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Jefferson City awaits Washington health care outcome

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Health care will once again be a big topic of discussion when the legislature returns to Jefferson City in January, but that discussion could be shaped in large part by how health care legislation plays out in Washington.

State lawmakers are closely watching the developments in the health care debate in Washington. House Majority Floor Leader Steven Tilley (R-Perryville) says what Washington decides will have a big impact on what Jefferson City considers.

“With regards to health care, we need to get our hands around what they’re wanting to do at the federal level and then, hopefully, we can do something to dovetail it from here,” Tilley says. [Read more…]

AG Koster announces additional $22 million recovery from Pfizer today

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"All-time high in Missouri’s Medicaid fraud recovery"

Attorney General Chris Koster announced today that Missouri will receive $22 million as part of the largest nationwide Medicaid fraud settlement in history. This recovery adds to Missouri’s record-breaking year for Medicaid fraud recovery, Koster says. The Attorney General’s Medicaid fraud unit has collected more than $75 million since Jan. 1 on behalf of Missouri’s Medicaid system. (The previous high total was more than $33.5 million in calendar year 2008.)

Today’s nationwide settlement is with the pharmaceutical company, Pfizer, and its subsidiaries. Missouri, in conjunction with the United States Justice Department and other Attorneys General, alleged that Pfizer and its subsidiaries paid kickbacks and engaged in off-labeling marketing campaigns that improperly promoted numerous drugs that Pfizer manufactures.

"Pharmaceutical companies are a critical player in Missouri’s health-care system, and like every other part of the system these companies must play by the rules," Koster says.

Pfizer will pay the states and the federal government a total of $1 billion in civil damages and penalties to compensate Medicaid, Medicare, and various federal healthcare programs for harm suffered as a result of its conduct.

In addition, Pharmacia & Upjohn Company, Inc., a Pfizer subsidiary, has agreed to plead guilty to a felony violation of the Food, Drug, and Cosmetic Act and to pay a criminal fine and forfeiture of $1.3 billion. The criminal component of the agreement centers on the illegal marketing and promotion of Bextra, an anti-inflammatory drug that Pfizer pulled from the market in 2005. Because of the illegal promotion, Pharmacia & Upjohn Company, Inc. has agreed to plead guilty to a felony violation of the FDCA for misbranding the drug with the intent to defraud or mislead.

The states and federal government alleged that Pfizer, the largest pharmaceutical manufacturer in the world, engaged in a pattern of unlawful marketing activity to promote multiple drugs for certain uses which the Food and Drug Administration had not approved. While it is not illegal for a physician to prescribe a drug for an unapproved use, federal law prohibits a manufacturer from promoting a drug for uses not approved by the FDA. This promotional activity by Pfizer included:

– Marketing Bextra for conditions and dosages other than those for which it was approved;

– Promoting the use of the antipsychotic drug Geodon for a variety of off-label conditions such as attention deficit disorder, autism, dementia and depression for patients that included children and adolescents;

– Selling the pain medication Lyrica for unapproved conditions;

– Making false representations about the safety and efficacy of Zyvox, an antibiotic only approved to treat certain drug resistant infections.

In addition, Pfizer is alleged to have paid illegal remuneration to health care professionals to induce them to promote and prescribe Bextra, Geodon, Lyrica, Zyvox, Aricept, Celebrex, Lipitor, Norvasc, Relpax, Viagra, Zithromax, Zoloft and Zyrtec. These payments allegedly took many forms, including entertainment, cash, travel and meals. Federal law prohibits payment of anything of value in exchange for the prescribing of a product paid for by a federal health care program.

As a condition of the settlement, Pfizer will enter into a Corporate Integrity Agreement with the United States Department of Health and Human Services, Office of the Inspector General, which will closely monitor the company’s future marketing and sales practices.

Listen to interview with Joe Dandurand, assistant to Attorney General Koster, below.


Jessica Machetta interviews Joe Dandurand, assistant Attorney General [Download/listen MP3 – 8 min.]

Kids Count report: child abuse down, high school dropouts up

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The annual KidsCount report is out. It provides county-by-county data on the health and wellbeing of Missouri’schildren.

While child abuseand neglect cases in Missouriare down from last year, high school dropout rates are higher.

The Kids Countreport compares information and statistical trends on the conditions of ourstate’s children and families in all 114 counties and the City of Saint Louis.

St. Charles County,just outside of St. Louis,did the best this year. Not the case just a few miles away. St. Louis City scored lowest "across the board," says Scott Gee, director of Citizens for Missouri’sChildren. He says the areas that ranked the lowest are also the state’spoorest.

However, St. Louis did improve its numbers in all categories — save high school dropout rates — over last year.

The report breaksdown the rates for infant mortality, low birth weight, teen pregnancy, students on free or reduced lunches, babies born to mothers without a high school diploma, child deaths, children removed from homes, and violent deaths to teens.

The study also provides a breakout for various economic factors, demographics, family support systems, health and mental health.

For example, St. Louis had 1,226 high school dropouts, or 11.6 percent. St. Charles County had 449 dropouts, or 2.8 percent.

The report states that every day in Missouri:
18 babies are born with a low birth weight
41 children are born to mothers who lack high school diplomas
2 babies die before their ?rst birthday
15 children are removed from their homes
127 children receive attention from the Mo. Department of Social Services
   due to reports of child abuse and neglect
1 child or teen dies
29 teens drop out of school
25 teens between the ages of 15 and 19 give birth
212,369 children live in poverty

Gee says the reportserves local and state policymakers, as well as not-for-profits at the locallevel in identifying needs and boosting certain programs.

To see how your county ranks and individual breakdowns, visit the Citizens for Missouri’s Children Web site.

 

Jessica Machetta reports [Download/listen MP3]

House, in rare move, adjourns early on next-to-last day

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In a rare move, the House adjourned on the next-to-last day of the legislative session at 4:30pm, extremely early as the session winds down from days to hours.

House Majority Floor Leader Steve Tilley (R-Perryville) says the House simply ran out of legislation to work on, since major bills now are in conference with the Senate. Two big bills hang in the balance of negotiators this evening: the jobs bill and a health care measure. Some have speculated that the two are linked, though no one has confirmed that.

The economic development bill has taken many forms and has been a source of contention between the House and Senate. The House moved quickly on economic development, approving HB 191 in early February. The Senate never brought the bill to a vote after several senators raised concerns about the effectiveness of tax credits. A stripped down version moved through the House, but also stalled in the Senate. Hopes now are pinned on SB 377 , which includes tax credit reform.

The health care legislation, SB 306 , took an odd route to become a center-piece of this legislative session. The House rejected a proposal by Governor Nixon to expand Medicaid eligibility to 35,000 Missourians even though the proposal would not have cost the state any general revenue. The plan envisioned using a voluntary increase in the hospital provider tax totaling $52 million to draw down about $94 million in federal funds. That would have been enough to raise Medicaid eligibility to 50% of the federal poverty level.

The dispute over the Medicaid expansion plan threatened to derail the $23 billion state budget. A compromise worked out between House and Senate negotiators dropped the Medicaid proposal in exchange for a promise by House leadership to consider a different approach, SB 306. The House is pushing to essentially expand the state high-risk pool to cover approximately 100,000 Missourians considered uninsurable, because of pre-existing conditions. It would also extend coverage to about 21,000 poor Missourians now without health coverage.

Tilley says the House also is interested in a local government bill, a transportation bill and a judiciary bill.

Download/listen House Majority Floor Leader Steven Tilley (R-Perryville) on early adjournment (2 min MP3)

Health care measure moves forward

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A health care measure moves forward in the House, barely, and heads for a conference with the Senate as time runs out this legislative session.

The House narrowly approved HCS SS SCS SB 306 , with only one vote to spare. This bill rose higher on the priority list when House members balked at expanding Medicaid. House leadership agreed to consider SB 306 in exchange for the Senate dropping an expansion of Medicaid from the social services budget. That agreement allowed the budget to be approved last week.

Rep. Doug Ervin (R-Kearney) sponsors the bill in the House. He told colleagues during House floor debate that the state needs to expand the Show Me Health Care Initiative.

"There’s some who advocate that we should just do a straight Medicaid expansion. I’m not in that camp," Ervin said. "There are others who advocate that we should take a free-market approach and cover those healthy adults, able-bodied adults. I’m still not buying that."

Ervin said that SB 306 provides a framework for health care for those earning up to 225% of the federal poverty level. To receive benefits from the Show Me Health Care Initiative, a person must qualify for the high-risk insurance pool by being without insurance for six months. Ervin said that while the proposal to expand Medicaid would have covered 35,000 Missourians, the provisions in this bill would provide a way for 21,000 poor Missourians to receive health care coverage while providing health insurance access to approximately 100,000 Missourians who cannot get health insurance due to pre-existing conditions.

The formula for who would receive coverage and how the state would pay for the program is rather complicated; prompting Rep. Mary Still (D-Columbia) to says Medicaid expansion would have been a simpler route.

"This plan does very little to help hard-working, but low paid folks afford insurance," Still stated during House floor debate.

Differences between the House and Senate approach to health care must be worked out in the next three days to pass this legislative session.

Download/listen Brent Martin reports (:60 MP3)

House Republicans accuse Governor of improper lobbying

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House Republicans accuse Governor Nixon of crossing the line in lobbying for an expansion of Medicaid.

House Speaker Pro Tem Bryan Pratt (R-Blue Springs) took to the floor to criticize Nixon Administration lobbying on the social services budget. Pratt even made reference to the alleged federal investigation underway at the Capitol.

"Oh, how I wish the FBI was wondering the halls today," Pratt stated during a floor speech. "You know what they would find? The FBI would find, walking the halls today, comments from the governor’s office; ‘What do you need?’ ‘What can I do for you?’ ‘Can I give you a job is there something special I can give to you?’"

Pratt’s comments fanned the flames of an already emotional and tense House, which had lost decorum. Members quit listening quietly to each other speak, but applauded statements with which they agreed, shouted and booed those they didn’t and even let out a few catcalls. The contentious day ended with defeat of HB 11 , sending it back to conference with the Senate.

Less than a minute into his floor speech, Pratt was interrupted by Minority Floor Leader Paul LeVota (D-Independence) who raised a point of order.

"I would like to ask the Pro Tem to apologize to our elected governor, the person who represents our state for any type of wrongdoing," LeVota demanded. "That’s shameful!"

Pratt continued, expanding on his accusation against Governor Nixon and his administration.

"At the very best, the comments about this bill around the Capitol today, at the very, very best are sleazy and distasteful," Pratt said. "At the very worst, it’s a violation of the law."

More interruptions occurred. More Democrats raised points of order, objecting strongly to the accusation.

Pratt afterward expanded on his accusations in interviews with Capitol reporters, saying that Nixon Administration lobbyists made inappropriate comments to at least two freshmen Republican state representatives.

Freshman Republican Chris Molendorp (R-Raymore) said Governor Nixon Deputy Chief of Staff Dustin Allison seemed to offer a job for his vote.

"They were hopeful I could vote for this (HB 11) and if I was interested in a future career change, he was sure the governor would view that very favorably," Molendorp said.

Molendorp said he agonized over HB 11, stating he was torn by the bill. Molendorp speculated the governor’s office might have targeted him, because he is a former member of a local hospital board and is a health insurance agent.

Fellow Republican freshman Anne Zerr (R-St. Charles) told a similar story, saying she was approached by State Labor and Industrial Relations Department lobbyist Chris Moreno about HB 11.

"Then the young man said, ‘You know, the governor likes to reward people who share his views.’" Zerr said. She said she told Moreno she couldn’t support the bill. "And then, the young man said ‘I’m prepared to make a deal right now.’"

Zerr speculated that she was targeted, because of her moderate voting record.

Governor Nixon’s spokesman, Jack Cardetti, denied the charge, though he confirmed that Allison spoke with Molendorp about HB 11 .

"Dustin pulled the representative off (the House floor) and talked to him about how important this was to the governor, but at no time did he offer anything in exchange for that vote," Cardetti told the Missourinet.

Cardetti also acknowledged that Moreno spoke with Zerr, but he denied Moreno offered Zerr a deal in exchange for a vote.

"So certainly, people from the governor’s office from the administration lobbied both Republicans and Democrats, but at no time was anything ever promised or exchanged for that vote," Cardetti said. "We wanted them to vote on that based on what was best to move the state of Missouri forward."

Cardetti said the accusation made by Pratt was clearly meant to be a distraction from the issue, which he said was expanding Medicaid to 35,000 Missourians at no cost to the state. HB 11 contained a provision that would leverage a voluntary increase in the hospital tax to draw down federal funds.

Cardetti insisted the administration never offered any representative anything in exchange for a vote.

Download/listen Brent Martin reports (:60 MP3)
Download/listen Speaker Pro Tem Pratt makes accusation on House floor (9 min MP3)
Download/listen Nixon spokesman Jack Cardetti response (4 min MP3)

Compromise reached to keep budget process moving

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A compromise has been reached to move the budget process along and complete the $23 billion state budget by tomorrow evening, but whether it will expand health care remains to be seen.

Appropriations/Budget Committee Chairmen: Senator Gary Nodler (L) and Representative Allen Icet (R) The House rejected on a party-line vote HB 11 , the social services budget that contained a provision to expand Medicaid to cover an additional 35,000 Missourians. The expansion relied on an additional hospital tax; still House Republicans saw it as an unnecessary expansion of Medicaid. After the rejection of HB 11, House Budget Committee Chairman Allen Icet (R-Wildwood) requested the Senate return to the negotiating table.

Senate-House budget negotiators reconvened in the Legislative Library at the Capitol in an effort to hammer out a compromise that could keep the budget process moving while considering an expansion of health care coverage. Negotiators have agreed to remove an expansion of Medicaid in the social services budget, which would allow HB 11 to pass the House. In exchange, the House has agreed to consider SB 306 , a more market-drive expansion of health care.

House Budget Committee Chairman Allen Icet of Wildwood says it’s an effort to resolve a problem that threatened the budget process. He said it was a compromise between doing nothing after the rejection of HB 11 in the House and the Senate position of expanding Medicaid.

"We’re agreeing to try to do something through SB 306, to reach that compromise," Icet told reporters after the conference committee meeting.

Majority House Republicans rejected the proposed Medicaid expansion, but Democrat Chris Kelly of Columbia, a House budget negotiator, agreed to the deal even though it’s unsure what the results might be.

"I think there are people of good faith on the other side; Republicans of good faith," said Kelly. "They have to move a difficult caucus on this. And so, we can’t drop the ball this early."

The question remains: can Icet deliver Republican votes for the Senate bill to expand health care?

"I will certainly try, because I’ve agreed to this," said Icet.

House Majority Floor Leader Steve Tilley (R-Perryville) told reporters he plans to bring SB 306 before the House Monday and send it to conference to see if an agreement can be reached that is acceptable to the House, the Senate and the governor’s office.

Download/listen Brent Martin reports (1:15 MP3)

Harsh debate on House floor prior to rejection of Medicaid expansion

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Emotional, heated, and harsh all describe debate on the House floor as the House rejects a proposed expansion of Medicaid contained in the social services budget bill.

Republicans in the House use their majority muscle to defeat HB 11, the social services budget bill that contained an expansion of Medicaid. The proposed expansion relied on an increase in the tax paid by Missouri hospitals. The $52.6 million raised through the increased hospital tax would be used to draw down $94.2 million in federal funds to provide coverage for Missourians making up to 50% of the federal poverty level, approximately 35,000 more Missourians.

Despite the fact that the proposal relied on an increase hospital tax, not an increase in General Revenue dollars, Republicans attacked it as an unnecessary expansion of Welfare.

Opposition by Republicans to HB 11 was well known prior to the bill coming to the floor for debate.

Rep. Mary Still, a Democrat from Columbia, noted the packed chamber prior to the vote.

"And it as if the majority party has come in for the kill," Still said of Republicans. "And it turns my stomach."

The House defeated the measure 75-85 on a mostly party-line vote.

Rep. Mike Talboy (D-Kansas City) spoke on the floor after exchanges had already gotten heated. He turned up the heat even more, refusing to call the proposal an expansion of Medicaid.

"In reality, it simply is a restoration of all the mistakes that were made in 2005," Talboy said, referring to cuts to Medicaid House Republicans pushed through that year to balance the state budget. "And the cruel and unchristian and unfair tax cuts…"

With the use of the term "unchristian" boos descended from Republicans, nearly drowning out Talboy and Speaker Pro Tem Bryan Pratt (R-Blue Springs) who he was debating.

Republican Tim Jones of Eureka even took note of the tenor of debate before speaking on the floor.

"Mr. Speaker, it sounded a little bit more like the House of Commons here today," Jones said, referring to the daily question period in Britain’s House of Commons which is often very lively, sometime raucous.

House Budget Chairman Allen Icet (R-Wildwood) brought the conference committee report of HB 11 to the floor for debate, even though he refused to sign the report. No House Republicans on the conference committee signed the report, a sign they didn’t agree to its contents.

Icet told colleagues he couldn’t accept the Medicaid expansion in the bill.

"I filed the bill, because I wanted to give the body the opportunity to debate the bill," Icet said to close debate on the bill. "But, Mr. Speaker, it is with a heavy heart that I encourage my colleagues to vote against HB 11"

After the House rejected the bill, Icet moved to return to a conference with Senate budget negotiators, which the House agreed to and the Senate accepted. Conference members worked out a compromise designed to move the budget process along so it can be completed by the Friday 6pm deadline. The House will consider than compromise Thursday morning. The deal puts the question of health care expansion off until next week, when the House and Senate will try to reach an agreement on SB 306 .

 

Download/listen Brent Martin reports (1:11 MP3)

House appears ready to reject Nixon health care plan

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It appears the House is set to reject Governor Nixon’s proposal to expand health care coverage even though it won’t cost the state anything.

Governor Nixon announced the plan earlier this month during news conferences held at health centers across Missouri. Nixon has reached an agreement with the Missouri Hospital Association to raise a tax hospitals pay by a total of $14 million, allowing the state to draw down $93 million from the federal government.

"This is a tremendously good idea and a generous offer by Missouri’s hospitals," says Rep. Chris Kelly, a Democrat from Columbia. Kelly, though, hasn’t been able to convince majority Republicans, though he holds out hope minds still can be changed.

"The extreme right in the Republican Caucus is driving the Republican Caucus away from rationality," according to Kelly who says hospitals have agreed to the plan, because it makes financial sense. Hospitals, according to Kelly, have to absorb the cost of the uninsured. He says it makes sense then to raise a tax they are paying to expand health care coverage to nearly 35,000 Missourians.

Under the plan, the tax hospitals currently pay would increase in order for Missouri to qualify for the $93 million. Hospitals also would not seek $32 million in reimbursement the state would normally provide as partial payment for treating the uninsured. The governor’s office says all that is needed to increase coverage is for Medicaid eligibility in the budget to be increased from the current 19% of the federal poverty level to 50%. That though isn’t in the current budget set to come to the floor for debate this week.

At present, a single parent with two children qualifies for Medicaid if her income doesn’t exceed $292 a month. The proposal by the governor would increase that to $763 a month.

The legislature created the medical service provider tax in 1992 to draw down federal dollars. Kelly, who served in the House previously, sponsored the legislation, carrying it on behalf of then-Governor John Ashcroft, a Republican. Kelly says it’s the most significant legislation he has ever sponsored, saving the state billions of dollars over the years.

Kelly says it seems apparent that supporters of the plan have some more educating to do to get it to pass this session.

Download/listen Brent Martin reports (1:10 MP3)

Hospitals see increase in uninsured, underinsured emergency room patients

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The Missouri Hospital Association reports a dramatic increase in uninsured and underinsured patients checking into emergency rooms.

Spokeswoman Mary Becker says the problem is multi-faceted and that employers have been offering less insurance to employees for a few years now as premiums have gone up. The economic recession, she says, has merely exacerbated the problem.

State budget shortfalls could further financially impact patients and hospitals if cuts are made to the Medicaid system.

Click the sound icon below to listen to Mary Becker explain how this problem facing Missouri hospitals financially impacts everyone in the end.

 

Mary Becker, Missouri Hospital Association [MP3]