sick never were tested.

Other nations have stopped relying on lab-confirmed cases, too, and health officials say the current monitoring system is adequate. But not having specific, accurate counts of swine flu means the government doesn't have a clear picture of how hard the infection is hitting some groups of people, said Andrew Pekosz, a flu expert at Johns Hopkins University.

The novel H1N1 flu seems to be more dangerous for children, young adults, pregnant women and even the obese, according to studies based on small numbers of patients. But exactly how much more at risk those people are is hard to gauge if the overall numbers are fuzzy.

"This wasn't as critical early on, when case numbers were low," said Pekosz. But now, it's hard to say exactly how swine flu's dangers vary from group to group, he said.

The Centers for Disease Control and Prevention is relying on a patchwork system of gathering death and hospitalization numbers. Some states are reporting lab-confirmed cases. Others report illnesses that could be the new swine flu, seasonal flu or some other respiratory disease.

Some say that's a more sensible approach than only counting lab-confirmed cases. Many people who got sick never get tested, so the tally of swine flu cases was off almost from the very beginning, they say.

"It was a vast underestimate," said Dr. Zack Moore, a respiratory disease expert for the North Carolina Department of Health and Human Services.

What's more, as the initial panic of the new virus ebbed, fewer people were fully tested, so the results weren't as accurate or comprehensive. "The kinds of numbers you were getting later in the summer were different from the numbers early on," said Dr. Daniel Jernigan, deputy director of the CDC's influenza division.

That's why the CDC shifted to counting the new flu like it counts seasonal flu cases, agency officials said. "We're concerned folks are focused on the numbers and missing that influenza is monitored by looking at trends," Jernigan said.

It's likely that millions of Americans have been sickened by swine flu by now, CDC officials say. New York City alone estimates it had roughly 1 million cases since swine flu first hit last spring.

While everyone would like an exact measure of how every disease is affecting society, that simply doesn't exist. "We don't even have a good measure of how many heart attacks there are every day," which would seem like a relatively easy thing to track, noted Marc Lipsitch, a Harvard University professor of epidemiology.

More comprehensive tracking is not possible with current resources and medical record-keeping, some public health advocates say.

"The fact that it is a challenge to come up with these data proves that we have underdeveloped surveillance systems in this country," said Jeff Levi, executive director of Trust for America's Health, a Washington-based public health research organization.

Most disease investigation and case-counting is done by state and local health departments. But quality varies state to state, and in many places it may be getting worse: State budget shortfalls and other problems led to the elimination of 7,000 health department jobs last year and 8,000 more jobs in the first six months of this year.

"You take for granted this work goes on. But it is difficult to take for granted any longer, with these cuts going on," said Robert Pestronk, executive director of the National Association of County and City Health Officials.

However, Pestronk and others think the government's current system of flu tracking is adequate and getting better.

The CDC has nine ways of monitoring influenza. Some focus on people who die from flu-like illness — one tracking deaths of children, another counting pneumonia and flu deaths of all ages in 122 cities.

Other systems gather flu-testing information from labs across the country. And some rely on reports of flu-like illness from hospital emergency departments and from estimates from state and territorial health officials.

Those systems combine to give a good general picture of whether more or fewer people are going to the doctor with flu, and how often lab samples are showing swine flu as compared to other respiratory bugs, health officials say.

There are problems that make even that data incomplete or inaccurate. Rapid flu tests — which are used in counting hospitalizations — are often wrong when they indicate a patient doesn't have swine flu, CDC studies have shown. In some cases, flu or swine flu was only confirmed at autopsy. But most deaths are not autopsied.

These problems are not unique to the United States. The World Health Organization also stopped counting cases in July, after deciding that tracking individual swine flu cases was too overwhelming for countries where the virus was spreading widely. The WHO has continued to update swine flu reports, but with the disclaimer that since countries are no longer required to test and report cases, WHO's numbers underestimate.

Britain also releases weekly swine flu updates, but the numbers are estimates based on how many people go to their doctors with flu-like illness, as well as calls logged to the national flu service.

Despite resource limitations and data imperfections, experts say the U.S. system is good enough to alert the experts when major changes occur in the pandemic.

"There will always be an error factor, misdiagnosis, misclassifications," said Pestronk, formerly the head of a county health department in Michigan. "We'll never be at 100 percent of people getting tested. The question is what's good enough for purposes of planning and acting on the burden of disease."

UPDATE: Kimberly-Clark Buy Of I-Flow Adds To Health Care Ops

NEW YORK (Dow Jones)--Kimberly-Clark Corp. (KMB) agreed Friday to acquire I-Flow Corp. (IFLO) for $276 million, excluding cash acquired, marking the second acquisition of a pain management company this week for the maker of consumer paper products.

Kimberly-Clark said acquiring the maker of pain-management and drug-delivery technology would increase its medical device sales by more than 50% and is part of the company's strategy to move into higher-growth, higher-margin medical devices.

Earlier this week, the company bought the privately held Baylis Medical Co. for an undisclosed price.

Sales of Kimberly-Clark's core brands - which include Huggies diapers, Scott paper towels and Kleenex tissues - have been under pressure as consumers increasingly look to purchase lower-priced products from private-label makers during the recession.

"The question is: Are these smaller acquisitions enough to dilute the negative effects of its core consumer tissue and diaper business?" Sanford C. Bernstein analyst Ali Dibadj asked.

Kimberly-Clark's strategy contrasts with that of peer Proctor & Gamble Co. (PG), which is selling off its prescription drug business and has been shifting focus to lower-priced offerings to boost its sagging market share as consumers shun pricier goods.

BMO Capital Markets analyst Connie Maneaty said the situations were different because P&G was getting rid of non-core, slower-growth assets - such as its pharmaceutical business and Folgers - and focusing more on beauty products. Meanwhile, Kimberly-Clark's strategy has been to go into health care, excluding pharmaceuticals, Maneaty said.

The deal has a total value of $324 million, including acquired cash, and valued I-Flow at $12.65 a share, 7.6% above its closing price Thursday and a 31% premium to its 60-day average share price. I-Flow shares recently rose 84 cents, or 7.1%, to $12.60. Kimberly-Clark shares slipped 14 cents to $58.92.

Both companies' boards have approved the deal, expected to close in the fourth quarter, and Kimberly-Clark expects the acquisition to add to earnings in 2011.

Caris & Co. analyst Linda Bolton Weiser said it doesn't look like the deal is going to be hugely accretive because I-Flow has lost money through the first six months, although the business offers potentially attractive margins if Kimberly-Clark could cut costs.

The medical-device acquisitions made by Kimberly-Clark tend to be smaller companies with poor distribution operations to the health care industry, Bernstein's Dibadj said, allowing Kimberly-Clark to profit simply by adding the acquired companies' products on to their deliveries to hospitals.

Kimberly-Clark's health-care segment, which had $1.22 billion in sales last year, includes products for digestive health, airway management and pain management. Medical device sales represent 20% of the company's total health care revenue, Kimberly-Clark spokeswoman Kay Jackson said.

Through the first six months of 2009, Kimberly-Clark's health care division is the only one to register sales growth, up 4.8% to $633 million, and its operating profit growth of 45%, outpaces the other divisions.

-By Kerry Grace Benn, Dow Jones Newswires; 212-416-2353; kerry.benn@dowjones.com

(Tess Stynes in New York contributed to this article.)

Nations no longer counting pandemic flu cases; last US estimate in July, stuck at 1 million

ATLANTA (AP) — U.S. health officials have lost track of how many illnesses and deaths have been caused by the first global flu epidemic in 40 years.

And they did it on purpose.

Government doctors stopped counting swine flu cases in July, when they estimated more than 1 million were infected in this country. The number of deaths has been sitting at more than 600 since early September. Health officials had previously counted lab-confirmed cases, though the tally was skewed because many people who got sick never were tested.

Other nations have stopped relying on lab-confirmed cases, too, and health officials say the current monitoring system is adequate. But not having specific, accurate counts of swine flu means the government doesn't have a clear picture of how hard the infection is hitting some groups of people, said Andrew Pekosz, a flu expert at Johns Hopkins University.

The novel H1N1 flu seems to be more dangerous for children, young adults, pregnant women and even the obese, according to studies based on small numbers of patients. But exactly how much more at risk those people are is hard to gauge if the overall numbers are fuzzy.

"This wasn't as critical early on, when case numbers were low," said Pekosz. But now, it's hard to say exactly how swine flu's dangers vary from group to group, he said.

The Centers for Disease Control and Prevention is relying on a patchwork system of gathering death and hospitalization numbers. Some states are reporting lab-confirmed cases. Others report illnesses that could be the new swine flu, seasonal flu or some other respiratory disease.

Some say that's a more sensible approach than only counting lab-confirmed cases. Many people who got sick never get tested, so the tally of swine flu cases was off almost from the very beginning, they say.

"It was a vast underestimate," said Dr. Zack Moore, a respiratory disease expert for the North Carolina Department of Health and Human Services.

What's more, as the initial panic of the new virus ebbed, fewer people were fully tested, so the results weren't as accurate or comprehensive. "The kinds of numbers you were getting later in the summer were different from the numbers early on," said Dr. Daniel Jernigan, deputy director of the CDC's influenza division.

That's why the CDC shifted to counting the new flu like it counts seasonal flu cases, agency officials said. "We're concerned folks are focused on the numbers and missing that influenza is monitored by looking at trends," Jernigan said.

It's likely that millions of Americans have been sickened by swine flu by now, CDC officials say. New York City alone estimates it had roughly 1 million cases since swine flu first hit last spring.

While everyone would like an exact measure of how every disease is affecting society, that simply doesn't exist. "We don't even have a good measure of how many heart attacks there are every day," which would seem like a relatively easy thing to track, noted Marc Lipsitch, a Harvard University professor of epidemiology.

More comprehensive tracking is not possible with current resources and medical record-keeping, some public health advocates say.

"The fact that it is a challenge to come up with these data proves that we have underdeveloped surveillance systems in this country," said Jeff Levi, executive director of Trust for America's Health, a Washington-based public health research organization.

Most disease investigation and case-counting is done by state and local health departments. But quality varies state to state, and in many places it may be getting worse: State budget shortfalls and other problems led to the elimination of 7,000 health department jobs last year and 8,000 more jobs in the first six months of this year.

"You take for granted this work goes on. But it is difficult to take for granted any longer, with these cuts going on," said Robert Pestronk, executive director of the National Association of County and City Health Officials.

However, Pestronk and others think the government's current system of flu tracking is adequate and getting better.

The CDC has nine ways of monitoring influenza. Some focus on people who die from flu-like illness — one tracking deaths of children, another counting pneumonia and flu deaths of all ages in 122 cities.

Other systems gather flu-testing information from labs across the country. And some rely on reports of flu-like illness from hospital emergency departments and from estimates from state and territorial health officials.

Those systems combine to give a good general picture of whether more or fewer people are going to the doctor with flu, and how often lab samples are showing swine flu as compared to other respiratory bugs, health officials say.

There are problems that make even that data incomplete or inaccurate. Rapid flu tests — which are used in counting hospitalizations — are often wrong when they indicate a patient doesn't have swine flu, CDC studies have shown. In some cases, flu or swine flu was only confirmed at autopsy. But most deaths are not autopsied.

These problems are not unique to the United States. The World Health Organization also stopped counting cases in July, after deciding that tracking individual swine flu cases was too overwhelming for countries where the virus was spreading widely. The WHO has continued to update swine flu reports, but with the disclaimer that since countries are no longer required to test and report cases, WHO's numbers underestimate.

Britain also releases weekly swine flu updates, but the numbers are estimates based on how many people go to their doctors with flu-like illness, as well as calls logged to the national flu service.

Despite resource limitations and data imperfections, experts say the U.S. system is good enough to alert the experts when major changes occur in the pandemic.

"There will always be an error factor, misdiagnosis, misclassifications," said Pestronk, formerly the head of a county health department in Michigan. "We'll never be at 100 percent of people getting tested. The question is what's good enough for purposes of planning and acting on the burden of disease."

UPDATE: Kimberly-Clark Buy Of I-Flow Adds To Health Care Ops

NEW YORK (Dow Jones)--Kimberly-Clark Corp. (KMB) agreed Friday to acquire I-Flow Corp. (IFLO) for $276 million, excluding cash acquired, marking the second acquisition of a pain management company this week for the maker of consumer paper products.

Kimberly-Clark said acquiring the maker of pain-management and drug-delivery technology would increase its medical device sales by more than 50% and is part of the company's strategy to move into higher-growth, higher-margin medical devices.

Earlier this week, the company bought the privately held Baylis Medical Co. for an undisclosed price.

Sales of Kimberly-Clark's core brands - which include Huggies diapers, Scott paper towels and Kleenex tissues - have been under pressure as consumers increasingly look to purchase lower-priced products from private-label makers during the recession.

"The question is: Are these smaller acquisitions enough to dilute the negative effects of its core consumer tissue and diaper business?" Sanford C. Bernstein analyst Ali Dibadj asked.

Kimberly-Clark's strategy contrasts with that of peer Proctor & Gamble Co. (PG), which is selling off its prescription drug business and has been shifting focus to lower-priced offerings to boost its sagging market share as consumers shun pricier goods.

BMO Capital Markets analyst Connie Maneaty said the situations were different because P&G was getting rid of non-core, slower-growth assets - such as its pharmaceutical business and Folgers - and focusing more on beauty products. Meanwhile, Kimberly-Clark's strategy has been to go into health care, excluding pharmaceuticals, Maneaty said.

The deal has a total value of $324 million, including acquired cash, and valued I-Flow at $12.65 a share, 7.6% above its closing price Thursday and a 31% premium to its 60-day average share price. I-Flow shares recently rose 84 cents, or 7.1%, to $12.60. Kimberly-Clark shares slipped 14 cents to $58.92.

Both companies' boards have approved the deal, expected to close in the fourth quarter, and Kimberly-Clark expects the acquisition to add to earnings in 2011.

Caris & Co. analyst Linda Bolton Weiser said it doesn't look like the deal is going to be hugely accretive because I-Flow has lost money through the first six months, although the business offers potentially attractive margins if Kimberly-Clark could cut costs.

The medical-device acquisitions made by Kimberly-Clark tend to be smaller companies with poor distribution operations to the health care industry, Bernstein's Dibadj said, allowing Kimberly-Clark to profit simply by adding the acquired companies' products on to their deliveries to hospitals.

Kimberly-Clark's health-care segment, which had $1.22 billion in sales last year, includes products for digestive health, airway management and pain management. Medical device sales represent 20% of the company's total health care revenue, Kimberly-Clark spokeswoman Kay Jackson said.

Through the first six months of 2009, Kimberly-Clark's health care division is the only one to register sales growth, up 4.8% to $633 million, and its operating profit growth of 45%, outpaces the other divisions.

-By Kerry Grace Benn, Dow Jones Newswires; 212-416-2353; kerry.benn@dowjones.com

(Tess Stynes in New York contributed to this article.)

Nations no longer counting pandemic flu cases; last US estimate in July, stuck at 1 million

ATLANTA (AP) — U.S. health officials have lost track of how many illnesses and deaths have been caused by the first global flu epidemic in 40 years.

And they did it on purpose.

Government doctors stopped counting swine flu cases in July, when they estimated more than 1 million were infected in this country. The number of deaths has been sitting at more than 600 since early September. Health officials had previously counted lab-confirmed cases, though the tally was skewed because many people who got sick never were tested.

Other nations have stopped relying on lab-confirmed cases, too, and health officials say the current monitoring system is adequate. But not having specific, accurate counts of swine flu means the government doesn't have a clear picture of how hard the infection is hitting some groups of people, said Andrew Pekosz, a flu expert at Johns Hopkins University.

The novel H1N1 flu seems to be more dangerous for children, young adults, pregnant women and even the obese, according to studies based on small numbers of patients. But exactly how much more at risk those people are is hard to gauge if the overall numbers are fuzzy.

"This wasn't as critical early on, when case numbers were low," said Pekosz. But now, it's hard to say exactly how swine flu's dangers vary from group to group, he said.

The Centers for Disease Control and Prevention is relying on a patchwork system of gathering death and hospitalization numbers. Some states are reporting lab-confirmed cases. Others report illnesses that could be the new swine flu, seasonal flu or some other respiratory disease.

Some say that's a more sensible approach than only counting lab-confirmed cases. Many people who got sick never get tested, so the tally of swine flu cases was off almost from the very beginning, they say.

"It was a vast underestimate," said Dr. Zack Moore, a respiratory disease expert for the North Carolina Department of Health and Human Services.

What's more, as the initial panic of the new virus ebbed, fewer people were fully tested, so the results weren't as accurate or comprehensive. "The kinds of numbers you were getting later in the summer were different from the numbers early on," said Dr. Daniel Jernigan, deputy director of the CDC's influenza division.

That's why the CDC shifted to counting the new flu like it counts seasonal flu cases, agency officials said. "We're concerned folks are focused on the numbers and missing that influenza is monitored by looking at trends," Jernigan said.

It's likely that millions of Americans have been sickened by swine flu by now, CDC officials say. New York City alone estimates it had roughly 1 million cases since swine flu first hit last spring.

While everyone would like an exact measure of how every disease is affecting society, that simply doesn't exist. "We don't even have a good measure of how many heart attacks there are every day," which would seem like a relatively easy thing to track, noted Marc Lipsitch, a Harvard University professor of epidemiology.

More comprehensive tracking is not possible with current resources and medical record-keeping, some public health advocates say.

"The fact that it is a challenge to come up with these data proves that we have underdeveloped surveillance systems in this country," said Jeff Levi, executive director of Trust for America's Health, a Washington-based public health research organization.

Most disease investigation and case-counting is done by state and local health departments. But quality varies state to state, and in many places it may be getting worse: State budget shortfalls and other problems led to the elimination of 7,000 health department jobs last year and 8,000 more jobs in the first six months of this year.

"You take for granted this work goes on. But it is difficult to take for granted any longer, with these cuts going on," said Robert Pestronk, executive director of the National Association of County and City Health Officials.

However, Pestronk and others think the government's current system of flu tracking is adequate and getting better.

The CDC has nine ways of monitoring influenza. Some focus on people who die from flu-like illness — one tracking deaths of children, another counting pneumonia and flu deaths of all ages in 122 cities.

Other systems gather flu-testing information from labs across the country. And some rely on reports of flu-like illness from hospital emergency departments and from estimates from state and territorial health officials.

Those systems combine to give a good general picture of whether more or fewer people are going to the doctor with flu, and how often lab samples are showing swine flu as compared to other respiratory bugs, health officials say.

There are problems that make even that data incomplete or inaccurate. Rapid flu tests — which are used in counting hospitalizations — are often wrong when they indicate a patient doesn't have swine flu, CDC studies have shown. In some cases, flu or swine flu was only confirmed at autopsy. But most deaths are not autopsied.

These problems are not unique to the United States. The World Health Organization also stopped counting cases in July, after deciding that tracking individual swine flu cases was too overwhelming for countries where the virus was spreading widely. The WHO has continued to update swine flu reports, but with the disclaimer that since countries are no longer required to test and report cases, WHO's numbers underestimate.

Britain also releases weekly swine flu updates, but the numbers are estimates based on how many people go to their doctors with flu-like illness, as well as calls logged to the national flu service.

Despite resource limitations and data imperfections, experts say the U.S. system is good enough to alert the experts when major changes occur in the pandemic.

"There will always be an error factor, misdiagnosis, misclassifications," said Pestronk, formerly the head of a county health department in Michigan. "We'll never be at 100 percent of people getting tested. The question is what's good enough for purposes of planning and acting on the burden of disease."

UPDATE: Kimberly-Clark Buy Of I-Flow Adds To Health Care Ops

NEW YORK (Dow Jones)--Kimberly-Clark Corp. (KMB) agreed Friday to acquire I-Flow Corp. (IFLO) for $276 million, excluding cash acquired, marking the second acquisition of a pain management company this week for the maker of consumer paper products.

Kimberly-Clark said acquiring the maker of pain-management and drug-delivery technology would increase its medical device sales by more than 50% and is part of the company's strategy to move into higher-growth, higher-margin medical devices.

Earlier this week, the company bought the privately held Baylis Medical Co. for an undisclosed price.

Sales of Kimberly-Clark's core brands - which include Huggies diapers, Scott paper towels and Kleenex tissues - have been under pressure as consumers increasingly look to purchase lower-priced products from private-label makers during the recession.

"The question is: Are these smaller acquisitions enough to dilute the negative effects of its core consumer tissue and diaper business?" Sanford C. Bernstein analyst Ali Dibadj asked.

Kimberly-Clark's strategy contrasts with that of peer Proctor & Gamble Co. (PG), which is selling off its prescription drug business and has been shifting focus to lower-priced offerings to boost its sagging market share as consumers shun pricier goods.

BMO Capital Markets analyst Connie Maneaty said the situations were different because P&G was getting rid of non-core, slower-growth assets - such as its pharmaceutical business and Folgers - and focusing more on beauty products. Meanwhile, Kimberly-Clark's strategy has been to go into health care, excluding pharmaceuticals, Maneaty said.

The deal has a total value of $324 million, including acquired cash, and valued I-Flow at $12.65 a share, 7.6% above its closing price Thursday and a 31% premium to its 60-day average share price. I-Flow shares recently rose 84 cents, or 7.1%, to $12.60. Kimberly-Clark shares slipped 14 cents to $58.92.

Both companies' boards have approved the deal, expected to close in the fourth quarter, and Kimberly-Clark expects the acquisition to add to earnings in 2011.

Caris & Co. analyst Linda Bolton Weiser said it doesn't look like the deal is going to be hugely accretive because I-Flow has lost money through the first six months, although the business offers potentially attractive margins if Kimberly-Clark could cut costs.

The medical-device acquisitions made by Kimberly-Clark tend to be smaller companies with poor distribution operations to the health care industry, Bernstein's Dibadj said, allowing Kimberly-Clark to profit simply by adding the acquired companies' products on to their deliveries to hospitals.

Kimberly-Clark's health-care segment, which had $1.22 billion in sales last year, includes products for digestive health, airway management and pain management. Medical device sales represent 20% of the company's total health care revenue, Kimberly-Clark spokeswoman Kay Jackson said.

Through the first six months of 2009, Kimberly-Clark's health care division is the only one to register sales growth, up 4.8% to $633 million, and its operating profit growth of 45%, outpaces the other divisions.

-By Kerry Grace Benn, Dow Jones Newswires; 212-416-2353; kerry.benn@dowjones.com

(Tess Stynes in New York contributed to this article.)

New Health Care Scorecard Finds Wide Differences In Access, Quality And Cost Across U.S. States

The states that led in the 2007 state scorecard generally continued to lead, often setting new benchmarks and widening the gap between leading and lagging states. Across states, health insurance coverage for adults declined, health care costs rose, and quality improved in areas where outcomes were reported to the public. According to the report, the continuing and growing disparities in state performance point to the urgent need for comprehensive national health system reform.

Health insurance coverage for adults declined in a majority of states since the first state scorecard was released in 2007. In contrast, the majority of states made gains in health coverage for children due to federal and state support for the Children's Health Insurance Program (CHIP). In addition, national efforts to publicly report performance and improve care have led to dramatic improvements in some measures of quality of care in hospitals and nursing homes, demonstrating the impact federal action and collaborative improvement efforts can have on state health care systems, the report found.

The report, Aiming Higher: Results from the 2009 State Scorecard on Health System Performance, is a follow-up to the Commission's 2007 State Scorecard report; it ranks states on 38 indicators in the areas of access, prevention/treatment quality, avoidable hospital use and costs, healthy lives, and equity. In 2009, Vermont, Hawaii, Iowa, Minnesota, Maine, and New Hampshire lead the nation as top performers on a majority of scorecard indicators. Leading states set new, higher benchmarks on a majority of indicators. Conversely, states in the lowest quartile often lag the leaders on multiple areas and the gaps have grown wider in multiple areas.

"Leading states have raised the bar for better access, quality of care, and reducing disparities," said Commonwealth Fund Senior Vice President and study co-author Cathy Schoen. "Where you live in the U.S. matters in terms of your health care, and it shouldn't. These wide and persistent gaps among states highlight the need for national reforms and federal action to support states. National leadership has been critical for children– particularly for states with historically high rates of children uninsured— so we know that strong national efforts can make a real difference even in struggling states."

The sharp variation across states spans access, quality of care, costs, and lives. For example, rates of hospital readmissions (within 30 days of a previous hospital stay) among Medicare beneficiaries ranged from a high of 23 percent of hospital admissions in Nevada to a low of 13 percent in Oregon. The percent of adult diabetics getting recommended preventive care ranged from a low of 33 percent in Mississippi to a high of 67 percent in Minnesota as of 2006-07, a new high. On these and other measures, the lowest ranked states would have to improve 40 percent to 100 percent on average to achieve the performance of top ranking states.

The scorecard points to substantial opportunities to improve. If all states could reach the level achieved by the top performing states:

Twenty-nine million more people would have health insurance—cutting the number of uninsured by more than half;
Nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care;
Nine million more adults age 50 and older would receive recommended preventive care, and almost 800,000 more children would receive key vaccinations;
Five billion dollars could be saved annually by avoiding preventable hospital admissions and readmissions for vulnerable elderly and disabled residents.
Promising Quality Improvements

The report found that national efforts to measure, benchmark, and publicly report performance had a marked effect on quality improvements at the state level. Following a national effort to track and report hospital treatment data, nearly all states improved on measures of treatment for heart attack, heart failure, pneumonia, and prevention of surgical complications. In some instances, the lowest state rate now exceeds the average three years ago. In addition, most states improved significantly on several measures of the quality of care in nursing homes (reductions in pressure sores, pain, and use of restraints) following a national effort to make that data publicly available.

"The differences we see among the states translate to real lives and dollars," said Commonwealth Fund President Karen Davis. "If we can enact health reforms that give all states the opportunity to do as well as the best states we will save lives, improve quality, and cut costs. And, the good news is that these aren't pie in the sky goals—we know they are attainable because we see it happening in the states at the top of the pack."

Coverage Erodes for Adults, Expands or Holds Steady for Children

The report examines health insurance coverage trends across states since the beginning of the decade and finds a decline in health insurance coverage for adults—in 1999-2000 there were only two states with 23 percent or more of adults uninsured, by 2007-2008 there were nine. In 1999-2000, 22 states had less than 14 percent of adults uninsured; by 2007-2008 the number dropped to only 11 states. Children fared much better—due in large part to the CHIP program. The number of states with 16 percent or more of children uninsured dropped from nine to three between 1999-2000 and 2007-2008.

Gaps in coverage between states were particularly stark, with 32 percent of working-age adults uninsured in Texas compared to only 7 percent in Massachusetts as of 2007-2008. Several states stood out in terms of health insurance coverage expansions, as part of comprehensive reforms. Massachusetts, which had only begun to implement its universal health insurance program during the period covered by the State Scorecard, had the greatest increase in coverage for adults and gains in coverage for children. The reforms passed by Vermont in 2006 to cover the uninsured and establish a "blueprint for health" focused on preventing and controlling chronic disease are providing a new model for other states. And, Minnesota has achieved high rates of adult coverage and better preventive care through public–private collaboration.

Additional Opportunities to Improve

Poorly coordinated care and inefficient use of resources continue to undermine care and drive up costs in many state health care systems, according to the report. States with higher medical costs tend to have higher rates of readmissions to the hospital and potentially preventable hospital admissions for chronic conditions like asthma and diabetes.

The report finds that several states in the Upper Midwest—Iowa, Minnesota, Nebraska, North Dakota, and South Dakota—were all providing high quality care at lower cost. Their examples suggest that better coordinated care and more efficient use of resources could improve the quality of care people receive while keeping cost in check.

Moving Forward

The State Scorecard's overall findings of eroding coverage and rising costs, and concerns about poorly coordinated care, underscore the need for comprehensive national reforms that can expand health insurance coverage, improve quality, and control costs. The report points to the uneven performance or failure to improve on many scorecard indicators as further evidence of the pressing need for coordinated national action. The authors conclude that federal action is needed to raise the floor on performance levels across all states and create a supportive climate for state innovation. If the health care system continues on its current course of rising costs and declining health insurance coverage, states will have an increasingly difficult time going it alone on providing access to affordable, quality health care.

An interactive map that allows users to look at and download individual state information and compare states on various measures is available at http://www.commonwealthfund.org.

Methodology

The 2009 state scorecard includes 38 indicators grouped into five dimensions of performance—access, prevention/treatment quality, avoidable hospital use and costs, equity, and healthy lives. The analysis ranks states on each indicator and then averages the indicator ranks to determine the dimension rank. Dimension scores determine the overall rank. Equity measures the gaps in performance between vulnerable groups and the national average.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.