By MARSHA SHULER
Advocate Capitol News Bureau
A top state Senate leader said Monday she has reservations
about a proposed public-private partnership that would lead to the closure of
LSU’s Earl K.
Long Medical
Center on Airline Highway in Baton Rouge.
State Senate President Pro Tem Sharon Broome, in whose
district the charity hospital sits, made the comment before filing a
resolution alerting lawmakers of a potential deal in the works between LSU
and Our Lady of the Lake
Regional Medical
Center on Essen Lane near
Interstate 10. The plan would make the Lake
home to LSU’s physician-training programs.
“Right now I cannot put my stamp of approval on this,”
said Broome, D-Baton Rouge. “Certainly this Our Lady of the Lake
merger is one alternative. … I want us to use this opportunity to also look
at some other alternatives.”
One of those alternatives could be use of Perkins Road
property already owned by LSU and used as an outpatient surgery center to
build a smaller, less costly hospital, Broome said.
“I’m just worried we are giving them
(OLOL officials) way more than we will actually gain in the process,” said
Broome.
Under the proposed arrangement, LSU medical education
programs, at Earl K. Long, would be moved to the Lake.
Poor and uninsured patients now seen at Earl K. Long would be seen by LSU
physicians at the Lake. The north Baton Rouge hospital
would close with the conversion.
LSU System Vice President Fred Cerise said he plans to
meet with Broome today to discuss her concerns.
“If everybody behaves like everybody indicates they want
to behave in this deal, the potential at the Lake is to provide the most
services to people and provide the most ability to expand graduate medical education,”
said Cerise. But, he said, “It’s a big change, a big leap. I understand it.
Believe me.”
Cerise said the specifics — including financing — must be
nailed down in a more definitive cooperative endeavor agreement which
officials are hoping to have completed by Sept. 30.
Cerise and the Lake’s CEO
Scott Wester announced the signing of a memorandum
of understanding last week — outlining general parameters of a potential
deal.
Broome said when she looks at the $129 million that would
still be needed for construction on the Lake’s
campus, “there are some other alternatives we could also consider.”
The original new hospital construction plan called for a
200- to 300-bed facility at a cost of $300 million to $400 million, Broome
said.
“We have adjusted all of that now and recognize with all
these (LSU community) clinics we don’t need that many beds. Perhaps with $129
million we could go back to the drawing board,” said Broome.
After Hurricane Gustav shuttered EKL, operations moved to
the old Vista property on Perkins Road, she said.
One possible alternative is expanding at that location,
which would allow LSU to retain its authority, she said.
Broome said she also does not like talk of building a
separate tower at the Lake for LSU. “I don’t
want to go into this separate but equal type of stuff,” she said.
“I’m not fully persuaded yet that the graduate medical
education will be fully served at OLOL,” said Broome.
Broome said LSU has received national recognition for its
residency, or physician in training, programs, and she doesn’t want anything
to interfere with that.
At EKL the biggest challenge is not education or quality
of care, it’s the facility, she said.
Hospital and graduate medical education agencies have
threatened to yank accreditation because of the poor conditions.
Broome said she is proceeding with the resolution because
those accrediting agencies are looking for evidence “we are making a
good-faith effort to get out of that building.”
“I applaud LSU for trying to take some progressive steps
forward, but I don’t want to see us do anything that minimizes the quality of
care or medical education.”
http://www.2theadvocate.com/news/48123132.html
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Kyle Bove
Daily
Reveille file photo
LSU System President John Lombardi told all academic,
health care and research institutions to finalize their plans for deep
spending cuts by the end of next week.
Unpredictable and tense — so goes the 2009 legislative
session.
Thursday marked the beginning of what’s expected to be a
long and drawn-out end to the state’s budget debate, as the Louisiana House
voted 69-25 in favor of agreeing with amendments the state Senate tacked on
to HB 1 — the state’s $28.7 billion spending proposal. The shocking move sent
the bill to Gov. Bobby Jindal and a sense of
urgency to LSU’s campuses.
LSU System President John Lombardi told all academic, health
care and research institutions on Monday to finalize their plans for deep
spending cuts, effective July 1, by the end of next week.
“These cuts are real, and we must begin now to address the
consequences for our students, employees and other commitments to the state
of Louisiana,”
Lombardi said in a news release.
Many expected HB 1 to go into conference committee, where
a handful of lawmakers would have ironed out the details of the budget.
Instead, the House passed the budget to Jindal for
final approval — a move that leaves Senate funding measures included in HB 1
for higher education vulnerable.
Several funding measures for higher education and
agriculture the Senate added to HB 1 are contingent
on House approval, like SB 335, which would use $118 million generated from
the delay of a planned income tax break for higher education. SB 335 and
other Senate “contingencies” are not expected to pass, meaning the budget
will look like how the House and governor originally had it.
And Jindal said on Monday he
plans to veto about $278 million in spending from the budget that is tied to
separate legislation, vowing to work with lawmakers to restore some of that
money. Included in the $278 million worth of contingencies — money that can
only be spent if certain legislation in passed — is SB 335.
That leaves $120 million lawmakers can use to plug holes
in the budget, made up of $50 million from a proposed tax amnesty program,
and $70 million from an expired insurance fund.
Jindal said his goal is to
reduce the cuts to higher education to 10 percent or less, instead of the 15
percent proposed in the original budget. The governor has 12 days to review
the budget.
“While the additional financial relief from the
Legislature and the governor is much appreciated, it does not eliminate the
need for significant budget adjustments,” Lombardi said. “We have to be
accountable and effective in acting responsibly for today and the future even
if the overall budget cut is reduced.”
Lombardi also called for the completion of the
University’s massive realignment plan, which aims to reorganize and rename
nearly every academic college on campus. The plan will need approval from the
Board of Supervisors before changes can begin and Louisiana Board of Regents
approval may also be needed.
While a “transition task force” made up of faculty and
administrators was formed to address conflicts with the implementation of the
plan, Executive Vice Chancellor and Provost Astrid Merget
said no changes will be made to the plan.
http://www.lsureveille.com/news/legislature-passes-2009-10-state-budget-jindal-says-he-will-strip-278-million-from-budget-1.1763206
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Jindal
to trim $278 million
By Jan Moller
Capital bureau
BATON ROUGE -- Gov. Bobby Jindal
said Monday that he plans to strike about $278 million in proposed spending
from the state budget bill, but that he will work with lawmakers to make sure
some money is restored for higher education through other legislation still
pending.
Jindal, who has 12 days to
review the $28 billion budget bill after receiving it from the Legislature on
Sunday, said he decided to announce the line-item vetoes early to give
legislators time to make other arrangements before their June 25 adjournment.
"We don't want to play games with the Legislature. We
want to be very clear about what we're doing," Jindal
said at a meeting with reporters to discuss his priorities for the week.
The vetoes include money for Medicaid, public colleges and
universities, arts programs, tourism promotion, agriculture extension
programs and legislators' pet projects. All of the money was included in the
budget bill, but tied to the passage of separate bills.
Jindal said the line-item vetoes
will free up "at least $120 million" that legislators can plug into
spending bills to fill holes in higher education, health care and other
programs. He said the top priority for that money should be to reduce the
cuts to higher education to less than 10 percent, from the 15 percent cut
that Jindal originally proposed.
To meet that target, at least $50 million would have to be
plugged in to public colleges and universities, which would still leave them
with a cut of more than $140 million.
--- House, Senate divided ---
The governor's announcement came on a day when House and
Senate leaders moved to tamp down the rancor that has erupted between the
chambers, even as it became clear that the Senate remains far apart from the
House and the Jindal administration on how best to
patch the remaining holes in the budget.
"We are not at odds . . . on where we want to get.
It's just how we get there," House Speaker Jim Tucker, R-Algiers, said.
Senate President Joel Chaisson
II, D-Destrehan, said he was encouraged by Jindal's
statement that restorations for higher education should be a top priority.
"It is encouraging that Gov. Jindal and House
leadership now agree with us that higher education should be the top priority
when deciding how to invest taxpayer dollars," Chaisson
said in a written statement.
But Chaisson's statement made it
clear he still supports the Senate's version of House Bill 1, which finances
most government expenses in the fiscal year that starts July 1.
The budget bill was sent to Jindal's
desk last week with $278 million in "contingencies," or spending
tied to the passage of other bills. The contingencies include $118 million
for higher education that would come from postponing an income-tax break
scheduled to take effect this year, as well as $70 million from an expired
insurance fund and $86 million from the state's rainy-day fund.
With those contingency items facing a veto, the focus now
shifts to the Senate, where several spending bills could be reworked to add
back some of the money.
--- Points of conflict ---
There is little disagreement on using money from the
insurance fund, and House leaders also support the use of $50 million from a
proposed tax amnesty program to offset cuts.
But the House, with Jindal's
backing, has ruled out any bills they consider to be
a tax increase. And they want to reserve the rainy-day fund for future years,
when Louisiana's
budget crunch is expected to worsen as federal economic stimulus money dries
up.
Sen. Lydia Jackson, D-Shreveport, the vice chairwoman of
the budget-writing Senate Finance Committee, said the rainy-day fund should
be on the table during the upcoming negotiations, as should the tax-cut
delay.
One of the key flashpoints could be the fate of $28
million in "member amendments" included in the budget for pet
projects in legislators' districts. The earmarks are among the items facing a
veto, but House leaders have said they want the money put back into another
bill.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245129681222170.xml&coll=1
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By David Dinsmore
Katrina Smith, (right), supervisor of the chemistry
lab, teaches Allison Kirkland, 15, a Grant High School student, during the
AHEC summer program at Huey P. Long Medical Center.
PINEVILLE -- People can learn a lot of interesting medical
facts by watching reruns of "House" this summer, but some Central Louisiana students are getting a little closer
look at the field of medicine.
The Central Louisiana Area
Health Education
Center, or AHEC, once again has
offered high school kids the opportunity to have A-HEC of a Summer at Huey P.
Long Medical Center in Pineville and Christus St.
Frances Cabrini Hospital in Alexandria.
The program at Huey P. Long accepts 12 students interested
in a career in the medical field and places them in rotations at the hospital
to learn about the responsibilities of the various departments.
"I thought it would give me good hands-on
experience," Buckeye student Kaitlyn Fussell said. "I'll be able to know what I want to
do better."
Students rotate through disciplines like pharmacy,
surgery, nursing, radiology, biomedical and more, where they observe and
practice the duties of the workers in that department, Huey P. Long education
director Brenda Ray said.
"We enjoy the kids being here during the
summer," nursing director Cindy Vanlangendonck said.
The kids also receive daily lectures on subjects of
microbiology, nutrition, social services and even forensic medicine
throughout the course, Ray said.
While AHEC provides the course at no cost to the
participants, the acceptance process is designed to select only those who
will be truly committed to the entire five-week program, Ray said.
AHEC summer program participant Jessica Jefferson,
16, (left), from Grant High School, is taught about physical therapy by
therapist Angela Spears at Huey P. Long Medical Center.
Students must have a 2.0 grade point average, have a
letter of recommendation from an education professional and write a personal
essay, Ray said. Those who complete this process then undergo an interview
process conducted by organization and hospital officials.
Those who get into the program, the students receive great
opportunities to see what life is like for health care workers, make valuable
connections, receive advice about schooling and also earn one-half of a high
school credit, Ray said.
If you're looking for what you want to do in the medical
field, this is a good place to start," Grant High School
student Jessica Jefferson said.
Programs like A-HEC of a Summer and others through the
organization have yielded some impressive results, Cenla
AHEC health careers coordinator Joy Gilhousen said.
For instance, about 70 percent of students who have participated in various
AHEC programs have gone into a health care profession.
"We think it's a good idea to catch them while
they're young," Gilhousen said. "Our hope
is that they will come back to their hometowns after school and
practice."
http://www.thetowntalk.com/article/20090616/LIFESTYLE/906160301#pluckcomments
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By NANCY ARMOUR, AP National Writer
CHICAGO – The gym at Eberhart
Elementary School is
bright and spacious — with high ceilings, several basketball hoops, even a
large, colorful climbing wall.
But for much of the day, the gym doubles as a cafeteria
where the school's 1,800-plus students are offered breakfast and lunch.
There's another gym on the fourth floor, but it's so old
it has basketball hoops attached to ladders. Time and space limitations mean
each class gets physical education just once a week for 40 minutes.
In the fight against childhood obesity, getting kids
moving is one of the most effective ways to combat the problem. But only Illinois and Massachusetts
require P.E. classes for all kids in kindergarten through 12th grade. And, as
Eberhart's example shows, even those requirements
sometimes are not enough.
"I understand the funding issue. I understand the
space issue," said Betty Hale, one of two P.E. teachers at Eberhart. But "our children are getting
shortchanged."
Illinois
first adopted P.E. requirements in 1915, and the state has been mandating
phys ed for all grades since 1957.
But those rules have not prevented Illinois kids from getting heavier. An
estimated 20.7 percent of 10- to 17-year-olds in Illinois are obese, according to a 2007
survey released last month by the Child and Adolescent Health Measurement
Initiative. That's the fourth-highest rate in the country, behind only Mississippi, Georgia
and Kentucky.
Nationwide, an estimated 32 percent of American kids ages
2 to 19 are overweight, including 17 percent who are obese, according to the
Centers for Disease Control.
Illinois
mandates gym class but does not have a standardized P.E. curriculum, meaning
what counts as phys ed can vary widely. For
instance, kids at Eberhart on Chicago's
West Side play kickball once a week in a
cluttered, 100-year-old gym. Meanwhile, students in suburban Niles are high jumping
in a gym that includes a weight room with better equipment than some health
clubs.
The state does not monitor schools to ensure they are
meeting the daily P.E. requirement, and there are no penalties for not doing
it. The Illinois General Assembly even gives waivers to districts that have
financial issues or want more classroom time.
But it's the health of the kids that tells the full depth
of the problem.
When Hale arrived at Eberhart 10
years ago, most kids could run a mile in 13 or 14 minutes. Now only a few
can.
At Louisiana State
University in New
Orleans, professor Melinda Sothern sees children at the school's Health Sciences Center
with a range of related problems more typical of adults: high cholesterol,
diabetes, muscular-skeletal disorders.
"What really hurts me is they never have that
euphoric feeling I had as a child of riding their bike down the street. They
just don't have the stamina to do it," said Sothern, a former gym
teacher.
Physical fitness "is just so not valued today. And
it's what would turn this thing around."
Health experts recommend 30 minutes of daily physical
education for elementary school students, and 45 minutes for those in junior
high and high school.
But in a recent CDC study, less than 4 percent of
elementary schools, less than 8 percent of middle schools and just over 2
percent of high schools required daily P.E. for all students for the entire
school year.
At Eberhart, the weekly
40-minute period passes quickly.
By the time a class of fifth-graders settled down and did
their warm-up calisthenics recently, more than five minutes had passed. It
took another five minutes for Hale to split the class into teams and give
them a quick refresher on how to play kickball, and there were still more
interruptions during the game to explain the rules.
With no money for new equipment, the kids use a ball worn
to the point of crumbling, and the floor is soon strewn with little bits of
yellow foam. The wooden pins for bowling look like something out of the
school's time capsule.
The facilities are lacking as well — and not simply
because the one gym can only be used part-time. Hale's classes were kicked
out of the older gym the previous week because of a space camp, and leftover
garbage still cluttered one corner: two black plastic bags stuffed to the
brim, a blue plastic barrel, a Styrofoam cooler and two cardboard boxes — one
with a crumpled Doritos bag inside.
Having P.E. "even twice a week would make a world of
difference," Hale said. "These kids need to move. Exercise is just
as important as sitting down and learning their math, their science, their
reading."
Some educators complain that physical education — along
with art and music — has been squeezed out by No
Child Left Behind, which prods schools to boost the performance of
low-achieving students. With annual math and reading tests, many schools are
trying to find extra teaching time wherever they can.
But doing it at the expense of physical education is
misguided, said Russell Pate, associate vice president for Health Sciences at
the University
of South Carolina.
Studies have long shown that giving kids time to play, both through P.E. and
recess, does not hurt their test scores, Pate said.
In fact, the breaks could help.
"I'm all for holding schools to high standards with
regard to academic outcomes," Pate said. "But we need to have some
balance. We need our schools to be healthy places for kids."
That's the approach at the elementary and middle schools
in District 64 in Park Ridge and Niles, suburbs on the northwest side of Chicago. Three of the
eight schools in the district received the National Association for Sports
and Physical Education's STARS award for outstanding P.E. programs; they are
the only schools in Illinois
to earn the recognition.
There are no vending machines with candy or soda at any of
the schools, and the food service at the middle schools gives students
healthy choices.
Elementary classes have P.E. for a half-hour four days a week, and gym-like activities at recess on the fifth day.
Middle school students have P.E. for 40 minutes each day. The curriculum is
designed to get students moving and appeal to everyone, regardless of
athletic ability. There are units on everything from softball to wrestling to
field hockey.
Grades are based on kids' preparation for class — being on
time and in uniform — as well as written tests on the sports they learn.
There are fitness tests twice a year, but instead of telling kids they must
run a mile in a specific time or do 50 sit-ups, progress is measured against
previous results. The results are not counted in their grades.
"We want them to gain an appreciation of being
active, to enjoy being active," said Aaron Schauer,
who teaches at Emerson
Middle School and is
the district's P.E. curriculum specialist. "So when they're on their
own, they'll make active choices."
The facilities are top-of-the-line, starting with a
26-person P.E. department for the eight schools. Each school has ready access
to green space, and there's enough room outside to hold six soccer fields.
When students at Emerson want to track their heart rates
while running or walking, they can use one of 32 Polar monitors, which retail
for $60.
"Physical education cannot be expected to solve
society's obesity problems," said Pate, a past president of the National
Coalition on Promoting Physical Activity.
"But I do think it's realistic to expect P.E. to help
solve the problem."
http://news.yahoo.com/s/ap/20090615/ap_on_he_me/obesity_physical_education
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By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
Louisiana House leaders spoke of harmony Monday while
state senators pointed to deep divisions over the budget with nine days left
in the session.
The House wants to reinsert in the budget “member
amendments,” many of which are legislators’ pet projects and often are
derided as “slush funds.”
The Senate wants to increase revenue for higher education,
health care and other state government services hit hard by the governor’s
budget cuts.
Gov. Bobby Jindal, for his part,
said Monday that he warned lawmakers that he planned to veto Senate plans for
raising money for a budget that is expecting $1.3 billion less in revenue
this year.
The House paved the way for the governor’s vetoes by
sending him the budget rather than working with the Senate on a compromise.
The battle now moves to the remaining House appropriations
bills, all of which are awaiting action on the Senate side. The House wants
the Senate to use the bills to settle differences over the budget.
Legislators have until June 25 to resolve their
differences on the $28 billion budget for the fiscal year that starts July 1.
The biggest sticking point seems to be the $30 million in
“member amendments,” which Jindal plans to remove
from House Bill 1, the budget legislation.
House leaders want the Senate to amend other legislation
to include money for roads, community organizations, museums and other
projects important to lawmakers’ individual districts.
The Senate leadership said the state has more pressing
needs than funding “member amendments.”
The House and the Senate also are divided on how to soften
the heavy cuts that Jindal proposed for health care
and higher education.
The Senate wants to delay a tax break and to tap the
state’s “rainy day” fund.
The House and the governor oppose those proposals,
preferring to take $50 million from a proposed tax amnesty program and using
that money for higher education.
Gov. Bobby Jindal announced
Monday he plans to veto $278 million in spending from HB1.
Some of his proposed vetoes deal with contingencies, since
the spending relies on legislation that is unlikely to pass. With the
governor’s actions, the House and the Senate would have $124 million to spend.
The available money includes the balance of a dormant
insurance fund and the proceeds of a proposed tax amnesty program.
Louisiana House leaders said higher education, legal
judgments and legislators’ projects should be priorities.
State Sen. Mike Michot,
R-Lafayette and chairman of the Senate Finance Committee, predicted it will
be hard to justify spending money on projects in legislators’ districts.
He said he is more concerned about finding additional
funds for higher education.
“The Senate is looking at any and all options,” Michot said.
Jindal said he would red-line
provisions that use some “rainy day” funds and tap dollars remaining in a
special insurance fund for specific purposes.
Those two actions would then allow lawmakers to
appropriate — through other bills — a potential $120 million or more to
higher education.
But Jindal also said he wants
higher education to come up with plans to restructure and operate more
efficiently. He noted one-time funds would be freed up and financial problems
would continue in the next budget year too.
“This is one-time funding that gives them some time,” said
Jindal. “It’s important that we have a plan.”
House Speaker Jim Tucker, R-Terrytown,
said he favors using the “rainy day” fund in three years, when the state
still is expected to be grappling with financial problems.
The “rainy day” fund, formally known as the Budget
Stabilization Fund, was set up to tide the state over during a budget
deficit.
State Sen. Lydia Jackson, who proposed delaying the tax break,
told the Press Club of Baton Rouge that the piecemeal approach to resolving
the state’s budget problems seems to be contrary to the Jindal
administration’s push for efficiency and transparency.
“It’s a budgetary nightmare,” she said.
Jackson,
D-Shreveport, said it is a good thing the remaining appropriations bills are
in the hands of the Senate.
The budget as it stands now, she said, is the governor’s
original proposal.
“It’s a budget that everybody says is unacceptable … to
the House, to the Senate, to the business community,” Jackson said.
Michot said a case can be made
for using the state’s “rainy day” fund.
He said the Senate spoke once and will more than likely
speak again to reduce cuts.
House leaders insist the storm clouds are just beginning
to gather and the time is not ripe to use the rainy day fund.
State Rep. Hunter Greene, R-Baton Rouge, predicted that in
the end the budget cuts will be minimal.
He said legislators should see how the cuts work before
tapping the “rainy day” fund.
The fight over the state’s limited finances is stalling
other legislation.
The Senate Revenue and Fiscal Affairs Committee spent more
than two hours Monday mostly debating and then deferring bills that were
never expected to get out of committee because of the relatively large costs
associated with many proposed tax credits.
In all, only seven bills of the nearly 40 on the agenda
were heard, with two of little fiscal consequence being the only ones
approved, despite a packed room of lobbyists and some legislators waiting for
bills to be heard.
Committee chairman Rob Marionneaux
recessed the committee for lunch without setting a time to reconvene. He
closed by recessing with an ominous, “until further notice.”
Jordan Blum and Marsha Shuler of the Capitol news bureau
contributed to this report.
http://www.2theadvocate.com/news/48123717.html
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Jindal
announces major vetoes
By Caroline Moses
BATON ROUGE, LA (WAFB) - Governor Jindal
announced Monday he plans to cut all proposed legislative solutions out of
the budget bill, which means the House and Senate only have two weeks to find
another bill to fund some of higher education's needs.
There is some political play and even some "smack
talk" between the House and Senate at the state Capitol. "We have
done all we can on the House side," said House speaker Jim Tucker, R-Terrytown. "I would like to say the senate has been
the champion of higher education from day one," said Senate president
Joel Chaisson, D-Destrehan.
Governor Jindal seems to be
playing referee. He says he plans to veto all members' pet projects out of
the budget he was given Sunday. He'll also cut the proposed solutions to
higher education and health care funding gaps. Jindal
says the solutions come in one package deal and to reject one would kill them
all. Instead, he's leaving any new plans up to the legislature. "There's
still time for another appropriations bill for the legislature to add money
back to higher education," said Jindal.
Jindal suggests lawmakers use
money from either the proposed tax amnesty program or the "rainy
day" fund. He still objects to any tax increases, even the tax break
delay approved by the Senate. The one thing both chambers and the governor do
agree on is restoring about $70 million to higher education. They have two
weeks to put aside any chamber rivalry and decide if and how they can make
that happen.
"We're hopeful that the Senate will work with us in
fixing this in committee or on the Senate side," said Tucker. "It's
not about liberal, Democrat, or Republican. It's about saving higher
education," said Chaisson.
If the House and Senate can't come up with a solution the
governor likes, then health care and higher education may not see the money
they say they need. Governor Jindal has 11 more
days to officially file budget vetoes.
http://www.wafb.com/Global/story.asp?S=10536949
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By JORDAN BLUM
Advocate Capitol News Bureau
The Louisiana House rejected legislation Monday that would
have raised taxes on cigarettes and other tobacco products.
The vote was 45 for and 55 against the measure, which
would have dedicated about $100 million in tax proceeds to health care.
During the 90-minute debate, about a dozen supporters,
including some smokers, spoke in favor of the measure while only state Rep.
Joseph Lopinto, R-Metairie, publicly opposed House
Bill 889.
Lopinto argued that legislators
need to “tighten our belts” in state spending before hiking up taxes.
He apparently had 54 others silently backing him up. The
bill needed 70 votes, or two-thirds House approval, and fell 25 votes short.
Smokers pay 36 cents in state tax on a pack of cigarettes.
The proposal would have increased the tax to 86 cents a pack. The national
average is about $1.20. Taxes on cigars and smokeless tobacco also would have
increased.
The bill’s sponsor, House Speaker Pro Tem Karen Peterson,
urged her colleagues to follow their moral compasses.
The average Louisiana
household spends $627 a year on taxes related to health-care costs for
smoking-caused health problems, she said, whether the people in each
household smoke or not.
“It (HB889) will lower the tax burden on people who work
hard every day so they don’t have to pay that $627 a year,” Peterson said.
Louisiana
is one of the nation’s unhealthiest states, she said, and tobacco is the No.
1 cause of preventable deaths. Nearly 25 percent of Louisiana residents smoke.
Half of the money from the increased tax would have been
used to pay health-care providers who treat Medicaid patients. The rest of
the money would largely be committed to cancer research and prevention
programs. The Pennington
Biomedical Research
Center would get a
share of the proceeds.
The tax increase was expected to generate about $100
million a year.
Gov. Bobby Jindal opposed the
legislation, calling it an unfair tax increase on citizens during a
recession. He vowed to veto it.
Some smokers such as state Rep. Harold Ritchie, D-Bogalusa,
spoke in favor of HB889.
“I’ve already had two angioplasties, and I’m still a heavy
smoker,” Ritchie said. “I don’t know if 50 cents will help me quit, but I
think it’ll help other people quit.”
State Rep. Hollis Downs, R-Ruston, talked about how cigarettes
— “the most destructive consumer product on the face of the Earth today
that’s legal” — took his father’s life.
“If I thought I could tax them out of existence, that’s
what I’d do,” Downs said. “I don’t care if
we take the money, put it in a bucket and burn it.”
State Rep. Walt Leger III, D-New Orleans, said the tax
argument was empty.
“This anti-tax rhetoric is simply a pretext to support big
tobacco,” Leger said. “You can go with Joe Camel and the Marlboro man or you
can go with the people of Louisiana.”
The state is facing a $1.3 billion drop in revenue for the
fiscal year that starts July 1. To address the shortfall, Jindal
proposed heavy cuts to health care and higher education. The Legislature is
trying to reduce some of those cuts.
Funds from HB889 could have offset some cuts to health
care.
The bill initially proposed raising cigarette taxes by $1
a pack. It died in committee.
Peterson then cut the tax in half and refiled
the measure.
Last week, opponents tried and failed in three separate
parliamentary moves to scuttle the legislation without directly voting on
HB889.
Here’s how the House voted when it killed HB889 that would
have increased tobacco taxes:
VOTING FOR the tax (45): Reps. Abramson, Anders, Arnold, Aubert, A. Badon, Baldone, Barrow, Brossett,
Burrell, Carmody, Carter, Chaney, Danahay, Dixon, Doerge,
Downs, Edwards, Ellington, Ernst, Franklin, Gallot, Hardy, Harrison, Henderson, Hill, Hines, Hoffmann, Honey, G. Jackson, M. Jackson, R. Jones,
LaFonta, Lambert, LeBas,
Leger, Norton, Peterson, Richmond, Ritchie, Roy, G. Smith, P. Smith, St. Germain, Stiaes and Williams.
VOTING AGAINST the tax (55): Speaker Tucker and Reps. Armes, B. Badon, Barras, Billiot, Burford, H. Burns, T.
Burns, Champagne, Chandler, Connick, Cortez,
Cromer, Dove, Fannin, Foil, Geymann,
Gisclair, Greene, Guillory, Guinn, Hazel, Henry,
Howard, Hutter, Johnson, S. Jones, Kleckley, LaBruzzo, Landry, Ligi, Little, Lopinto, McVea, Mills, Monica, Montoucet,
Morris, Nowlin, Pearson, Perry, Pope, Pugh, Richard,
Robideaux, Schroder, Simon, Smiley, J. Smith, Talbot, Templet, Thibaut, Waddell, White and Willmott.
NOT VOTING (4): Reps. Katz, Ponti,
Richardson and Wooton.
http://www.2theadvocate.com/news/48123727.html
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By Amber Sandoval-Griffin
Staff writer
On the side of a white clinic on wheels, Magic Johnson's
smiling face stood 8 feet high in the Algiers Family
Health Center
parking lot -- inviting passers-by to drop in and get tested for HIV.
The slogan beside the pearly whites of the HIV-positive
retired pro basketball player was clear and simple.
"Safe. Easy. Free."
Next stop: a parking spot beside Cafe du Monde in the French
Quarter.
During its first-ever tour across the United States, the
AIDS Healthcare Foundation/Magic Johnson Caravan is traveling to 14 cities in
three weeks in an effort to raise AIDS awareness and offer free testing for
HIV, the immunity-damaging virus that leads to AIDS.
After stops in Phoenix, Albuquerque and Houston,
the traveling clinic set up in New
Orleans Monday. It worked with the organization
FACES and the NO/AIDS Task Force to offer services at the Algiers Family
Health Center
and at the Quarter attraction.
According to a 2007 report from the Centers for Disease
Control and Prevention, 1.1 million people in the country were living with
HIV/AIDS and 1.8 percent of all U.S. confirmed AIDS cases, or 18,612, were
found in Louisiana. A report by the CDC in August 2008 showed there had been
a 40 percent increase in HIV infection cases in the United States since 2006, or an
estimated 56,300 new cases.
"Half of those new patients are in the South,"
said Azul Mares-Delgrasso,
field services manager for the AIDS Healthcare Foundation. "From what
we've heard from our (agency) partners is that there is still a lot of stigma
in the South regarding HIV and AIDS. So we decided to reach out to the
agencies in the South and draw attention to those agencies by having this
mobile unit out here."
The mobile vehicle, which arrived at the Algiers Family
Health Center
at 8:30 a.m., tested five individuals within the first two hours.
"That is five people that normally wouldn't come in
here and get tested on a Monday morning," said JoAnna
Bruster, a clinical health educator and ourtreach coordinator at the Algiers clinic. "We normally would
only get one person on a Monday if we are lucky."
By the end of the day, 44 people were tested at the Algiers and French Quarter
locations. Of the total, 43 tested negative -- no sign of the virus -- and 1
tested positive, prompting a referral to local medical care, directors of the
effort said.
AIDS Healthcare Foundation coordinators roamed blocks near
the two service locations, handing out cards to let people know about the
free, 20-minute oral swab test offered nearby. The health care foundation, a
21-year-old nonprofit based in Los
Angeles, provides $5,000 in grant money to local
agencies that assist with the information and testing effort in any city.
Frank McCoil Jr., one of those
tested in Algiers,
said the highly visible mobile clinic is essential because it catches the
public's attention.
"Most people walk around and don't really think about
it," he said. "It gives them a chance to consider the testing and
think about it. I probably wouldn't have come here today if I didn't see
it."
The caravan will stop today in Jackson, Miss. Its national
tour is expected to end in Washington,
D.C., on National HIV Testing
Day, June 27.
http://www.nola.com/news/t-p/neworleans/index.ssf?/base/news-10/1245129648222170.xml&coll=1
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Louisiana
budget proposal almost back where it started, Jackson says
Shreveport Times| 06.16.09
By Mike Hasten
BATON ROUGE — Almost all of the work the Louisiana
Legislature has done on the state budget proposal the past two months has
been erased.
That's the opinion of Sen. Lydia Jackson, vice chairwoman
of the Senate Finance Committee, after Gov. Bobby Jindal
said Monday he will line-item veto all provisions in House Bill 1 that rely
on passage of other legislation to provide funds.
"The budget before us now is pretty much the
executive budget" as originally presented by the governor," Jackson, D-Shreveport,
told the Press Club of Baton Rouge.
Rep. Jim Fannin, D-Jonesboro,
chairman of the House Appropriations Committee and author of House Bill 1,
said he's unwilling to go as far as Jackson.
"(But) I have not looked at the bill from that perspective. The bill is
pretty much like it left the House."
Jackson said she doesn't see it that way because the
governor says he will strip from the budget $278 million in spending tied to
other pieces of legislation, including numerous projects House members wanted
and other spending that was inserted.
The House version restores some of the cuts to higher
education, health care, the arts and tourism. The Senate put those items and
some other planned restorations in sections to be funded if a controversial
delay of income tax credits, stripping of an insurance fund and legislation
authorizing drawing from the budget stabilization, or rainy day, fund are
approved.
Prior to Jackson's
speech, Jindal announced during a news conference
he will veto "everything in the bill" related to those three
funding sources.
But "the Legislature still has time to add funds back
for higher education" utilizing House-passed legislation in the Senate
Finance Committee, the governor said.
Jindal said he will keep his
pledge to his predecessors in the governor's office to reduce higher
education cuts from the proposed 15 percent — $219 million — to "below
10 percent." Since the higher education budget is $1.42 billion, it
would be a cut of less than $142 million.
To many lawmakers' surprise, the House agreed to the
Senate changes but without approving the funding sources needed to implement
them.
"I wanted them to agree," Jackson said. "But I wanted them to
pass the bills to fund it. The error isn't in what they did. It's what they
didn't do."
She said she is disappointed the House decided to
"throw up our hands and let the governor decide. That's not what I'm
going to do as long as I'm a legislator." Senators are working on ways
to use the House bills to fund what they believe are the state's priorities,
she said, including higher education, health care and important services to
the state.
"There are a whole lot of
interesting chess moves going on in the budget process," Jackson said.
In a separate news conference, Fannin
and House Speaker Jim Tucker, D-Algiers, said they also consider "member
amendments" — local projects for lawmakers' districts — important for
the Legislature to fund.
"We are hopeful the Senate will work with us," Tucker
said. "We are not at odds" as to where the state needs to go.
"It's just how we get there."
One of the differences is in using the budget
stabilization fund. The Senate leadership believes the Legislature needs to
draw down the one-third legally available and spread out its use over three
years. The House leadership agrees with the governor that the state should
wait two more years before drawing money out of the fund.
Jackson
said the way the fund is structured, this is the only year the state can draw
on it because it requires a significant drop in state revenue from a prior
year. Louisiana
could see an increase in oil and gas revenue in a couple of years that would
erase the opportunity to use the rainy day money, she said.
However the funding problems are worked out, it must be
done by Monday, the last day the Legislature can pass bills this session.
Only concurrence in amendments and conference committees can occur on the
final three days.
http://www.shreveporttimes.com/article/20090616/NEWS01/906160326
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The Associated Press
NEW ORLEANS
- An organization that says it wants to reduce the influence of big money in
Congress is targeting U.S. Sen. Mary Landrieu for her position on a
health-care reform issue.
Advertisement
The organization Change Congress is attacking the New
Orleans Democrat for her opposition to forming a government health insurance
program that would compete with private insurance companies, an option
favored by President Barack Obama.
Change Congress suggests that her position is influenced
by $1.6 million in campaign contributions from health care and insurance
interests.
"Sen. Landrieu makes policy decisions based what is
best for the people of Louisiana,
not campaign contributions," Landrieu press secretary Aaron Saunders
said in an e-mail response to a request for an interview. He did not dispute
the $1.6 million figure.
Change Congress cites a June 9 article in the online
Huffington Post in which Landrieu is quoted as saying she is "not open
to a public option" and that she backs a bipartisan proposal that
doesn't include such an option.
"Sen. Landrieu supports a predominantly private
system that features a federal backup plan that serves as a safety net,"
Saunders said Monday.
He added: "As the debate proceeds, Sen. Landrieu is
open to compromise in a comprehensive legislative package, and is focused on
appropriate consumer protection and patient-centered care."
Change Congress is a nonpartisan group that lists as its
founders Lawrence Lessig, a professor at Stanford
Law School who advised Obama's campaign on technology issues, and Joe Trippi, a political consultant who has worked for several
high-profile Democrats.
The group's CEO, Adam Green, said Monday that Change
Congress uses pressing domestic issues to demonstrate the potential influence
of monied special interests on policy makers in Washington.
Landrieu was targeted on the health care issue because,
Green said, "Those who appear to be most at odds with their constituents
on this issue are Democrats who are opposing that public option. That's
what's driving our strategy at this point."
Green said Change Congress would begin its campaign with
advertisements on Web sites aimed at Internet users in Louisiana. Direct mail and television ads
are also planned.
http://www.theadvertiser.com/article/20090616/BUSINESS/906160328/Group-says-campaign-contributions-influence-Landrieu-s-health-care-reform-stance
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The Louisiana House of Representatives bewildered
everyone, even some of its own members, Thursday when it voted to concur with
the Senate version of HB1, the fiscal 2010 state budget.
Advertisement
The bewilderment comes from the fact that the Senate
version is based on revenue enhancements, including use of the "rainy
day" fund and a delay for an income tax break, that the House will
almost certainly reject. So the budget is out of balance, an eventuality
forbidden by Louisiana's
Constitution.
Why would the House take such action, if that's the word?
The answer is easier to see if we cast the problem the way an economist
would. First, we'll assume a lack of backbone.
By now, everyone who follows state government is only too
familiar with the overall problem. Falling energy prices, slowly rising
unemployment and other factors are depressing state government revenue.
Faced with a potential $1.3 billion drop in state income
during the budget year that begins July 1, Gov. Bobby Jindal
submitted a budget that lopped $450 million from health- care spending and
$219 million from higher education.
In response, the Senate voted to delay provisions that
would lower Louisiana
income taxes. Beginning with 2009 returns, state income-tax payers were to be
able to deduct 100 percent of excess federal tax deductions. Currently, we
can deduct 65 percent. The Senate voted to raise about $100 million by
keeping the deductibilty at 65 percent for a while
longer.
The pressure to avoid such drastic health-care and
higher-education cuts had been building for weeks.
College administrators sounded the alarm first, saying
their institutions would lose talented faculty members and jobs. Health-care
providers chimed in. Finally, on Thursday, the morning of the House vote,
four former governors urged Jindal to go easier on
higher education.
There are many solid reasons to complain about Gov. Jindal's proposed cuts. But he found a problem and tried
to fix it, even though his solution isn't popular.
The Senate can be mocked for delaying a tax cut as the
state begins to suffer from the national recession. But the Senate found a
problem and tried to fix it, even though its solution isn't popular.
The House dithered for a while, and then punted, avoiding
hard votes, dodging any effort that might have contributed to a solution,
ducking the wrath of influential people in health care and higher education,
and putting Louisiana in budget limbo.
It was a cowardly thing to do.
http://www.theadvertiser.com/article/20090615/OPINION01/906150312/1014/OPINION/House-must-fix--not-duck--problems
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By Jeff Sadow
We’ll find out shortly whether the resolve of Gov. Bobby Jindal pays off with bills to restructure the state’s
fiscal budgetary procedures.
A criticism of the mechanisms placed into law and the
Louisiana Constitution is that, in times such as these when forecasted budget
deficits cause significant restructuring of state spending patterns,
inflexibility leads to sub-optimal policy choices. Specifically in this
cycle, disproportionate chunks must be taken out of health care and higher
education due to these strictures.
The recognition basically has sunk in. The Louisiana State University
system finally reconciled itself to carry out such reductions, and health
care providers continue to lament the need as well, which in its case end up
being even more significant because there often is a matching federal dollar
component to their expenditures.
But all of this agony may have a larger political point.
The Jindal Administration spawned a large number of
bills addressing these kinds of matters, many of which will surface in front
of the House Appropriations Committee today. They are designed to increase
budgetary flexibility.
Interestingly, there is non-trivial opposition to such
measures. Some argue that certain functions are too important not to be
protected, while others point out that the increased flexibility could allow
government to transfer funds put into account directly from the
non-government sector to benefit the donors. Several ardent opponents of
these measures appear to be on the committee. However, the stark reality of
the costs of the inflexible system are being loudly trumpeted by the most
prominent victims of it, higher education and health care, putting pressure
on the Legislature to pass these measure for Jindal’s
signature.
Unfortunately, one outstanding measure, HB 738 by state
Rep. Joel Robideaux which would require review of
funds every four years to see whether they should continue with special
protections that reduce flexibility, is not being considered along with the
other flexibility bills of Senate Pres. Joel Chaisson
SB 1, SB 2, and SB 34. It would do considerable service if the committee
would amend its provisions onto one of these other bills.
Successful passage of these bills not significantly
altered out of this committee probably assures they will be made into law.
Hopefully that proper outcome will occur today.
http://jeffsadow.blogspot.com/2009/06/fiscal-pain-by-some-emphasize-need-for.html
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by Robert Travis Scott, The Times-Picayune
BATON ROUGE -- The House of Representatives this afternoon
defeated a bill that would increased tobacco taxes by a vote of 45-55, which
was 25 votes short of the two-thirds majority needed to pass.
An intense lobbying effort by supporters and opponents led
Monday's House floor vote.
Gov. Bobby Jindal had pledged to
veto the legislation, which had become a rallying point for lawmakers seeking
revenue for state health care programs in an era of deep budget cuts.
"The evidence is clear -- our people are hurting. The
jury's in, and if we don't do anything soon, it will only get worse,"
said bill author Rep. Karen Carter Peterson, D-New Orleans. "We've got
to start someplace."
A block of House members were against any tax increase in
principle and favored budgetary restraints.
"Let's call it what it is: a tax. Can they justify
this? Absolutely," said Rep. Joseph Lopinto,
R-Metairie, the only lawmaker who spoke on the House floor against the bill.
"But we are here to change the status quo, and I don't believe that
should be to raise new taxes. My problem is, my citizens in my area voted for
me to come up here and tighten our belts."
Called the Louisiana Healthier Families Act, House Bill
889 calls for a 50-cent-per-pack tax increase on cigarettes and an increase
in taxes on other tobacco products. If passed, it would raise an estimated
$92 million in new state revenue the first year and more than $100 million in
subsequent years, according to the Legislative Fiscal Office. If smoking
declined more than expected in Louisiana,
the revenue would be less. The money would be dedicated to health-care
programs in the Department of Health and Hospitals and cancer research
centers.
The current Louisiana
tax rate is 36 cents per pack and Peterson's would raise it to 86 cents.
The federal cigarette tax increased from 39 cents to about
$1.01 per pack on April 1.
A $1.41-per-pack tax on cigarettes in Texas
helps draw customers from that state into Louisiana, which would lose much of that
business with a higher tax of its own, opponents of the bill said. Mississippi recently
increased its tobacco tax to 68 cents per pack.
The legislation has had a hard journey this session. The
Ways and Means Committee killed the first version of the bill, for a
$1-per-pack increase, on the second day of the session.
Peterson brought a new version of the bill to the
committee on May 12 at a 50-cent rate. The panel could not gather enough
members to form a quorum for a meeting as two members holed up in the
governor's office.
Peterson, whose grandmother died of lung cancer, finally
got a committee hearing last week and came away with an 8-7 favorable vote.
On the House floor last week, opponents fell short in efforts to derail the
measure with procedural moves to shift it into more committee hearings.
Opponents to the bill included tobacco companies and trade
associations for product sellers, who argued that it would put a severe tax
on an already decreasing number of tobacco users who make up about 22 percent
of the population.
A bevy of supporters included the American Cancer Society,
the American Heart Association, the American Lung Association and the
Coalition for a Tobacco Free Louisiana. They said the higher tax would deter
young people especially from smoking and provide better resources for health
care services and research.
Had the bill passed, it would have gone to the Senate,
where a friendlier reception might have been expected. The proposal could
reappear as an amendment to some other bill in the Senate.
http://www.nola.com/politics/index.ssf/2009/06/house_cigarette_tax.html
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By Jessica Zigmond
A majority of Americans—61%—say they believe health reform
is more important than ever, given the nation’s serious economic problems,
according to a June health tracking poll from the Kaiser Family Foundation.
Also, six in 10 Americans
say the nation’s healthcare system could be reformed without spending more
money to do so. In a news release about the poll, Kaiser President and CEO
Drew Altman said that view might be unrealistic.
“With all of the talk of inefficiencies in the system and
achieving future savings, the public may confuse the potential for long-term
savings with the need for short-term outlays and think that healthcare can be
reformed for free,” Altman said. “This could make policymakers’ jobs tougher
when the price tag for legislation comes out.”
Meanwhile, 55% of Americans reported that they or another
member of their household have put off some medical care—such as not filling
a prescription or skipping a recommended test—in the last 12 months due to
cost. A healthy majority, 70%, said they liked the idea of insurance
exchanges, an element of the legislation now being drafted on Capitol Hill,
as a way to help people purchase insurance on their own. Also, a little more
than half (54%) of Americans say they oppose taxing the employer-sponsored
health benefits of those with the most generous plans, while about 67% say
they are against across-the-board increases on income taxes.
The survey was conducted from June 1 through June 8 among a nationally representative
random sample of 1,205 adults who were 18 years of age or older.
http://www.modernhealthcare.com/article/20090616/REG/306169996
[BACK TO TOP]
The New York Times | 06.15.09
By ROBERT PEAR and JACKIE CALMES
Doug
Mills/The New York Times
Addressing the American Medical Association,
President Obama promised to work with doctors to reduce “defensive medicine.”
WASHINGTON
— President Obama went before a convention of receptive but wary doctors on
Monday to make the economic case for a health care overhaul, both for the
nation and for the physicians’ own bottom lines.
But as the president spoke at the annual conference of the
American Medical Association in Chicago,
it became clear that one of the major health plans on the table would cost at
least $1 trillion over 10 years yet leave tens of millions of people
uninsured.
Congress is wrestling with how to pay for Mr. Obama’s
vision to extend health care to all Americans, and some lawmakers are
considering tax increases and spending cuts different from the ones he has
proposed. House Democrats, for example, are weighing a tax on soft drinks and
a value-added tax, a broad-based consumption tax similar to the sales taxes
many states levy.
An analysis released Monday by the nonpartisan
Congressional Budget Office raised the hurdles for draft legislation in the
Senate just as its Health, Education, Labor and Pensions Committee planned to
begin voting on Wednesday. The office concluded that a plan by the
committee’s Democratic leaders, Senators Edward M. Kennedy of Massachusetts and Christopher J. Dodd of Connecticut, would
reduce the number of uninsured only by a net 16 million people. Even if the
bill became law, the budget office said, 36 million people would remain
uninsured in 2017.
That finding came as a surprise. Robert D. Reischauer, an
economist who headed the budget office when Congress tackled the health care
issue in the Clinton
administration, said that if so many people remained uninsured, it might not
be feasible to cut special federal payments to hospitals that serve many
low-income people.
Mr. Obama said Saturday that the government could save
$106 billion over 10 years by cutting such hospital payments as more people
gained coverage.
Senator Orrin G. Hatch of Utah, a senior Republican on both
committees drafting health legislation, said he found the office’s numbers
stunning. He calculated that the Kennedy bill would cost taxpayers $62,500
per uninsured person over the 10 years.
Mr. Obama took the cost issue head on in Chicago. “The cost of inaction is greater,”
he told the doctors, because rising health care prices are “an escalating
burden on our families and businesses” and “a ticking time bomb for the
federal budget.”
Opening a week in which health care will dominate
attention in Congress, the president’s speech on Monday was the latest
example of an oft-used ploy to press his case: appearing before skeptical
audiences, confident of his powers of persuasion but willing as well to say
what his listeners do not want to hear.
Mr. Obama spoke just days after the A.M.A. had signaled
opposition to his proposal for a public health insurance plan to compete with
private insurers as part of a menu of choices, much like the one for members
of Congress.
“The public option is not your enemy,” Mr. Obama said. “It
is your friend, I believe.” Saying it would “keep the insurance companies
honest,” the president dismissed as “illegitimate” the claims of critics that
a public insurance option amounts to “a Trojan horse for a single-payer
system” run by the government.
Mr. Obama twice referred to the use of such “fear tactics”
about “socialized medicine” in past legislative battles, without pointing out
that the A.M.A., a traditionally Republican-leaning group, was among those
using the charge, as in the mid-1960s debate over creating Medicare for
people 65 and older.
Mr. Obama drew repeated applause, and even some standing
ovations, when he called for incentives to get more medical students to go
into primary care instead of the more lucrative specialty practices, and when
he pledged to work with doctors to reduce their often unnecessary “defensive
medicine” to avoid malpractice lawsuits. But scattered boos met his follow-up
remark that he opposed any cap on malpractice awards.
The president’s emphasis on reducing health care costs
over expanding insurance coverage, which dates to his campaign, reverses
Democrats’ priorities of recent years. Obama advisers say the focus on cost
savings has appeal for all Americans, not just the uninsured. Some advisers,
including veterans of the Clinton
administration, say President Bill Clinton’s emphasis on covering the
uninsured helped doom his health care plan in 1994.
“We have made cost control a coequal objective, just as
important as the expansion of insurance coverage, which has traditionally
been the dominant goal for Democrats,” said Rahm
Emanuel, the White House chief of staff. “The entire discussion has to be
centered on controlling or reducing costs.”
That rationale has been Mr. Obama’s answer to those who,
after his election, predicted that he would have to shelve his campaign
promise to overhaul health care to attend instead to an economy in crisis.
“If we fail to act, premiums will climb higher, benefits will erode further,
the rolls of the uninsured will swell to include millions more Americans, all
of which will affect your practice,” he told the A.M.A. members.
The practical problem for Mr. Obama is that by all
accounts, the savings and efficiencies he envisions will not occur quickly,
certainly not in the 10-year time frame of budget scorekeeping for purposes
of passing legislation.
The budget office estimated that 39 million people would
get coverage through new “insurance exchanges.” But at the same time, it
said, the number of people with employer-provided health insurance would
decline by 15 million, or about 10 percent, and coverage from other sources
would fall by 8 million.
In effect, the office said, millions of people would get a
better deal if they bought insurance through an exchange because they could
qualify for federal subsidies not available if they stayed in their
employers’ health plans. Subsidies are expected to average $5,000 to $6,000 a
person.
Mr. Obama assured skeptics in the audience: “You did not
enter this profession to be bean counters and paper pushers. You entered this
profession to be healers. And that’s what our health care system should let
you be.”
On Wednesday, leaders of the Senate Finance Committee hope
to unveil what will be the one bipartisan measure in Congress.
Democrats on three House panels continue to meet privately
to seek consensus on a single plan. Democrats on the House Ways and Means Committee said
they were trying to decide whether to finance coverage of the uninsured with
one broad-based tax, like the value-added tax, or a combination of smaller
taxes.
The value-added tax, common in other countries, is
collected in stages from each business that contributes to the production and
sale of consumer goods. Economists say a 5 percent VAT could have raised $285
billion last year.
But a VAT could violate Mr. Obama’s campaign pledge not to
raise taxes on households with incomes under $250,000 a year.
http://www.nytimes.com/2009/06/16/health/policy/16obama.html?_r=1&ref=health
[BACK TO TOP]
Alcohol’s Good for You? Some Scientists Doubt It
The New York Times | 06.15.09
By RONI CARYN RABIN
Pier Paolo Cito/Associated Press
By now, it is a familiar litany. Study after study
suggests that alcohol in moderation may promote heart health and even ward
off diabetes and dementia. The evidence is so plentiful that some experts
consider moderate drinking — about one drink a day for women, about two for
men — a central component of a healthy lifestyle.
But what if it’s all a big mistake?
For some scientists, the question will not go away. No
study, these critics say, has ever proved a causal relationship between
moderate drinking and lower risk of death — only that the two often go
together. It may be that moderate drinking is just something healthy people
tend to do, not something that makes people healthy.
“The moderate drinkers tend to do everything right — they
exercise, they don’t smoke, they eat right and they drink moderately,” said
Kaye Middleton Fillmore, a retired sociologist from the University of California,
San Francisco, who has criticized the research. “It’s very hard to
disentangle all of that, and that’s a real problem.”
Some researchers say they are haunted by the mistakes made
in studies about hormone replacement therapy, which was widely prescribed for
years on the basis of observational studies similar to the kind done on
alcohol. Questions have also been raised about the financial relationships
that have sprung up between the alcoholic beverage industry and many academic
centers, which have accepted industry money to pay for research, train
students and promote their findings.
“The bottom line is there has not been a single study done
on moderate alcohol consumption and mortality outcomes that is a ‘gold
standard’ kind of study — the kind of randomized controlled clinical trial
that we would be required to have in order to approve a new pharmaceutical
agent in this country,” said Dr. Tim Naimi, an
epidemiologist with the Centers for Disease Control and Prevention.
Even avid supporters of moderate drinking temper their
recommendations with warnings about the dangers of alcohol, which has been
tied to breast cancer and can lead to accidents even when consumed in small
amounts, and is linked with liver disease, cancers, heart damage and strokes
when consumed in larger amounts.
“It’s very difficult to form a single-bullet message
because one size doesn’t fit all here, and the public health message has to
be very conservative,” said Dr. Arthur L. Klatsky,
a cardiologist in Oakland, Calif., who wrote a landmark study in the early
1970s finding that members of the Kaiser Permanente health care plan who
drank in moderation were less likely to be hospitalized for heart attacks
than abstainers. (He has since received research grants financed by an
alcohol industry foundation, though he notes that at least one of his studies
found that alcohol increased the risk of hypertension.)
“People who would not be able to stop at one to two drinks
a day shouldn’t drink, and people with liver disease
shouldn’t drink,” Dr. Klatsky said. On the other
hand, “the man in his 50s or 60s who has a heart attack and decides to go
clean and gives up his glass of wine at night — that person is better off
being a moderate drinker.”
Health organizations have phrased their recommendations
gingerly. The American Heart Association says people should not start
drinking to protect themselves from heart disease. The 2005 United States dietary guidelines
say that “alcohol may have beneficial effects when consumed in moderation.”
The association was first made in the early 20th century.
In 1924, a Johns Hopkins biologist, Raymond Pearl, published a graph with a
U-shaped curve, its tall strands on either side representing the higher death
rates of heavy drinkers and nondrinkers; in the middle were moderate
drinkers, with the lowest rates. Dozens of other observational studies have
replicated the findings, particularly with respect to heart disease.
“With the exception of smoking and lung cancer, this is
probably the most established association in the field of nutrition,” said
Eric Rimm, an associate professor of epidemiology
and nutrition at the Harvard School of Public Health. “There are probably at
least 100 studies by now, and the number grows on a monthly basis. That’s
what makes it so unique.”
Alcohol is believed to reduce coronary disease because it
has been found to increase the “good” HDL cholesterol and have anticlotting effects. Other benefits have been suggested,
too. A small study in China
found that cognitively impaired elderly patients who drank in moderation did
not deteriorate as quickly as abstainers. A report from the Framingham
Offspring Study found that moderate drinkers had greater mineral density in
their hipbones than nondrinkers. Researchers have reported that light
drinkers are less likely than abstainers to develop diabetes, and that those
with Type 2 diabetes who drink lightly are less likely to develop coronary
heart disease.
But the studies comparing moderate drinkers with
abstainers have come under fire in recent years. Critics ask: Who are these
abstainers? Why do they avoid alcohol? Is there something that makes them
more susceptible to heart disease?
Some researchers suspect the abstainer group may include
“sick quitters,” people who stopped drinking because they already had heart
disease. People also tend to cut down on drinking as they age, which would
make the average abstainer older — and presumably more susceptible to disease
— than the average light drinker.
In 2006, shortly after Dr. Fillmore and her colleagues
published a critical analysis saying a vast majority of the alcohol studies
they reviewed were flawed, Dr. R. Curtis Ellison, a Boston University
physician who has championed the benefits of alcohol, hosted a conference on
the subject. A summary of the conference, published a year later, said
scientists had reached a “consensus” that moderate drinking “has been shown
to have predominantly beneficial effects on health.”
The meeting, like much of Dr. Ellison’s work, was partly
financed by industry grants. And the summary was written by him and Marjana Martinic, a senior vice
president for the International Center for Alcohol Policies, a nonprofit
group supported by the industry. The center paid for tens of thousands of
copies of the summary, which were included as free inserts in two medical
journals, The American Journal of Medicine and The American Journal of
Cardiology.
In an interview, Dr. Ellison said his relationship with
the industry did not influence his work, adding, “No one would look at our
critiques if we didn’t present a balanced view.”
Dr. Fillmore and the co-authors of her analysis posted an
online commentary saying the summary had glossed over some of the deep
divisions that polarized the debate at the conference. “We also dispute
Ellison and Martinic’s conclusions that more
frequent drinking is the strongest predictor of health benefits,” they wrote.
(Dr. Fillmore has received support from the Alcohol
Education and Rehabilitation Foundation of Australia, a nonprofit group that
works to prevent alcohol and substance abuse.)
Dr. Ellison said Dr. Fillmore’s analysis ignored newer
studies that corrected the methodological errors of earlier work. “She threw
out the baby with the bathwater,” he said.
Meanwhile, two central questions remain unresolved:
whether abstainers and moderate drinkers are fundamentally different and, if
so, whether it is those differences that make them live longer, rather than
their alcohol consumption.
Dr. Naimi of the C.D.C., who did
a study looking at the characteristics of moderate drinkers and abstainers,
says the two groups are so different that they simply cannot be compared.
Moderate drinkers are healthier, wealthier and more educated, and they get
better health care, even though they are more likely to smoke. They are even
more likely to have all of their teeth, a marker of well-being.
“Moderate drinkers tend to be socially advantaged in ways
that have nothing to do with their drinking,” Dr. Naimi
said. “These two groups are apples and oranges.” And simply advising the
nondrinkers to drink won’t change that, he said.
Some scientists say the time has come to do a large,
long-term randomized controlled clinical trial, like the ones for new drugs.
One approach might be to recruit a large group of abstainers who would be
randomly assigned either to get a daily dose of alcohol or not,
and then closely followed for several years; another might be to recruit
people who are at risk for coronary disease.
But even the experts who believe in the health benefits of
alcohol say this is an implausible idea. Large randomized trials are
expensive, and they might lack credibility unless they were financed by the
government, which is unlikely to take on the controversy. And there are
practical and ethical problems in giving alcohol to abstainers without making
them aware of it and without contributing to accidents.
Still, some small clinical trials are already under way to
see whether diabetics can reduce their risk of heart disease by consuming
alcohol. In Boston, researchers at Beth Israel Deaconess Medical Center are
recruiting volunteers 55 and over who are at risk for heart disease and
randomly assigning them to either drink plain lemonade or lemonade spiked
with tasteless grain alcohol, while scientists track their cholesterol levels
and scan their arteries.
In Israel, researchers gave people with Type 2 diabetes
either wine or nonalcoholic beer, finding that the wine drinkers had
significant drops in blood sugar, though only after fasting; the Israeli
scientists are now working with an international team to begin a larger
two-year trial.
“The last thing we want to do as researchers and
physicians is expose people to something that might harm them, and it’s that
fear that has prevented us from doing a trial,” said Dr. Sei
Lee of the University of California, San Francisco, who recently proposed a
large trial on alcohol and health.
“But this is a really important question,” he continued.
“Because here we have a readily available and widely used substance that may
actually have a significant health benefit — but we just don’t know enough to
make recommendations.”
http://www.nytimes.com/2009/06/16/health/16alco.html?_r=1&ref=health
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By Melanie Evans
As not-for-profit hospitals prepare for more detailed
public disclosure of their charity care, a major healthcare finance
association offered ideas on how hospitals might determine whether a
patient’s unpaid account counts as charity care or bad debt.
Advertisement | Your Ad Here
The Healthcare Financial Management Association late last
month unveiled a sample policy for how to define and enroll needy patients in
hospital programs that write off medical bills for those unable to pay.
Not-for-profit hospitals across the U.S. are closely examining such
policies under pressure from key members of Congress to justify their tax
breaks and in advance of new tax rules for fiscal 2009 that require an
itemized breakdown of hospital charity care and other community benefits.
HFMA’s guidance isn’t so much a
standard as an example, said Rick Gundling, vice
president of thought leadership for the Westchester,
Ill.-based association. Gundling said that
hospitals can use the newly drafted sample policy, which was designed using
examples from across the U.S.,
as one way to evaluate whether their own policy is clear and comprehensive.
Not all of the sample policy must be adopted, he said; hospitals may define
charity care according to local needs.
Gundling said the sample policy
grew from the HFMA’s 2006 statement on the
politically sensitive subject of separating unpaid bills, categorized as bad
debts, from charity care. The statement defined bad debts as losses from
patients who fail to pay for medical care as expected. Hospitals can consider
as charity care any subsidized aid to needy patients as defined in hospital
policy, the statement said.
Gundling said hospitals sought
examples of charity-care policies in response to the 2006 statement.
The newly drafted charity-care policy underscores the HFMA’s position on separating bad debt and charity care.
Patients eligible for such aid are “uninsured, underinsured, ineligible for a
government program, or otherwise unable to pay, for medically necessary care
based on their individual financial situation,” the sample policy says.
Whether some bad debts can be counted as charity care has
divided hospitals amid a national debate among the industry, lawmakers and
watchdogs over how much aid not-for-profits provide in exchange for certain
tax exemptions. The Catholic Health Association has rejected bad debts as
charity. The American Hospital Association disagrees and argues bad debts
include patients unable to pay but who fail to seek assistance.
Under the HFMA sample policy, hospitals may find ways
other than an application form to identify patients eligible for charity
care, including enrollment in state-subsidized food or housing programs, or
enrollment for public health benefits, such as prescription drug aid.
However, should hospitals presume eligibility, “the only discount that can be
granted is a 100% write-off of the account balance.”
Julie Trocchio, CHA senior
director of community benefit and continuing care, said that the sample
policy adds depth to the HFMA’s prior resources on
defining charity care.
Melinda Hatton, general counsel for the AHA, said in a
written statement: “Most hospitals already have their own policies that are
attuned to their communities. While HFMA may provide some guidance, it’s no
substitute for knowing your community and crafting a policy that meets its
needs.”
Hospitals’ new tax reporting requirements, Schedule H of
the Internal Revenue Service’s Form 990, requires hospitals to itemize
charity care spending and excludes bad debts from the tally. However, the
form does allow a separate accounting of bad debts. Hospitals may estimate a
percentage of bad debts that may be unacknowledged care for needy patients,
but also requires hospitals to explain how the estimate was reached. Such
disclosure is not mandatory until tax year 2009.
Hospitals have begun collecting information, though some
have been mum on whether they will voluntarily report results (May 4, p. 10).
The AHA separately has launched an effort with accounting
firm Ernst & Young to collect and compare results from hospitals that
practiced completing the forms.
Sutter Health in Sacramento, Calif., pulled together
legal, finance, tax and community benefit experts to review the new tax form
and its instructions, and alter the system’s data collection, if needed, said
spokesman Bill Gleeson, in an e-mail.
The system, which owns 22 hospitals and manages one more,
adheres to guidelines laid out by the Catholic Health Association, he said.
“With respect to bad debt, we are not planning on reporting any portion as
charity care.”
http://www.modernhealthcare.com/article/20090614/REG/306149993/0
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