(Kansas City, Kan., Aug. 9, 2011) - EPA has awarded the Iowa Department of Agriculture and Land Stewardship (IDALS) $30,000 to assist with outreach, education and implementation of the Clean Air Act's Risk Management Program. All fertilizer facilities that handle, process or store more than 10,000 pounds of anhydrous ammonia are subject to EPA's chemical safety requirements. There are approximately 700 agricultural retail anhydrous ammonia facilities in Iowa.

"This grant is designed to prevent releases and protect the health and safety of area residents, and enhance communications with local emergency responders and regulated facilities," said Karl Brooks, regional administrator. "IDALS is receiving this funding to conduct on-site audits, workshops and follow-up safety assessments at agricultural retail anhydrous ammonia facilities in Iowa."

Anhydrous ammonia is generally safe provided handling, storage and maintenance procedures are followed. However, it is toxic and can be a health hazard. Inhaling anhydrous ammonia can cause lung irritation and severe respiratory injuries.

EPA Region 7 receives more accidental release reports for ammonia than for any other chemical.  In addition to releases caused by transportation accidents, human error and equipment failure, a number of releases have been caused by anhydrous ammonia thefts. Anhydrous ammonia is a key ingredient in the illegal production of methamphetamine. When stolen, the toxic gas can be unintentionally released, causing injuries to emergency responders, law enforcement personnel, the public and the criminals themselves.

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WASHINGTON - Sen. Chuck Grassley today urged a key federal agency not to dilute a long-awaited transparency rule that would help disclose financial ties between medical researchers who receive billions of dollars in federal funding and the pharmaceutical industry.

"The public's business ought to be public," Grassley said.  "Transparency is a backstop against research that's compromised by doctors' self-interest, to the detriment of consumers.  Backsliding on transparency would undermine the good work done in recent years to shine a light on these financial relationships."

Grassley wrote to the Office of Management and Budget in response to a media report that the agency is proposing to weaken transparency rules proposed in May 2010 by the Department of Health and Human Services.  According to the article, the Office of Management and Budget is removing the requirement in the proposed rule for a publicly available website that would publish the outside financial interests of researchers funded by taxpayers. 

The Department of Health and Human Services includes the National Institutes of Health (NIH), which is the primary means of federal funding of medical research at universities and large medical centers.  The President's proposed budget for the National Institutes of Health for 2012 is $32 billion, with about 83 percent dedicated for research around the country.

In 2007, Grassley began looking into whether universities have disclosed their professors' outside financial interests and found several cases indicating that more transparency might be helpful, including:

--The chair of the Psychiatry Department at Emory University failed to report hundreds of thousands of dollars in payments from a pharmaceutical company while researching that same company's drugs with an NIH grant.  The Health and Human Services Office of the Inspector General is now investigating the matter.

--The chair of the Psychiatry Department at Stanford University received an NIH grant to study a drug while partially owning a company that was seeking Food and Drug Administration approval of said drug.  He was later removed from the grant.

--Three psychiatrists at Harvard University failed to report almost a million dollars each in outside income while heading up several NIH grants.  Harvard released a report on the matter, and a briefing has been scheduled with Grassley's office.

Also, the Inspector General for the Department of Health and Human Services concluded that the NIH doesn't adequately monitor its outside grants for conflicts of interest.

A law enacted last year through Grassley and Sen. Herb Kohl will require public disclosure of drug company and medical device manufacturer payments to doctors, starting in March 2013. 

The rule proposed for NIH grants would require the research institutions to determine potential conflicts of interest grant by grant, such as whether the doctor owns shares in a company that could cause bias in his or her federally funded research.  The details would have to be posted online for public access. The Office of Management and Budget is proposing to eliminate the online requirement, according to a media article. 

"If the online requirement is gone, it will be much harder for the public to see and use this information," Grassley said. "Without public scrutiny, we'd lose a valuable layer of oversight."

The text of Grassley's letter is available here.

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New Law Ensures Injured Student-Athletes Do Not Return to Play Without Medical Clearance and Increases Critical Head Injury Education

CHICAGO - JULY 28, 2011. Governor Pat Quinn today signed comprehensive legislation that will help protect Illinois' student-athletes from concussions and other brain injuries. The new law ensures that athletes who receive a concussion will not be allowed to return to play or practice until they are evaluated and receive written clearance from a licensed health professional. Additionally, the law ensures that student-athletes, their parents and their coaches are able to recognize the signs of a concussion.

"The desire to compete must never trump the safety of our student athletes," Governor Quinn said. "This new law will ensure that student-athletes, parents and coaches recognize the symptoms and understand the risks of concussions, so that they can prevent a more serious, lasting injury."

House Bill 200, sponsored by Illinois House Minority Leader Tom Cross (R-Oswego) and Sen. Kwame Raoul (D-Chicago), requires each school board in Illinois to adopt a concussion policy that complies with Illinois High School Association (IHSA) guidelines. Those guidelines prevent students who are removed from a game or practice due to a possible head injury from returning without being evaluated and cleared by a medical professional. 

The new law also requires all school boards in the state to partner with the IHSA to develop clear guidelines and materials to educate coaches, student athletes and their parents about concussions. In addition, the bill encourages park districts to educate about the dangers of concussions. 

"I am so thankful to the many groups, athletes and parents who came together to help this bill get to the point where it is being signed today by the Governor," said Rep. Cross. "We are hopeful that this new law will raise awareness for our youth in Illinois when it comes to these devastating and sometimes fatal head injuries."

"We have seen too many disturbing stories about the long-term negative impact of concussions," said Sen. Raoul. "From junior football to youth hockey, from girls' basketball or soccer to gymnastics, this new law will help make sure that young athletes are better protected from potentially life-altering head injuries."

CDC research indicates that sports are the second-leading cause of brain injury in young adults 15-24, and that more than 40 percent of high school athletes returned to play before fully recovering from a concussion. Former Chicago Bears guard Kurt Becker, a member of the 1985 championship team and proponent of the legislation, testified before an Illinois House of Representatives' committee on the effects of head injuries that can last a lifetime. Concussion, defined as a type of traumatic brain injury that interferes with normal function of the brain, creates long-term detrimental health effects that are especially harmful for teenagers.

House Bill 200 goes into effect immediately and has already begun to generate results. Chicago Public Schools has distributed concussion awareness materials to all CPS schools and begun to hold meetings with the IHSA to discuss next steps for implementation. 

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Friday, July 22, 2011

For your information, a copy of the letter sent today from the U.S. Center for Medicare and Medicaid Services to the Iowa Insurance Commissioner is attached.

As described in the letter, the federal government has approved Iowa's request for a waiver from the medical loss ratio requirements of the Affordable Care Act of 2010.

The new health care law basically requires states to change the requirement of plans in their states to spend more money on care and less on administration and reserves.  As a practical matter, it could run small carriers out of the state.  The potential market disruption has led a number of states to seek waivers of the medical loss ratio requirement until 2014.  Maine and New Hampshire already have waivers.  Today North Dakota was turned down.  Kentucky was effectively turned down, as well.  Iowa was partially approved.

Here is a comment from Sen. Grassley:

"The purpose of this waiver is to allow Iowa to have different medical loss ratios for insurers than would have been required under the health care overhaul enacted last year.  Without this waiver, because of the mandates in the new law, insurers likely would have left the state, leaving Iowans with fewer health coverage options.  The need for this kind of waiver emphasizes that it should be up to states to regulate their insurance markets.  The 2010 health care needs to be repealed and replaced with policies that allow coverage that fits the needs of different marketplaces."

Here is a fact sheet from the Centers for Medicare and Medicaid Services:

Medical loss ratios apply to all health insurance plans, including job-based coverage and coverage sold in the individual market. However, insurance plans in the individual market often spend a larger percent of premiums on administrative expenses and non-health related costs than job-based health plans do.

Recognizing the variation in local insurance markets, the Affordable Care Act allows States to request a temporary adjustment in the MLR ratio for up to three years, to avoid disruptions to coverage in the individual market. This flexibility allows consumers to maintain the choices currently available to them in their State while transitioning to a new marketplace where they will have more options for coverage and more affordable health insurance through State-based Health Insurance Exchanges. This is one of many ways the Affordable Care Act is building a bridge from today's often disjointed and dysfunctional markets to a better health care system.

HHS has set up a transparent process for how States can apply for an MLR adjustment and what criteria will be used to determine whether to grant those requests. States must provide information to the Department of Health and Human Services (HHS) showing that requiring insurers in their individual market to spend at least 80 percent of their premiums on medical care and quality improvement may cause one or more insurers to leave the market, reducing access to coverage for consumers. States must also show the number of consumers likely to be affected if an adjustment is not granted and the potential impact on premiums charged, benefits provided, and enrollee cost-sharing. All State application materials are posted on the HHS website.

Iowa's Department of Insurance requested an adjustment of the 80 percent MLR to a 60% MLR standard for 2011, 70% for 2012, and 75% for 2013. 

Three of Iowa's dominant issuers, Wellmark, Time and American Family -with 88% of Iowa's individual market share- are not expected to be impacted by the 80% MLR standard.  Wellmark and American Family both had a 2010 MLR of well above 80% and while Time had a 2010 MLR below 80%, it does not expect to owe rebates in 2011 or beyond.  Enrollees in these plans will not be affected by the new 80% MLR standard.

However, the remaining three smaller issuers that would owe rebates in 2011, Golden Rule, Coventry, and American Republic - comprising 5.4% of the market share - have MLRs of 48% to 68%.  These three smaller issuers also reported relatively high commissions, validating Iowa's concern that they may have difficulty adjusting their business models to meet an 80% standard as a result of being locked into binding multi-year agent commission and provider contracts.  Some or all of these three issuers could be impacted by meeting an 80% standard and could withdraw from the market, potentially leaving roughly 15,000 enrollees without coverage.

At the same time, the information provided in Iowa's application makes it clear that issuers can meet a higher MLR than it requested for 2011, 2012 and 2013.

Of the six issuers expected to owe rebates in 2011, five have MLRs above Iowa's requested 2011 adjustment to 60%, and three of those 5 have MLRs above 67%.

For these reasons, Iowa is granted an alternative adjustment of 67% for 2011, 75% for 2012, and 80% thereafter.  This approach creates a glide path for compliance with the 80 percent standard and balances the interests of consumers, the State and the issuers in accordance with the principles underlying the MLR provision