News in brief - June 20, 2005

Suspension, fine for Medicare official - Governors announce Medicaid reform policy - Medicaid recipients hit harder by out-of-pocket spending increases - Wal-Mart criticized for health coverage

Suspension, fine for Medicare official

Sean R. Tunis, MD, the chief medical officer for the Centers for Medicare & Medicaid Services, has agreed to a temporary suspension of his medical license and a fine for falsifying documentation of his continuing medical education credits.

The Maryland Board of Physicians suspended Dr. Tunis for a minimum of one year and fined him $20,000. The license can be reinstated only if he completes the 35.25 hours of CME that he lacked when renewing his license in 2001 and if he agrees to a two-year probation period after reinstatement.

CMS would not immediately say whether Dr. Tunis would remain chief medical officer at the agency. He has been on paid administrative leave since April.

Governors announce Medicaid reform policy

The National Governors Assn. has released an interim policy outlining its goals for reforming Medicaid, which has been eating up an increasing proportion of state budgets during a period when they are still recovering from an economic recession. The governors have been trying to move Medicaid reform discussions away from cost-containment proposals being forwarded by federal officials and lawmakers.

"Comprehensive Medicaid reform must focus both on reforming Medicaid and on strengthening other forms of health insurance and long-term care coverage," the policy states.

Medicaid recipients hit harder by out-of-pocket spending increases

While out-of-pocket health spending is growing in general, it is rising faster for Medicaid recipients than for patients with private health insurance, according to a new report from the Center on Budget and Policy Priorities. Such expenses rose, on average, 9.7% a year between 1997 and 2002 for Medicaid patients, compared with 6% for the privately insured, the study shows.

The increase in cash spending by Medicaid enrollees is the result of states implementing co-payments and benefit reductions that mean the patients have to pay for more services themselves.

"When Medicaid imposes cost-sharing, people with disabilities and those with chronic health problems tend to bear the highest burdens," the authors concluded.

Wal-Mart criticized for health coverage

Wal-Mart is finding itself the target of criticism and legislative action for its health benefits policies. The megastore fails to provide health coverage to more than 500,000 of its workers, putting profits above people, according to Wake-Up Wal-Mart, a union-backed advocacy group that is holding rallies to draw attention to the issue.

The group is also urging states to take up legislation, such as a bill recently passed by the Maryland Legislature. The measure would have required Wal-Mart and other large companies to spend 8% of their payrolls on health benefits or pay into the state's Medicaid program. Gov. Robert Ehrlich vetoed the bill, but the Legislature could overturn his decision when it is back in session next January.

M. Susan Chambers, executive vice president of benefits administration for Wal-Mart, stated: "The health care issue is much broader than Wal-Mart. Our nation -- including large and small employers -- faces a health care crisis. Maliciously targeting one company doesn't address this issue."