Wednesday, February 6, 2013

Connecticut Mirror - Malloy's push to avoid taxes, preserve education, spurs more borrowing

Connecticut Mirror - Group brings national right-to-die movement to state legislature

CT News Junkie - Mental Health Reform Needs Supportive Housing

CT News Junkie - Republican Lawmaker Is Not Impressed With Malloy’s Budget

Middletown Press - Opinion: TO make doctor's errors less common, keep a public record

New Britain Herald - Proposed bill calls for health insurance coverage of breast thermography tests

New London Day - Backus removes Daticon building from tax rolls, resulting in hit to Norwich

New London Day - Deep cuts mark Malloy budget plan

Hartford Courant - Malloy To Propose Spending Increase; Budget Filled With Gimmicks, GOP Says

Hartford Courant - READER SUBMITTED: Congressman Courtney Announces Renewal Of Medicare Dependent Hospital Program

Hartford Courant - READER SUBMITTED: Manchester Family Of Organ Donor Recognized At Hartford Hospital Gala

Hartford Courant - READER SUBMITTED: Hartford Federal Credit Union Donates Over 200 Hats & Gloves

Hartford Courant - READER SUBMITTED: McLean Joined The St. Francis Hospital CJRI In Operation Walk USA

Hartford Courant - READER SUBMITTED: Windham Hospital To Offer Weekly Cancer Support Group

Journal Inquirer - Windham Hospital plans women’s facility in Hebron

Norwich Bulletin - Malloy’s 2-year budget to cut $1.8 billion

Norwich Bulletin - Donations allow Day Kimball to buy new monitors

Boston Globe - Specialty drug labs in Mass. fail safety inspection

New York Times - Health Insurance Companies Get in Shape for 2014

New York Times - People With Mental Illness More Likely to Be Smokers, Study Finds

Wall Street Journal - Debt Rise Colors Budget Talks

Wall Street Journal - FDA Warns of New Batch of Fake Cancer Drug

Washington Post - As Obama calls for short-term fix to avert sequester, CBO reports falling deficits

The complete article is included in its entirety if a link was not available.

Connecticut Mirror - Tuesday, February 05, 2013
Malloy's push to avoid taxes, preserve education, spurs more borrowing
By Keith M. Phaneuf

While Gov. Dannel P. Malloy pledged to avoid new taxes and preserve education reforms, the legislature's top Republicans charged Tuesday that the governor's new budget dramatically expands the state's hefty credit card balance.

Click here to read the entire article

Connecticut Mirror - Tuesday, February 05, 2013
Group brings national right-to-die movement to state legislature
By Grace Merritt

Leaders of a national right-to-die lobbying group came to Connecticut Tuesday to urge lawmakers to approve a bill to legalize assisted suicide for patients with a terminal illness.

Click here to read the entire article

CT News Junkie - Tuesday, February 05, 2013
Mental Health Reform Needs Supportive Housing
By Susan Campbell

If we’re going to talk about changing our culture post-Newtown, we need to talk about supportive housing.

Click here to read the entire article

CT News Junkie - Tuesday, February 05, 2013
Republican Lawmaker Is Not Impressed With Malloy’s Budget
By Christine Stuart

The budget gimmicks Gov. Dannel P. Malloy promised to avoid on the campaign trail in 2010 have made their way into his second two-year budget proposal, according to sources who have been briefed.

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Middletown Press - Tuesday, February 05, 2013
Opinion: TO make doctor's errors less common, keep a public record

Surgeons have an encouraging term for their mistakes: “never events,” because they should never happen. Yet they do, with startling frequency.

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New Britain Herald - Monday, February 04, 2013
Proposed bill calls for health insurance coverage of breast thermography tests
By Scott Whipple

NEW BRITAIN — State Rep. Peter Tercyak, D-New Britain, has proposed a bill that calls for health insurance to cover a test he says is key to the early detection and treatment of breast cancer. The legislation would require health insurance coverage for breast thermography.

Click here to read the entire article

New London Day - Wednesday, February 06, 2013
Backus removes Daticon building from tax rolls, resulting in hit to Norwich
By Claire Bessette

Norwich - As a controversial 10-year tax break deal for the former Daticon building in the Norwich Business Park is set to expire, the building's new owner, The William W. Backus Hospital, is removing the $6 million assessment from the tax rolls permanently.

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New London Day - Wednesday, February 06, 2013
Deep cuts mark Malloy budget plan

Hartford - Deep cuts to hospitals and changes in Medicaid eligibility are among the reductions Gov. Dannel P. Malloy is proposing in his new two-year budget, set to be presented today.

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Hartford Courant - Tuesday, February 05, 2013
Malloy To Propose Spending Increase; Budget Filled With Gimmicks, GOP Says

Gov. Dannel P. Malloy on Wednesday will propose extending several taxes that had been scheduled to expire in order to help pay for his plan to increase state spending by nearly 10 percent over the next two fiscal years, according to legislators briefed on the proposal.

Malloy — who faces a projected deficit — will call for extending the surcharge on corporate profits that was scheduled to expire at year's end, as well as a tax on electricity generators, lawmakers said Tuesday.

"In the biennium, it's an increase in spending of 9.7 percent,'' Senate Republican leader John McKinney said. "That amounts to $1.8 billion in increased spending over two years. The first year alone is a 5.6 percent increase. The budget, on its face, does not meet the constitutional spending cap. It's over the cap to the tune of about $1 billion. The governor gets around that requirement by redefining the cap.''

"There's so many gimmicks. I don't know where to stop,'' McKinney said. "This is the most dishonest budget I've seen.''

One of the gimmicks, McKinney said, is that the state was supposed to make a payment on economic recovery notes, which were used to cover the state's operating deficit in the 2009 fiscal year. But Malloy will propose that the payments will not be made over the next two years, which McKinney said is similar to a homeowner not making a mortgage payment for two years.

"In short, he's doing the very same thing that he was highly critical of others for doing,'' McKinney said. "He's literally kicking the can down the road. It's impossible to deny.''

Malloy spokesman Andrew Doba said that criticisms by McKinney and House Republican leader Larry Cafero were misguided.

"In an attempt to begin budget negotiations in a bipartisan manner, [the governor's budget advisers] briefed Republican leaders on the proposal earlier today,'' Doba said Tuesday. "It's unfortunate that Sen. McKinney and Rep. Cafero used that confidential briefing and their ambitions for higher office to serve as an opportunity to leak half truths about the governor's budget. It may not fit in with their political agendas, but tomorrow the governor is going to present a balanced budget with no new taxes, one that grows our economy and creates jobs."

McKinney, who is considering a run for governor, did not attend the briefing, but said that his staff members did not believe it was confidential.

The key taxes that were set to expire are the levy on power plants that runs out on June 30 and a 20 percent surcharge on corporate profits that expires on Dec. 31. Republicans have argued for years that any taxes on business, whether a nuclear power plant like the Millstone complex or a major corporation like Fairfield-based General Electric, will be passed on to consumers.

Republicans said Malloy will balance the budget with borrowing and refinancing. Republicans received the briefing verbally and did not receive any paperwork with details.

Malloy's stance on the taxes due to expire is certain to set off a political battle at the Capitol because the governor has said for months that he had no intention of raising taxes. The definition of a tax increase came up recently when Malloy talked to reporters about his budget plan. When he was asked whether he believes that extending taxes due to expire is a tax increase, Malloy said no.

"What I've said is I don't plan on raising taxes,'' Malloy said recently. "It doesn't mean that every tax that would otherwise expire will expire.''

But Cafero said last week that he believes the moves would definitely constitute a tax increase.

"By definition – you could have a person down from Mars – if you have a tax that's set to sunset, that means in the year it sunsets, the tax should not exist,'' Cafero said. "When you continue the tax, it is a tax that was not supposed to be there. By definition, that's an increase. So is it a tax increase? Sure, it is.''

The taxes due to phase out generate more than $360 million over the two-year budget cycle.

Cafero said Tuesday that businesses want the legislature to maintain a steady hand over taxes so that they can properly plan into the future and not get blind-sided by unexpected changes.

Hartford Courant - Tuesday, February 05, 2013
READER SUBMITTED: Congressman Courtney Announces Renewal Of Medicare Dependent Hospital Program
By Steve Coates, Windham Hospital Windham

Willimantic- -- Congressman Joe Courtney (D-CT 2nd District), joined by Windham Hospital and Natchaug Hospital President and CEO Steve Larcen and hospital staff, announced today the renewal of the Medicare Dependent Hospital (MDH) program, restoring $5.2-million to the hospital and ensuring that Windham Hospital will continue to offer a full range of essential medical services to residents of eastern Connecticut.

Earlier this month Congress, as part of the "fiscal cliff" legislation, agreed to renew the MDH program thanks in part to a push by Congressmen Courtney and Congressman John Larson, a member of the House Ways and Means Committee. The program expired on Sept. 30, 2012.

MDH provides enhanced reimbursement for small rural hospitals that have at least 60-percent of inpatient days or discharges covered by Medicare. Small rural hospitals are more vulnerable to inadequate Medicare payments than other hospitals, because they are less able to cross-subsidize with private payer reimbursements. As such, Congress established special payment protections to buttress these hospitals. Windham Hospital is the only hospital in the state and one of 212 nationwide that meet the criteria supported by MDH.

"Windham Hospital has long provided high-quality, cost-effective care to the residents of Windham and surrounding counties," said Congressman Courtney. "The Medicare Dependent Hospital (MDH) program, which expired last October, has helped ensure fair Medicare reimbursements for this care. Fortunately, the American Taxpayer Relief Act included a year-long extension of the MDH program, upholding an obligation for fair Medicare payments to Windham and dozens of other hospitals and ensuring that Medicare beneficiaries continue to receive the quality care they need and deserve."

The $5.2-million in funding from MDH represented about 6-percent of Windham Hospital's operating budget in 2012.

"The loss of funding through the Medicare Dependent Hospital program would have been devastating in our effort to provide critical health care services to residents of eastern Connecticut," said Larcen. "I thank Congressmen Courtney and Larson for their commitment and determination to ensure the people of eastern Connecticut have access to world-class care right here in the community and that Windham Hospital remains a vital component of the local economy."

The provision in the "fiscal cliff" legislation extends the MDH program until Oct. 1, 2013.

Hartford Courant - Tuesday, February 05, 2013
READER SUBMITTED: Manchester Family Of Organ Donor Recognized At Hartford Hospital Gala
By Alisa Gaudiosi, Alliances by Alisa Media Relations Manchester

Maureen Foley-Roy of Manchester, whose daughter Caitlin Roy of East Granby was an organ donor, was recognized at Hartford Hospital's Black & Red annual fundraising gala on Jan. 5 at The Bushnell to benefit the Transplant Program. More than 1,300 attendees helped to raise approximately $950,000. Hartford Hospital has joined forces with the Donate Life New England Donor Register to help register 1,000 new organ donors.

LifeChoice is a federally designated organ procurement organization (OPO) that serves six counties in Conn. and three counties in Western Mass., with a combined population of 2.2 million people. You can register as a donor and learn more at

Hartford Courant - Tuesday, February 05, 2013
READER SUBMITTED: Hartford Federal Credit Union Donates Over 200 Hats & Gloves
By Maria Carducci, Hartford Federal Credit Union Greater Hartford

Hartford Federal Credit Union employees helped out in January by donating over 200 winter hats, gloves, and scarves to the St. Francis Hospital Coat Drive. All items were distributed to local residents in need by the St. Francis Hospital Emergency Food Bank, which offers support to patients of the Saint Francis clinics and to people in the community that have been referred from other agencies and the 211 information hotline.

Hartford Federal, headquartered in Hartford, serves more than 13,000 members with locations at 964 Asylum Avenue in Hartford, 244 Trumbull Street in Downtown Hartford, 29 Albany Turnpike in West Simsbury, and 1665 Ellington Road in South Windsor.

Membership is open to anyone who lives, works, worship, or attends school in Hartford, Middlesex, and Tolland County as well as their family members. Hartford Federal offers a wide range of services including competitive loan and savings products, no-fee programs such as checking accounts and home and mobile banking. For more information, visit the website at

Hartford Courant - Tuesday, February 05, 2013
READER SUBMITTED: McLean Joined The St. Francis Hospital CJRI In Operation Walk USA
By Freddi Hoffmann, McLean Simsbury

McLean joined the St. Francis Hospital Comprehensive Joint Replacement Institute in Operation Walk USA. Arthritic disease is the most common cause of disability in the United States and now affects 46 million Americans, or more than 21 percent of the adult population. The debilitating pain of end stage hip or knee degenerative disease makes even the most simple of daily tasks excruciating. Hip and knee replacement surgeries are the most cost-effective and successful of all orthopedic procedures, eliminating pain and restoring patients to active, productive lives. Unfortunately, these surgeries are expensive, and out of reach for the many of our under or uninsured suffering neighbors, according to Operation Walk USA.

Operation Walk USA is a non-profit medical humanitarian organization that provides free hip or knee replacement surgeries for these patients. Operation Walk USA targets patients who do not qualify for government assistance programs. Harnessing a national network of volunteer hospitals, physicians, nurses, physical therapists and others, Operation Walk USA is committed to helping those in need by restoring their mobility, self-dignity, productivity, and helping them return to their social world.

This fall the CJRI at St. Francis Hospital approached McLean to partner with them to care for a patient. Drs. Schuster and Zimmerman lead the effort, and McLean was honored to be asked to provide Post Acute care. McLean happily reports that the patient is walking again and back home after his stay.

For further information on McLean's Comprehensive Joint Replacement Program visit or call 860 658-3740 and speak with Dr. Robyn Ligotti. You may also wish to attend one of her Preparing for Joint Surgery lectures. Dates are listed on the McLean website news section.

Hartford Courant - Tuesday, February 05, 2013
READER SUBMITTED: Windham Hospital To Offer Weekly Cancer Support Group
By Steve Coates, Windham Hospital Windham

Windham Hospital will host a weekly community cancer support group beginning Wednesday, Feb. 6 from 6 to 7:30pm. The sessions, which will be held each Wednesday in the Johnson Room on the hospital's third floor, will focus on support and the sharing of experiences of life after diagnosis. All cancer diagnoses are welcome. Caregivers are also encouraged to attend. Pre-registration is preferred. Light refreshments will be served. For more information or to register, please call 860 456-6896.

Journal Inquirer - Tuesday, February 05, 2013
Windham Hospital plans women’s facility in Hebron
By David Huck

HEBRON — Windham Hospital is planning to open medical offices specializing in women’s health care on Liberty Drive in early April.

The hospital, which is part of the Hartford HealthCare Medical Group, is renovating around 2,000 square feet of space behind the Post Office that was recently vacated by Hebron Eye Care.

Two physicians from Mansfield OBGYN will be at the facility four days a week, while the hospital’s mammography and bone-density services will be available five days a week. Lab work also will be available through Clinical Laboratory Partners.

The facility will be named the Windham Hospital Women’s Health Center.

Michael Dion, a Hebron resident and vice president of patient care services, said the hospital has been looking to expand into the Hebron area for some time.

Although Hebron is only nine miles away from Windham, he said, “Our market share was not as significant as we had hoped.”

Last summer, the hospital held a focus group with about 15 women to see what health needs they were seeking to have met.

“Generally, the theme was that they wanted an office where the majority of services for women could be provided,” Dion said.

Town Planner Michael O’Leary said officials from the hospital recently introduced themselves during a networking meeting that is held at a local eatery. He said the town is excited about the opening.

“It’s a great new opportunity for the town and the residents, providing some more convenient services,” O’Leary said. “It’s a need that we’ve talked about internally here as we discussed hiring our economic coordinator.”

The facility has been issued all the permits it needs, and the space is already approved for medical offices.

“I think it’s a great opportunity for Hebron to bring services like this to the community, recognizing that the future of health care is going to be about providing ambulatory services closer to home,” Dion said.

The hospital does have a small presence already in town, as family physician Dr. Kristine Gildersleeve, who is affiliated with the group, practices in a space next to the new location.

The building is at 21 Liberty Drive, Unit A.

Norwich Bulletin - Tuesday, February 05, 2013
Malloy’s 2-year budget to cut $1.8 billion

Hartford, Conn. — Deep cuts to hospitals and changes in Medicaid eligibility are among the reductions Gov. Dannel P. Malloy is proposing in his new, two-year budget.

A budget document obtained Tuesday by The Associated Press shows the Democratic governor’s plan cuts $1.8 billion in spending from the current services section of the budget, which is the spending required by law.

Malloy, who’s scheduled to release his plan Wednesday, has been criticized by Republicans for spending initiatives that rely on borrowing.

His plan is likely to be criticized for increasing spending in the general fund - the state’s main account - by roughly 5 percent the first year and 3.7 percent the second.

Malloy’s budget director says much of the increase stems from state employee retirement health care and pension costs, and expanding Medicaid eligibility under federal health care reform.

Norwich Bulletin - Tuesday, February 05, 2013
Donations allow Day Kimball to buy new monitors

Day Kimball Hospital, of Putnam, recently bought two new vital signs monitors with money raised through a canoeing fundraiser last year.

The 2012 Paddle for a Cure event, coordinated by Lance Collins raised more than $7,000.

Boston Globe - Wednesday, February 06, 2013
Specialty drug labs in Mass. fail safety inspection
By Kay Lazar and Chelsea Conaboy

Surprise state inspections at 37 specialty pharmacies in Massachusetts show that only four have been fully complying with industry safety standards, health officials announced Tuesday, a finding that underscores concerns about the risk of drug contamination.

All 37 are similar to the Framingham compounding pharmacy blamed for the fatal outbreak of fungal meningitis last year.

Serious violations of state pharmacy regulations were found in 11 compounders, prompting the state to temporarily shut down all or part of their operations, while 21 others were cited for more minor violations. The state previously announced that Infusion ­Resource of Waltham surrendered its license in October ­after inspectors found “significant issues” in the clean rooms where sterile injectable drugs were prepared.

The Department of Public Health began the inspections in October after New England Compounding Center’s tainted steroids were linked last fall to meningitis and other infections that have sickened nearly 700 people across the country and been blamed for 45 deaths.

Patient safety specialists, who have long advocated for stricter oversight of the industry nationwide, say they are not surprised that only a fraction of the state’s sterile compounding pharmacies, which make inject­able and intravenous medications, were obeying all the rules.

“I am sure the same things would be found in other states, not just Massachusetts,” said Michael Cohen, president of the Institute for Safe Medication Practices, a Pennsylvania-based nonprofit.

“If any good can come of this tragedy at all, it is that people have awakened to the risks now.”

Yet, unlike Massachusetts, many states do not require compounding pharmacies to follow nationally accepted safety guidelines, Cohen added.

Compounding pharmacies are supposed to prepare doses and formulations of drugs for individual patients that are not available from drug manufacturers, and sterile compounders make medications that must meet the highest standards of purity.

But state officials have said that New England Compounding Center, the pharmacy that made the contaminated steroids, was mass-producing drugs and making what were supposed to be sterile injections in unsanitary facilities.

New England Compounding shut down in October, and two sister companies with common owners remain closed under temporary orders.

The state did not release ­reports Tuesday detailing the problems at the more recently cited facilities.

But Madeleine Biondolillo, director of the Health Department’s Bureau of Health Care Safety and Quality, said there is no evidence that patients have been harmed by the pharmacies’ products.

She said the range of problems discovered were not as serious as those uncovered at New England Compounding, where investigators found widespread mold in the clean rooms that produced the supposedly sterile medications.

“It’s not rocket science,” she said in an interview. “You can’t say you are a sterile compounder if you are not comporting to the guidelines.”

Biondolillo said many of the latest problems pinpointed by investigators relate to flaws in the design or operation of the companies’ clean rooms. The state historically had inspected pharmacies only when they open, expand, or receive a complaint, a process that allowed outdated designs or practices to fester until a major problem was reported.

“We are now going at it proactively,” Biondolillo said.

She noted that additional money for inspections was ­included in Governor Deval Patrick’s proposed budget. He recommended adding $1 million for the Public Health Depart­ment to hire more staff to conduct routine inspections of compounding pharmacies.

The governor has also ­ordered stricter requirements for inspectors, including that all of them be pharmacists with five years of clinical experience.

Dr. Lauren Smith, interim public health commissioner, called the results of the surprise inspections troubling, but said in a statement that the process “has led to significant corrective measures and increased compliance among sterile compounders in Massachusetts.”

Biondolillo said investigators must approve plans to correct problems, which were submitted by each of the 11 compounders issued cease-and-desist orders, before they are allowed to resume operations.

Todd Brown — executive ­director of the Massachusetts Independent Pharmacists Association, a group that represents many compounders— said that national standards for the pharmacies are open to interpretation, and he believes state inspectors are now cracking down on minor deficiencies that may have been overlooked in the past.

“I can’t fault them for taking the strictest of interpretations,” Brown said. “I totally understand it. But there could be some interpretations that are too strict.”

No products were recalled as a result of the state inspections, although the state did not conduct its own tests of medications produced in the ­facilities. A number of the facilities produce medications for nursing homes and other long-term care facilities, which could complicate efforts to trace infections or other health issues if a problem was uncovered, said Cohen, the patient safety specialist.

The four Massachusetts sterile compounding pharmacies that fully met state rules, state regulators say, are: Freedom Fertility Pharmacy in Byfield; Coram Healthcare in Norwood; BioRX in Woburn; and Critical Care Systems in Shrewsbury.

Among the pharmacies ­ordered to shut down all sterile compounding is Home Infusion Solutions in Falmouth.

Pharmacy manager Jim Hermansen said the Dec. 27 ­order noted that the pharmacy’s clean room was outdated, and that the company needed to replace Formica counters and shelves with more state-of-the-art stainless steel.

He said the state also ­requires doors that open automatically, to avoid pharmacists having to touch doors while they are preparing sterile medications.

“They may be a little picky in some cases, but the public good is the most important thing,” Hermansen said. “I think it’s a good thing in the long run.”

He said the company has submitted a plan to correct the problems and is awaiting state approval.

Also cited was Baystate Home Infusion and Respiratory Services in Springfield, which is owned by the parent company of Baystate Medical Center, but does not supply compounded drugs for the hospital.

Baystate Health said that the Dec. 12 shutdown of its sterile compounding “was not triggered by any indication of contamination, product-quality issues, or adverse events.”

It said the problems related to “general documentation, standardization of workflow, and infrastructure” and that state regulators approved its plan for corrections in January.

New York Times - Tuesday, February 05, 2013
Health Insurance Companies Get in Shape for 2014

JACKSONVILLE, Fla. — Since Patrick J. Geraghty arrived here a year and a half ago to lead the state’s largest health insurer, Florida Blue, he has expanded its operations in Medicare and Medicaid, entered arrangements with hospitals and doctors, bought a medical group, and dabbled with a new private sector marketplace that allows employees to choose plans from different insurance companies.

At the same time, he is preparing Florida Blue, a nonprofit Blue Cross and Blue Shield plan, for 2014, when most of the requirements of the federal Affordable Care Act go into effect. Insurers will have to offer a policy to anyone who wants one, regardless of their health, and will not be allowed to charge more in premiums to people with expensive medical conditions. The plans the companies offer will be highly regulated through government-run exchanges that are still getting their final regulatory touches.

Insurance companies across the country, whether national profit-making players like WellPoint and UnitedHealth Group or nonprofit Blue Cross plans in states like Arizona and Michigan, are undergoing radical change as a result. After years of focusing on selling plans to employers, rather than individual consumers, the insurers must alter course.

“It’s like Yugoslavia, and Tito just died,” said Dr. Kent Bottles, a physician and former hospital executive who is now a consultant. “The A.C.A. disrupts their business model totally, and they’re scrambling around.”

Mr. Geraghty, 53, who has worked in insurance for three decades, appears undaunted. He is tirelessly upbeat in talking about the opportunities, and challenges, facing Florida Blue.

Since joining the company as chairman and chief executive — he came to Florida from Minnesota, where he ran another nonprofit Blue Cross plan — he has held about 50 town hall meetings across the state to talk with employees about the future. “We’ve got to be smart and to be quick,” he said in an interview in his office on the eighth floor of a sprawling headquarters complex. “In the past, we’ve been slow and hanging out.”

But the Affordable Care Act and the increasing pressure on the nation’s health care system to become more efficient represent a major departure for insurers — particularly those, like Florida Blue, that have enjoyed leading positions within their states. Florida Blue has more than four million health plan customers, giving it some 30 percent of the state’s insurance market and about $8 billion in annual revenue.

“No question, the pace and magnitude of change are immense,” said Catherine P. Bessant, a Bank of America executive who is the lead director on Florida Blue’s board. The goal, she said, is to make sure the insurer is positioned “not in a defensive crouch, but very much a foot-forward position.”

Although some of its profit-making rivals, like Cigna, have been diversifying their business into overseas ventures, or into related areas like health technology, like UnitedHealth and Aetna, Mr. Geraghty said Florida Blue remained committed to its core business, through insurance and new models of care. “We know the margins in health care are shrinking,” he said, referring to insurers’ projected profitability. “This is where we are.”

Florida Blue was ahead of many of its competitors in seeing the need to appeal directly to the people it was covering. In 2006, it set up its first retail store, where people can shop for coverage, ask a question about a claim or see a nurse to check their blood pressure

The company has 11 stores today. It says it has sold tens of thousands of policies and established the locations as places where customers like Mary Duke, who said she came to the Jacksonville store once a month, can ask the same representative questions about a bill. “I don’t like to handle these things on the phone,” Ms. Duke said recently. “It is so much better face to face.”

The new health care law also promises an expansion of Medicaid, although some Republican governors, like Florida’s Rick Scott, have not yet decided whether to take the federal money because they worry about the long-term cost of enrolling more people.

Insurers, however, see the change as an opportunity for growth, especially since so many low-income people will move back and forth between the exchanges and Medicaid to find coverage. “There’s a lot of maneuvering to get into the Medicaid space,” said Jack A. Rovner, a Chicago lawyer who advises health care clients on the changing dynamics of the industry.

Some companies, like WellPoint and Aetna, recently bought insurers specializing in the Medicaid market, and Florida Blue is working with AmeriHealth Mercy, a company affiliated with Blue Cross plans that specializes in Medicaid and operates in 14 states. The two recently invested in a provider network that focuses on low-income clients, and they are bidding with the group for a contract to manage some of the state’s three million Medicaid beneficiaries.

Like many insurers, Florida Blue has also been experimenting with various ventures with hospitals and doctors. While UnitedHealth had difficulty several years ago starting a so-called medical home program, in which doctors would be paid to be responsible for better care and coordination of a group of patients, the Blue plan has already enlisted nearly 2,400 of Florida’s doctors in the program, making it one of the largest in the nation.

“Florida Blue has the same problems everyone else has,” said Dr. Michael A. Wasylik, an orthopedic surgeon in Tampa who works with insurers through the Florida Medical Association, but “they have a better trust relationship with doctors.” The local representatives are better able to address doctors’ concerns, he said.

The insurer has also announced plans to work with a number of health systems to improve the quality of care while reducing costs. Mr. Geraghty, for example, is working with executives at Moffitt Cancer Center in Tampa on an accountable care organization, in which the two would save money by, say, reducing scans or choosing an equally effective but less expensive chemotherapy treatment. “We’re trying to work on a variety of different levels here,” he said.

Florida Blue also recently acquired the Diagnostic Clinic Medical Group, a large medical group in Largo, Fla. Some of the insurer’s ventures are unlikely to work in every area of the state, Mr. Geraghty said, but it is content to experiment with different programs in different regions. “What we know doesn’t work is unilateral, and we’re going to take things and cram them into the marketplace,” he said.

“Nobody has the perfect crystal ball,” Mr. Geraghty said. “We are trying to have some very rich pilots to see what works.”

And Florida Blue has had some missteps. Working with Disney, it developed Habit Heroes, an exhibit at Epcot where children could learn healthy habits, like exercising. But the decision to develop characters like the chubby Lead Bottom led to criticism that the program was a slight to overweight children, and a new exhibit was introduced last month.

Even the way insurers offer plans to people covered by their employer is expected to change, as some companies look to private exchanges, where they may contribute a fixed amount toward the policy but let the worker choose the plan and even the insurer.

While it is far from clear that these private sector exchanges will take off, Florida Blue decided to participate in one. “There’s a lot of unknown there,” said Jon Urbanek, a senior vice president at the insurer. “There’s a lot of risk there.”

So far, the experience has been positive: the insurer says it was chosen by 90 percent of the full-time Florida employees of Darden Restaurants, owner of Olive Garden and Red Lobster, who joined in the exchange.

But Mr. Geraghty’s most immediate challenge is to prepare Florida Blue for 2014, even as he worries that the logistics will become increasingly hard as critical decisions remain unmade.

While he acknowledged that the insurer had “a lot of legwork to do” to be able to start offering plans for the exchange this October, he said he wasn’t losing sleep over the uncertainty. “I don’t rattle easily,” he said.

New York Times - Tuesday, February 05, 2013
People With Mental Illness More Likely to Be Smokers, Study Finds

People with mental illness are 70 percent more likely to smoke cigarettes than people without mental illness, two federal health agencies reported Tuesday.

New data from the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration show that one of every three adults with mental illness smokes, compared with one in five adults without mental illness.

Adults with mental illness smoke about a third of all the cigarettes in the United States, and they smoke more cigarettes per month and are significantly less likely to quit than people without mental illness, the report said. There are nearly 46 million adults with mental illness in the United States, about a fifth of the population.

“Many people with mental illness are at greater risk of dying early from smoking than of dying from their mental health conditions,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control, during a press briefing.

The report is based on information from the National Survey on Drug Use and Health, which interviewed 138,000 adults in their homes from 2009 to 2011. People were asked 14 questions to assess psychological distress and disability, and were deemed to have mental illness if their responses indicated they had a mental, behavior or emotional disorder in the past 12 months. Those with substance abuse or developmental disorders were not considered people with mental illness. The report did not include patients in psychiatric hospitals or individuals serving in the military.

People who reported smoking all or part of a cigarette in the previous 30 days were counted as smokers.

The study found that smoking rates for people with mental illness were generally higher in states where overall smoking rates were high. Utah had the lowest rate of smoking among people with mental illness — 18.1 percent — while West Virginia had the highest rate, at 48.7 percent. Smoking among people with mental illness was higher among the poor and less educated, and among American Indians and Alaska Natives, although every ethnic group had significant percentages of smokers.

The study noted several possible reasons that smoking among the mentally ill has been and remains high, including marketing by the tobacco industry and the historical use of cigarettes as an incentive to improve behavior in psychiatric hospitals.

“There are some effects of nicotine which can mask some of the negative effects of mental illness,” Dr. Frieden said. The study said that smoking can also make some medications less effective, which may then lead the person with mental illness to smoke more to quell symptoms. And it said that people with mental illness, many of whom struggle to live a financially and socially stable life, may be less able to cope with withdrawal symptoms from quitting cigarettes.

While the study did not compare trends in smoking among people with mental illness over time, Dr. Frieden and Douglas Tipperman, lead public health adviser on tobacco prevention for the Substance Abuse and Mental Health Services Administration, cited indications that smoking rates for this population have not declined nearly as quickly as smoking in the general population. Dr. Frieden called the situation “a very serious health issue that needs more attention.”

Mr. Tipperman said a recent survey in New York showed that smoking rates among people with mental illness had not changed significantly over the past decade.

Still, Mr. Tipperman said that surveys show that many people with mental illness want to quit smoking, and can quit successfully with the right approaches, which may include extra antismoking counseling or longer use of smoking cessation medications. His agency has been working to establish and encourage smoking cessation programs that work.

Wall Street Journal - Tuesday, February 05, 2013
Debt Rise Colors Budget Talks

WASHINGTON—A slowly improving economy and recently enacted tax increases will help bring down the federal deficit for the next few years, the Congressional Budget Office said Tuesday, but it will take another $2 trillion in belt-tightening over the next decade to begin to move the federal debt closer to historic levels.

The updated CBO projections landed amid budget battles in Washington, underscoring not only the distance between the White House and Congressional Republicans on spending but also the gravity of the nation's fiscal woes.

CBO projects that if Congress leaves current laws unchanged, the debt will be 77% of GDP by the end of the decade, and it will be higher if across-the-board spending cuts are diluted or various expiring tax breaks extended. (The deficit is the difference between spending and revenues in a given year; the debt is the government's total borrowing, or the sum of past deficits.)


Douglas Elmendorf, director of the nonpartisan agency that advises Congress on budget and economic matters, emphasized the risks of failing to stabilize the debt.

"At this level of debt relative to GDP, our country would be incurring costs and bearing risks of a sort that we have not [had] in our history except for a few years around the end of the second World War," he said. "At the same time, bringing debt down relative to GDP requires reductions in services that we are getting from the government, or higher taxes paid to the government."

President Barack Obama and Republicans on Capitol Hill are fighting over what do about $85 billion in across-the-board spending cuts set for March 1 and how best to reduce deficits while accelerating a torpid economic recovery.

On Tuesday, President Obama called for averting those across-the-board spending cuts, at least temporarily, with an alternative package of tax increases and spending reductions.

"There is no reason that the jobs of thousands of Americans…should be put in jeopardy just because folks in Washington couldn't come together to eliminate a few special-interest tax loopholes or government programs that we agree need some reform," Mr. Obama said.

Congressional Republicans insist that any move to waive those cuts should rely solely on alternative reductions in spending with no additional tax increases.

Getty Images

Congressional Budget Office Director Douglas Elmendorf on Tuesday announces the release of the CBO's annual budget outlook.

"Government spending is completely out of control, and it's past time for the President and Senate Democrats to drop their poll-tested gimmicks—such as raising taxes on airplanes and energy production—and join Republicans in seeking real solutions to control runaway spending and debt,'' said Senate Minority Leader Mitch McConnell (R., Ky.)

For the current fiscal year, which ends Sept. 30, CBO projected the deficit will fall to $845 billion, or 5.3% of gross domestic product, after four years of trillion-dollar-plus deficits. That is well below the 2009 peak and down from last year's deficit of $1.1 trillion, or 7% of GDP. CBO factored the $85 billion of across-the-board cuts into its projections for 2013.

The CBO report showed how much the deficit has come down—as a share of the economy, it is almost half what it was in 2009—as well as how much more it will take to restore fiscal stability.

The projections will become a measuring stick for a rapid-fire series of budget decisions on Capitol Hill. Three key dates loom for policy makers: the across-the-board spending cuts are set to bite both military and domestic spending on March 1; that is followed by a March 27 deadline for funding government operations for the rest of the fiscal year as well as a new law that withholds lawmakers' pay unless they vote by April 15 on budget outlines.

Even if Congress allows across-the-board spending cuts to kick in, sunsetting tax provisions to actually expire and Medicare doctor fees to be cut, the deficit is projected to begin increasing gradually from 2016 onward as more of the baby boom generation qualifies for Social Security and Medicare.

Measured against the size of the economy, the federal debt has doubled since the mid-2000s from a sum equal to 36% of GDP in 2007 to 72.5% last year, according to a commonly used measure that excludes Treasury bonds held in the Social Security Trust Fund.

Despite the looming deadlines, Democrats and Republicans remain far apart. Some Democrats and liberal advocacy groups say that stabilizing the debt is sufficient. They would replace the across-the-board spending cuts—which amount to about $1 trillion over 10 years—with $1.4 trillion in spending cuts, tax increases and interest savings.

Others, including Erskine Bowles and Alan Simpson, who led an Obama deficit commission in 2010, argue for reducing the debt significantly more so that the government has maneuvering room in case of recessions or emergencies.

CBO said it would take $2.4 trillion in spending cuts, tax increases and interest savings over the next 10 years to bring the debt down to 67% of GDP by 2023.

House Republican Speaker John Boehner has asked House Budget Chairman Paul Ryan (R., Wis.) to craft a budget outline that would balance the budget in 10 years. CBO said that would require about $4 trillion in deficit-reduction over the decade, significantly more than Mr. Obama is likely to propose in his new budget, to be presented early next month.

The CBO report had at least one bright spot. Federal health spending is growing more slowly than had been anticipated for reasons the nonpartisan agency can't yet explain.

Federal spending on Medicare for the elderly and disabled and on Medicaid for the poor in 2012 was about 5% below CBO's March 2010 projection. The agency's projections for the two programs in 2020 are now $200 billion, or 15%, below the earlier estimates.

The deficit projections rest on the CBO's new forecast for the economy. It sees U.S. GDP growing just 1.4% this year, measured from the fourth quarter of 2012 to the fourth quarter of 2013, even slower than last year's 1.9%.

Mr. Elmendorf said that if not for recent increases in payroll and income taxes and spending restraint, the economy would likely grow closer to 3% this year. But he said failure to restrain future deficits would hurt the economy in the long run.

CBO forecasts that the unemployment rate, now 7.9%, will remain above 7.5% through next year. That would make 2014 the sixth consecutive year with a jobless rate that high, the longest stretch of such elevated unemployment in 70 years.

But the agency said the economy is expected to snap back in 2014, with growth of 3.4%.

Wall Street Journal - Tuesday, February 05, 2013
FDA Warns of New Batch of Fake Cancer Drug

The Food and Drug Administration said Tuesday it has warned doctors that another counterfeit batch of the cancer drug Avastin has reached medical practices in the U.S.

The warning follows a string of alerts last year, when the agency told doctors that versions of Avastin sold by at least two drug-distribution networks were fakes, containing cornstarch, acetone and other chemicals andnone of the genuine drug's active ingredient.

In Tuesday's warning, the FDA said Pharmalogical, which also does business as Medical Device King and Taranis Medical, had shipped two batches of Altuzan, the Turkish brand-name for Roche Holding AG's Avastin, to American customers. At least one batch contained no active ingredient, the agency said.

"It's not accurate," Richard Gertler, an East Meadow, N.Y.,-based lawyer for Pharmalogical, said of the FDA's warnings. "It paints the client in a false light," he said. He said he couldn't immediately provide more details.

Pharmalogica, based in Great Neck, N.Y., has been a licensed drug wholesaler in New York since 2009. But, its website says it buys its products from British and European distributors, a practice U.S. drug regulators consider illegal.

The FDA said it wasn't aware of any patients who have received the drug. A spokeswoman said the agency learned of the fakes amid "ongoing investigations targeting criminal enterprises involved in drug counterfeiting activities." The agency said it was still seeking to identify which doctors purchased the medicines.

U.S. law-enforcement agencies and drug makers have been aggressively pursuing international drug distributors that sell unapproved foreign drugs to U.S. customers, resulting in two new guilty pleas in recent weeks. Even when the drugs contain the proper active ingredients, the FDA considers foreign medicines to be "unapproved" unless they are imported by the manufacturer.

Earlier batches of fake Avastin were tied through a string of overseas subsidiaries to a Canadian online pharmacy operator, Canada Drugs. There is no indication that fake medicines were sold through the company's consumer-focused website, of the company acknowledged shipping the fake Avastin but said they weren't aware the medicines were counterfeit at the time.

Avastin costs about $2,500 for a 400-milligram vial. One treatment may require a vial or more. In some cases distributors have offered discounts of up to 60% for foreign versions of costly cancer drugs. Invoices filed in an earlier court case show Pharmalogical offered to sell doctors Botox for $375 per vial. Botox's maker, Allergan Inc., sells the same product for $525.

Also Tuesday, a Boca Raton, Fla.-based drug distributor pleaded guilty in federal court in San Diego to one count of conspiracy to commit mail and wire fraud by illegally importing medicines, according to the court calendar and people familiar with the case. The distributor, Martin Bean, 63 years old,, faces up to five years in prison and forfeited a 2004 Jaguar sports car.

Mr. Bean's company, GlobalRXStore, conspired with a San Diego-based distributor to import $7 million worth of cancer drugs such as the Sanofi SA medicines Taxotere and Eloxatin, for sale to U.S. doctors, federal prosecutors allege in court documents. Prosecutors acknowledge the medicines he sold weren't counterfeits.

"His drugs were exactly the same thing the pharmaceutical companies would have imported," said Mr. Bean's court-appointed lawyer, Lynn Ball.

Late last month, a San Diego oncologist, Joel Bernstein, pleaded guilty to buying an unapproved foreign version of Roche's cancer drug Rituxan, including from another San Diego distributor earlier was named by the FDA for selling fake Altuzan. His practice also entered a guilty plea for buying the medicine with the intent to defraud Medicare. Practices that obtain drugs from overseas distributors at deep discounts can profit by billing Medicare the full price.

Dr. Bernstein's lawyer, Charles Sevilla, said his client bought drugs with "identical ingredients" to what pharmaceutical makers sell. The plea comes with fines and forfeitures totaling more than $3 million. "It's going to be very difficult to meet those requirements," Mr. Sevilla said.

Washington Post - Tuesday, February 05, 2013
As Obama calls for short-term fix to avert sequester, CBO reports falling deficits
By Lori Montgomery and Zachary A. Goldfarb

President Obama on Tuesday urged Congress to head off deep automatic spending cuts set to hit the Pentagon and other federal agencies on March 1 and replace them, at least for a few months, with a new debt-reduction package that includes fresh tax revenue.

As Obama spoke, the nonpartisan Congressional Budget Office rolled out new projections showing that the spending battles of the past two years have helped shrink record budget deficits but have also hampered economic growth.

The deficit — the annual gap between taxes and spending — is projected to fall to $845 billion this year, the first time it has come in under $1 trillion since 2008.

The improvement in the 2013 deficit is due in large part to tax increases adopted Jan. 1 and to the automatic spending cuts, known as the “sequester.” Together, the CBO said, those policies are expected to shave about 1.25 percentage points off economic growth this year and to cost the nation about 1.5 million jobs.

Obama said that he is committed to a broad effort to restrain the national debt and that past White House proposals to rein in Medicare costs and increases in Social Security benefits “are still very much on the table” as part of that effort.

But with the sequester due to hammer the fragile economic recovery in less than a month, the president said Congress should take quick action on a short-term measure to replace it, giving policymakers more time “to finish the job of deficit reduction.”

“Congress is already working towards a budget that would permanently replace the sequester. At the very least, we should give them the chance to come up with this budget instead of making indiscriminate cuts now that will cost us jobs and significantly slow down our recovery,” Obama said during an appearance in the White House briefing room.

“So let me just repeat: Our economy right now is headed in the right direction, and it will stay that way as long as there aren’t any more self-inflicted wounds coming out of Washington.”

The CBO expects the recovery to be more robust in 2014, with economic growth approaching 3.5 percent by the end of the year. But an economy subdued by government austerity is likely to have a jobless rate above 7.5 percent for a sixth straight year, the CBO said — the longest period in 70 years with unemployment above that level.

“As we look across the economy, we see momentum building,” CBO Director Douglas Elmendorf told reporters. But this year spending cuts and tax increases are forecast to “offset most of that gathering strength in the economy.”

Proposed replacements

Replacing the sequester for one month, without increasing deficits, would require about $12 billion in alternative savings. Obama declined to outline his proposal, immediately drawing fire from Republicans. The president has made clear that he expects wealthier Americans and industries with special tax advantages to shoulder some of the burden.

House Democrats have proposed replacing this year’s sequester cuts, worth about $85 billion through the end of September, with equivalent savings spread out over the next decade. Those include tax increases on millionaires and oil and gas companies, as well as cuts in farm subsidies. Senate Democrats are working on a similar plan.

Many Republicans also want to replace the sequester, particularly about $45 billion in cuts to the Pentagon in 2013 that defense officials say would devastate the military. A report last week found that the economy contracted in the fourth quarter of 2012, in part because of sharp reductions in defense spending amid concerns about the sequester.

But House Speaker John A. Boehner (R-Ohio) said Tuesday that the GOP would oppose any effort to replace the cuts with tax increases.

“There is a better way to reduce the deficit, but Americans do not support sacrificing real spending cuts for more tax hikes,” Boehner said in a statement.

The likelihood that they would have to compromise with Democrats to replace the sequester has led to a growing inclination among Republicans to simply pocket the savings and move on to other battles.

House Budget Committee Chairman Paul Ryan (R-Wis.) has predicted that the sequester will hit on schedule, making it easier for conservatives to approve a plan later in March to prevent a government shutdown. Tuesday, a parade of conservative lawmakers took to the House floor to argue for that outcome.

Chris Chocola, a former Republican lawmaker who now heads the influential Club for Growth, said in a statement: “Republicans and Democrats voted for the debt limit deal that included the sequester, and President Obama signed it into law. They should keep their promise to the taxpayers. The cuts that were promised in the sequester should be done, in whole, this fiscal year.”

Caps as well as cuts

The sequester was adopted as part of the 2011 battle to raise the federal debt limit. Lawmakers agreed to two forms of spending cuts: caps that would trim agency budgets by $1 trillion over the next decade, and automatic cuts of $1.2 trillion that would slice every government account equally, across the board, unless policymakers could agree on a broader and more sensible debt-reduction plan.

The debt-limit deal, along with tax increases enacted Jan. 1 and other spending cuts, has reduced the projected accumulation of debt over the next decade from about $10 trillion to about $7 trillion, according to the CBO, and will stabilize borrowing at around 76 percent of the overall economy by the end of this year.

But these steps still leave the U.S. debt at its highest level in history, except for the period after World War II. And the CBO predicts that the debt will begin rising rapidly again in the next decade absent sharply higher taxes or major changes to the big drivers of future borrowing: Medicare, Medicaid and Social Security.

Meanwhile, the cuts adopted so far may prove hard to sustain, the CBO said. The “fiscal cliff” deal postponed the sequester for two months by making unspecified future cuts to agency budgets and counting revenue from a tax gimmick involving Roth IRAs.

Even without the sequester, the budget caps adopted in 2011 require lawmakers to shrink agency spending to 5.8 percent of GDP in 2023 — the lowest level since at least 1962, when such data were first recorded.

“While it’s critical for us to cut wasteful spending, we can’t just cut our way to prosperity,” Obama said Tuesday. “Deep, indiscriminate cuts to things like education and training, energy and national security will cost us jobs, and it will slow down our recovery.”