Lawmakers,Drugs,Money and the Taxpayer

Attached an article titled "Fiscal Footnote: Big Senate Gift to Drug Maker" reporting that key Senate lawmakers inserted a paragraph into Section 632 of the “fiscal cliff” bill which essentially delays a set of Medicare price restraints on a class of drugs that includes Sensipar, a lucrative Amgen pill used by kidney dialysis patients. The provision gives Amgen an additional two years to sell Sensipar without government controls which is projected to cost Medicare, or better the tax payer, up to $500 million over that period. Amgen, which has a small army of 74 lobbyists in the capital, was the only company to argue aggressively for the delay. Amgen’s success also shows that even a significant federal criminal investigation may pose little threat to a company’s influence on Capitol Hill. On Dec. 19, as Congressional negotiations over the fiscal bill reached a frenzy, Amgen pleaded guilty to marketing one of its anti-anemia drugs, Aranesp, illegally. It agreed to pay criminal and civil penalties totaling $762 million, a record settlement for a biotechnology company, according to the Justice Department. Amgen’s employees and political action committee have distributed nearly $5 million in contributions to political candidates and committees since 2007, including $67,750 to Mr. Baucus, the Finance Committee chairman, and $59,000 to Mr. Hatch, the committee’s ranking Republican. They gave an additional $73,000 to Mr. Mitch McConnell, some of it at a fund-raising event for him that it helped sponsor in December while the debate over the fiscal legislation was under way. More than $141,000 has also gone from Amgen employees to President Obama’s campaigns.In some cases, the company’s former employees have found important posts inside the Capitol. They include Dan Todd, one of Mr. Hatch’s top Finance Committee staff members on health and Medicare policy, who worked as a health policy analyst for Amgen’s government affairs office from 2005 to 2009. Mr. Todd, who joined Mr. Hatch’s staff in 2011, was directly involved in negotiating the dialysis components of the fiscal bill, and he met with “all the stakeholders." This is a sweet deal for Amgen because Congress in 2008 required Medicare to pay a single, bundled rate for a dialysis treatment and related medications starting in 2011. But lawmakers carved out a two-year delay in the inclusion of certain oral drugs, Sensipar among them, in the new bundled payment system. That meant demand for Sensipar would not decline and Amgen would maintain control over pricing and make MORE money. With that two-year exclusion set to expire in 2014, Amgen’s lobbyists successfully pushed for another two-year delay. Many lobbyists and Congressional aides said they first learned of the language when the final bill was posted publicly, only hours before being approved. It called for cutting $4.9 billion over 10 years by lowering Medicare payments for dialysis, but left hundreds of millions on the table by extending the oral drug delay. What is the moral of this story? Companies make big bucks, lawmakers line their pockets and we the people pay the bill. But the story gets even better: the Internal Revenue Service regards some of Amgen's penalties as a cost incurred in the course of doing business. Result: It's fully tax-deductible! So the taxpayer will subsidize them for the money they're ponying up to pay the fines. Are we really want to take this any longer? Yours Bernd

Penny Wise and Pound Foolish

Attached a link to an interesting article titled "Florida’s Medicaid fraud fighting cuts cost state millions in matching money, report says" highlighting the fact that Florida missed out on millions in federal funds by cutting the budget for its Medicaid fraud unit and prosecution referrals and arrest warrants are down. Twenty-three positions in the fraud unit have gone unfilled because of budget shortfalls, according to a report issued by the Florida Attorney General’s Office and the Agency for Health Care Administration.The report said because of “critical” shortfalls, “the Medicaid Fraud Control Unit’s general revenue budget reduction was approximately $631,290, which resulted in an additional loss of $1.89 million in federal funds to the State of Florida.” The federal government provides $12.5 million of the Medicaid fraud unit’s $16.7 million budget, but the money is partly tied to matching state funds, which were $4.2 million for the year ended June 30. Not mentioned in the release, but available in a 62-page report from the two agencies, is documentation of budget cuts and a decline in some measures of anti-fraud efforts: —A 9 percent decline in cases opened, 324, compared to the previous year. —A 15 percent decline in referrals for prosecution to 52. —A 22 percent decline in recoveries from Medicaid Program Integrity audits to $62.2 million. —A 23 percent decline in warrants for arrest to 69. In my opinion the (in)action taken by the State of Florida regarding the Medicaid fraud unit funding is either an indicator of administrative malpractice, or reveals plain simple stupidity. Who will be hold accountable for the loss of $1.89 million in federal funds to the State of Florida? Yours Bernd

Guns,NRA and the Affordable Care Act

The tragedy of the horrific shooting in Newtown Connecticut gradually faded from the daily news. Sadly, this shooting will be followed by another one and we will continue to seek answers to why it happened and what we could have done to prevent another massacre. In my opinion we have to recognize that the National Rifle Association (NRA) tentacles of influence have penetrated all aspects of our lives. An article published in the Washington Post highlighted that the National Rifle Association successfully lobbied for the national health care law signed by President Obama in 2010 to include provisions restricting the ability of doctors and health plans to collect patient information about gun ownership.The language, pushed by the National Rifle Association in the final weeks of the 2010 debate over health care was discovered only in recent weeks by some lawmakers and medical groups and is drawing fierce criticism. The provision says that “wellness and prevention” portions of the health-care law “may not require the disclosure or collection of any information” relating to the “presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property.” Further, the measure says the law cannot be used to “maintain records of individual ownership or possession of a firearm or ammunition.” It adds that the price of health coverage may not be affected by the ownership, possession or use of guns. The deal to add gun language to the health-care bill was struck so quietly that several top officials in the Obama administration and in Congress had no idea the passages had been added until approached by The Washington Post last week. Its important to understand that this questionable legislative compromise erected an almost insurmountable barrier to the type of research required to address gun safety and gun control issues vital for addressing the issues involved in the post-Newtown policy debate. Again, the NRA has skillfully implemented a gag rule into the health care law preventing physicians to contribute to the data collection of ANY gun related issue. As parents, responsible citizens and physicians we need to continue and intensify our struggle against the metastasizing influence of the NRA in our government and lives. Yours Bernd ADDENDUM: Attached the original wording contained in Sec. 1001\2717 PHSA t: PROTECTION OF SECOND AMENDMENT GUN RIGHTS.- "(1) WELLNESS AND PREVENTION PROGRAMS.-A wellness and health promotion activity implemented under subsection (a)(l)(D) may not require the disclosure or collection of any information relating to- "(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or "(B) the lawful use, possession, or storage of a firearm or ammunition by an individual. "(2) LIMITATION ON DATA COLLECTION.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used for the collection of any information relating to- "(A) the lawful ownership or possession of a firearm or ammunition; "(B) the lawful use of a firearm or ammunition; or "(C) the lawful storage of a firearm or ammunition. "(3) LIMITATION ON DATABASES OR DATA BANKS.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used to maintain records of individual ownership or possession of a firearm or ammunition. "(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR ELIGIBILITY FOR HEALTH INSURANCE.-A premium rate may not be increased, health insurance coverage may not be denied, and a discount, rebate, or reward offered for participation in a wellness program may not be reduced or withheld under any health benefit plan issued pursuant to or in accordance with the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use or storage of a firearm or ammunition. '(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR INDIVIDUALs.-No individual shall he required to disclose any information under any data collection activity authorized under the Patient Protection and Affordable Care Act or an amendment made by that Act relating to- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use, possession, or storage of a firearm or ammunition.