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News Articles from Kaisernetwork.org

   
The Bush administration on Thursday proposed new marketing rules for Medicare Advantage comprehensive coverage and drug plans that aim to curb aggressive sales tactics, the Wall Street Journal reports. According to the Journal, health insurers have been criticized for their "overly aggressive marketing tactics, such as enrolling seniors without explaining what they are getting into." In some cases, beneficiaries lost supplemental coverage or access to their physicians, the Journal reports (Zhang/Fuhrmans, Wall Street Journal, 5/9). Since the Medicare drug benefit was launched in 2006, some beneficiaries and state insurance commissioners have said that some insurance agents use incorrect information to enroll people in certain plans, "particularly those offering comprehensive health insurance," the AP/Google.com reports (Freking, AP/Google.com, 5/8).

The proposal would:
  • Prohibit cold-calling, door-to-door marketing and unsolicited marketing in places such as waiting rooms and senior centers (Wall Street Journal, 5/9). According to the AP, the proposal "essentially restricts face-to-face solicitations to those initiated by the customer" (AP/Google.com, 5/8);

  • Ban cross-selling of non-health care products (Wall Street Journal, 5/9). Sales agents could sell non-health care products, such as life or disability insurance, if they were cleared with the beneficiary prior to the meeting (AP/Google.com, 5/8);

  • Increase the government's ability to fine insurers that do not comply with the rules. The government currently can impose a civil fine of up to $25,000 for each violation, but the new rules would allow a fine of up to $25,000 for each beneficiary affected by a violation;

  • Limit to $15 gifts and promotional items for potential customers. In addition, it would bar no-cost meals, regardless of value, which would "end a common practice" of holding sales presentations at family restaurants where meals are provided, according to the New York Times;

  • Bar insurers from paying agents higher bonuses or commissions for the first-year enrollment of a beneficiary compared to a renewal, which creates a "financial incentive for agents to encourage beneficiaries to change plans each year," administration officials said. It also would prohibit insurers from paying more money to agents for enrolling beneficiaries in different plans of the same category; however, agents could receive a higher commission for enrolling a beneficiary in a comprehensive plan over a drug-only plan (Pear, New York Times, 5/9); and

  • Add new restrictions on special needs plans, including requiring providers to "more clearly establish and clarify" that they are providing additional benefits to beneficiaries of the plans, CQ HealthBeat reports. Special needs plans serve so-called "dual eligibles," beneficiaries who qualify for both Medicare and Medicaid; beneficiaries with disabling or severe chronic conditions; and beneficiaries living in nursing homes or long-term care facilities (Carey, CQ HealthBeat, 5/8).
CMS officials said they hope to issue a final rule by the end of October so that the marketing changes would be effective before the next open enrollment period begins (AP/Google.com, 5/8).

State Authority
The proposal does not address concerns by some consumers, lawmakers and state officials that states do not have enough authority to regulate marketing of the plans, according to the New York Times (New York Times, 5/9). The Los Angeles Times reports that the 2003 Medicare law, which created the drug benefit, "tightly limited the ability of state insurance regulators to police the plans" (Alonso-Zaldivar, Los Angeles Times, 5/9). According to the Journal, the "health insurance industry has tried to head off more state regulation ... by pushing for stronger federal oversight" (Wall Street Journal, 5/9). In addition, the lack of strengthened state regulation in the proposal "affirms the Bush administration's view that 'states do not have the authority to regulate the marketing' of private Medicare plans," the New York Times reports (New York Times, 5/9). According to Ap/Google.com, "The rule is unlikely to stop lawmakers' efforts to give states more authority to hold insurers accountable."

Comments
Acting CMS Administrator Kerry Weems said, "We want to make sure that beneficiaries aren't pressured into sales. In parking lots, waiting rooms and those kinds of places, a salesman can create a pressure environment or a threatening environment where a beneficiary will agree to anything just to get away."

Paul Precht, policy director for the Medicare Rights Center, said, "CMS doesn't have the boots on the ground to enforce even good rules like this," adding that states need more authority (AP/Google.com, 5/8). Robert Hayes, president of MRC, in an e-mail wrote, "The final regulation will need to be much tougher if it is to have the desired effect," adding, "Even the Bush administration, which has so zealously promoted the privatization of Medicare, recognizes that it must repeatedly reaffirm its instructions to these private, for-profit insurance companies to get them to play by the rules" (Bloomberg/Boston Globe, 5/9).

Karen Ignagni, president of America's Health Insurance Plans, said, "Moving away from federal regulation toward 50 states approaching this in 50 different ways doesn't set a uniform standard for beneficiaries" (AP/Google.com, 5/8). Ignagni added that under the proposal, "The rules will be clear, they will be specific and there will be no questions about how they should be interpreted" (CQ HealthBeat, 5/8).

Senate Finance Committee Chair Max Baucus (D-Mont.) said, "America's seniors have been pressured, prodded, preyed on and ripped off by shady marketing too often," adding, "I intend to get these bans into the law to insure aggressive marketing tactics are quashed once and for all" (Wall Street Journal, 5/9).



Current HIV prevention strategies have had limited success in fighting HIV/AIDS in Africa and should be shifted to promote male circumcision and partner reduction programs, according to a study published Friday in the journal Science, BBC News reports (BBC News, 5/9). The article was published in a special issue of Science to mark the 25th anniversary of the discovery of HIV, London's Times reports (Henderson, Times, 5/9).

Daniel Halperin of the Harvard School of Public Health, Malcolm Potts of University of California-Berkeley School of Public Health and their eight colleagues wrote that HIV prevention strategies usually involve the promotion and provision of condoms, HIV testing, microbicide research, abstinence and the treatment of other sexually transmitted infections that can increase the risk of HIV, according to an HSPH release.

However, condom promotion has not been effective in parts of Southern Africa because the epidemic is generalized and primarily heterosexual in the region, the researchers wrote. Other studies also have shown that HIV testing and treating STIs have not had a significant impact, they noted (HSPH release, 5/9). "Despite relatively large investments in AIDS prevention efforts for some years now, it's clear that we need to do a better job of reducing the rate of new HIV infections," Halperin said, adding, "We need a fairly dramatic shift in priorities, not just a minor tweaking" (BBC News, 5/9). "The vast majority of donor investments in HIV prevention in the generalized epidemics of Africa continue to go to approaches for which the evidence of actual impact is increasingly unclear," he said, adding, "Many of these approaches ... do have important public health benefits and should be continued, but not because we believe they will definitely have a major impact on reducing HIV infections."

According to Halperin, there is "still some foot dragging on more fully implementing those approaches for which the evidence is much stronger, namely to scale up safe, voluntary male circumcision services and to more assertively promote partner reduction," he wrote (Times, 5/9).

According to the researchers, less than 1% of UNAIDS funding has been allocated for male circumcision programs. They add that other, more costly strategies have been less effective in preventing HIV in the region, London's Independent reports.

Studies have shown that routine male circumcision could reduce a man's risk of contracting HIV by at least 60%, but the procedure also could have benefits for women, according to researchers. "Over time, male circumcision, which has been called a 'surgical vaccine,' would probably protect more women, albeit indirectly, than nearly any other achievable HIV prevention strategy," the researchers wrote.

The added, "Unlike most other interventions, male circumcision is a one-time procedure that confers lifelong protection. Modeling suggests that male circumcision could avert up to 5.7 million new HIV infections and three million deaths over the next 20 years in sub-Saharan Africa, many of these among women."

Potts said, "It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling," adding, "Large numbers of people will die as a result of this error" (Independent, 5/9).

Reaction
Michael Carter, spokesperson for Aidsmap said, "There is undoubtedly a growing sense of frustration about HIV incidence figures, and this inevitably leads to the search for methods of prevention that appear more effective." He added, "Circumcision and partner reduction do have a role and will have greater success in some settings than others."

Lisa Power, head of policy at the Terrence Higgins Trust said, "Different strategies are needed for different countries and with the United Kingdom's concentration of HIV in specific populations, targeted work is essential" (BBC News, 5/9).



Japan on Thursday announced that its Official Development Assistance program plans to give the Philippines a grant worth $171,060 for tuberculosis control efforts in low-income areas in the capital of Manila, GMANews.TV reports. The grant is expected to be used for the country's "Stop TB Para sa Lahat" program.

Japanese Ambassador to the Philippines Makoto Katsura and Maho Suzuki, who serves as a representative for the president of the Japan Anti-Tuberculosis Association, signed the grant, which will be given to Manila's TB control project. The grant aims to improve TB control through quality assurance of DOTS and other collaborative activities with nongovernmental agencies, according to the Japanese Embassy in the Philippines. The funds are expected to benefit about 440,000 low-income residents in the city.

The Philippines ranks ninth out of the 22 countries worldwide with the highest TB burdens. It also has the third highest number of TB cases in the Western Pacific region, the embassy said (GMANews.TV, 5/8).


    
 
    

 

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