AMA Sues Aetna, Cigna
The American Medical Association and several state medical associations have filed separate class-action lawsuits against insurers Aetna Health Inc. and CIGNA, each suit claiming that the company used faulty data to undercompensate physicians. Filed last month in New Jersey federal court, the two lawsuits are similar to an earlier AMA suit against the owner of the Ingenix billing database used by Aetna and CIGNA, UnitedHealth, to determine fees for patients' visits to out-of-network physicians. As a result of the UnitedHealth lawsuit and an investigation by New York Attorney General Andrew Cuomo, UnitedHealth agreed to shut down the database and pay $50 million to establish a new database run by a nonprofit organization. Among other things, the suits against Aetna and CIGNA seek a declaration that the insurers violated federal antitrust law and that they're liable to the plaintiffs for three times their damages, costs, and attorney fees. The medical associations also want the insurers to calculate and issue unpaid benefits to physicians. “We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients or the legitimate costs required to care for them,” said Dr. Nancy H. Nielsen, AMA president.
Many People Go Without Drugs
More children and working-age adults are failing to take needed prescription medications because of cost concerns, according to a national study by the Center for Studying Health System Change. In 2007, 1 in 7 Americans younger than age 65 years reported not filling a prescription in the previous year because they couldn't afford the medication, up from 1 in 10 in 2003. Rising prescription drug costs and less-generous drug coverage probably contributed to the change, the report said. Uninsured, working-age Americans saw the biggest jump in unmet prescription needs during 2003-2007, with the proportion going without medications rising from 26% to almost 35%, the report said. But a growing proportion of working-age Americans with employer-sponsored health insurance also reported going without prescription medications.
FDA on High-Risk List
The Food and Drug Administration faces significant challenges that compromise its ability to protect Americans from unsafe and ineffective products, the Government Accountability Office said in adding the FDA to its biennial “high-risk” list. The GAO gives that label to government programs or agencies that need to address mismanagement within them. In its 2009 report, the GAO said the FDA needs to beef up its foreign-drug inspection program, better manage its reviews of companies' promotional materials, and ensure that drug makers properly present clinical data.
Report Finds HIPAA Inadequate
The government's main health privacy rule does not adequately protect people's health information, yet it hinders important health research, a report from the Institute of Medicine concluded. The privacy rule, stemming from the Health Insurance Portability and Accountability Act, is difficult to reconcile with other federal regulations governing research and personal information, the IOM report said. In addition, organizations that collect and use health data vary greatly in how they interpret and follow HIPAA, leading to potential privacy problems, the report said. Congress should create an entirely new approach to protecting personal health information in research, separate from the HIPAA rule, an IOM panel recommended.
Poll: Affordability Is Tops
Making health insurance more affordable trumps improving quality and expanding coverage among the public's priorities for health care reform, says a new poll. The survey from the Kaiser Family Foundation and the Harvard School of Public Health found that most people believe that action on health care is important to help the nation out of recession. But when asked to choose between coverage expansion, cost reduction, and delivery-system change, 4 in 10 named affordability as most important, followed by 3 in 10 who said that expanding coverage is the top priority. Roughly 2 in 10 picked improving the quality and cost-effectiveness of the health care delivery system. Two-thirds of those surveyed favored requiring all individuals to have health insurance, but when told that some may then have to buy health insurance they consider too expensive or don't want, support for the mandate dropped to 19%.