Alicia Ault

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

The 4th U.S. Circuit Court of Appeals seems poised to reject Virginia’s challenge to the constitutionality of the individual mandate in the Affordable Care Act, observers noted after oral arguments at the court on May 10.

In a press conference after the arguments, both Ron Pollack, executive director of Families USA, and Walter Dellinger, a constitutional scholar, said that they believed that the court’s three appellate judges would find that the state does not have standing to proceed with its case against the federal government.

Virginia Attorney General Ken Cuccinelli (R), filed the state’s challenge soon after the Affordable Care Act (ACA) was enacted, claiming that the federal government did not have the legal authority to require individual citizens to buy health insurance. He cited a new Virginia statute revoking the so-called individual mandate as the basis for his claim, saying that the federal government could not broach the state’s sovereignty on that issue. A district court agreed; the federal government appealed.

The three judges, who were randomly selected from the 4th Circuit bench to hear the case, seemed to "disparage" Mr. Cuccinelli’s reasoning that the state had standing, Mr. Pollack said.

Mr. Dellinger, a former U.S. Solicitor General, agreed that the judges seemed dubious of Virginia’s claims to sovereignty on this issue. If the court agreed with Mr. Cuccinelli’s arguments, the judges said, then states could pass laws refusing to allow its residents to participate in Social Security or the Selective Service System, said Mr. Dellinger, who currently leads Harvard Law School’s Supreme Court and Appellate Litigation Clinic. "The court saw no limit whatsoever on the challenges that could be lodged in federal court."

Mr. Cuccinelli said that he viewed the situation differently. In a separate press conference, he said that the federal government was making a bid for "unlimited authority," and that "the questions from the panel today indicated the judges struggled with this unprecedented exercise of authority."

The Virginia attorney general added that he continued to believe that the federal government could not override state laws. "That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority," he said.

In the opinion of both Mr. Dellinger and Mr. Pollack, if the appellate panel ruled against the Virginia challenge, it would put all the state suits filed to this point to rest. "I do believe that the Attorney General of Virginia will not have a role in court after this, nor will the other state attorney generals," Mr. Dellinger said.

Mr. Cuccinelli, however, said he expected to continue his battle. "We hope to hear from the 4th Circuit sometime this summer. Then, we hope to move on to the Supreme Court," he said.

The second case heard May 10 by the appeals court, Liberty University vs. Timothy Geithner, may proceed, however, according to Mr. Dellinger. That appeal is more focused on the merits of the case – basically whether Congress is regulating activity or inactivity when it is requiring purchase of insurance or payment of a penalty, he said.

Mr. Dellinger said it was his belief that the appeals court judges showed that they believed that Congress had the right to ask individuals earning $18,000 a year to participate in the health insurance market, just as they are required to pay Social Security and Medicare taxes. The judges said that no one can choose not to participate in the health care market, he said. They used an example of four young people in a car accident who are evacuated to a hospital; gravely injured, they will not have the ability to say they don’t want to get health care.

The three judges all happened to be Democratic appointees. But Mr. Dellinger said he did not think a panel of Republican appointees would have acted any differently. Both he and Mr. Pollack said they still expect one of the 31 legal challenges to make its way to the U.S. Supreme Court.

Several more judicial challenges to the ACA will be heard in appeals courts around the country within the month: one on June 1 at the 6th Circuit and one on June 8 at the 11th Circuit.

Adolescent women whose mothers use tanning beds are more likely to be indoor tanners themselves, according to a survey by the American Academy of Dermatology (AAD). 

The AAD survey targeted white, non-Hispanic females aged 14-22, and was conducted online from late December to mid-January. After selecting out for the target population, the survey encompassed responses from some 3,800 women.

Overall, a third said they had used a tanning bed in the past year, with one-quarter going to a tanning salon at least weekly. Eighty percent had tanned outdoors.

Indoor tanners were more than twice as likely to have a family member who used a tanning bed, compared with non-tanning bed users. And, indoor tanners were four times as likely (42%) to indicate that their mothers used tanning beds, compared with those who were not indoor tanners (10%).

Parents knew their daughter was using a tanning bed, said 94% of indoor tanners.

"The survey shows how influential mothers can be on their daughters' behavior, and that is why it's critical for mothers to set a good example by not tanning," said Dr. Ellen S. Marmur, associate professor of dermatology at The Mount Sinai Medical Center in New York, in an AAD statement.

Peer pressure is another factor: tanning bed users were nearly twice as likely to say they felt pressure to be tan (49%), compared with non-users (28%). 

Finally, although the majority said that tanning beds could cause skin cancer, a quarter to a third of younger tanners said they thought indoor tanning was safer than the sun and did not cause cancer. Younger tanners (aged 14-17) were also less likely to report they planned to stop using tanning beds. 

Adolescent women whose mothers use tanning beds are more likely to be indoor tanners themselves, according to a survey by the American Academy of Dermatology (AAD). 

The AAD survey targeted white, non-Hispanic females aged 14-22, and was conducted online from late December to mid-January. After selecting out for the target population, the survey encompassed responses from some 3,800 women.

Overall, a third said they had used a tanning bed in the past year, with one-quarter going to a tanning salon at least weekly. Eighty percent had tanned outdoors.

Indoor tanners were more than twice as likely to have a family member who used a tanning bed, compared with non-tanning bed users. And, indoor tanners were four times as likely (42%) to indicate that their mothers used tanning beds, compared with those who were not indoor tanners (10%).

Parents knew their daughter was using a tanning bed, said 94% of indoor tanners.

"The survey shows how influential mothers can be on their daughters' behavior, and that is why it's critical for mothers to set a good example by not tanning," said Dr. Ellen S. Marmur, associate professor of dermatology at The Mount Sinai Medical Center in New York, in an AAD statement.

Peer pressure is another factor: tanning bed users were nearly twice as likely to say they felt pressure to be tan (49%), compared with non-users (28%). 

Finally, although the majority said that tanning beds could cause skin cancer, a quarter to a third of younger tanners said they thought indoor tanning was safer than the sun and did not cause cancer. Younger tanners (aged 14-17) were also less likely to report they planned to stop using tanning beds. 

Adolescent women whose mothers use tanning beds are more likely to be indoor tanners themselves, according to a survey by the American Academy of Dermatology (AAD). 

The AAD survey targeted white, non-Hispanic females aged 14-22, and was conducted online from late December to mid-January. After selecting out for the target population, the survey encompassed responses from some 3,800 women.

Overall, a third said they had used a tanning bed in the past year, with one-quarter going to a tanning salon at least weekly. Eighty percent had tanned outdoors.

Indoor tanners were more than twice as likely to have a family member who used a tanning bed, compared with non-tanning bed users. And, indoor tanners were four times as likely (42%) to indicate that their mothers used tanning beds, compared with those who were not indoor tanners (10%).

Parents knew their daughter was using a tanning bed, said 94% of indoor tanners.

"The survey shows how influential mothers can be on their daughters' behavior, and that is why it's critical for mothers to set a good example by not tanning," said Dr. Ellen S. Marmur, associate professor of dermatology at The Mount Sinai Medical Center in New York, in an AAD statement.

Peer pressure is another factor: tanning bed users were nearly twice as likely to say they felt pressure to be tan (49%), compared with non-users (28%). 

Finally, although the majority said that tanning beds could cause skin cancer, a quarter to a third of younger tanners said they thought indoor tanning was safer than the sun and did not cause cancer. Younger tanners (aged 14-17) were also less likely to report they planned to stop using tanning beds. 

Physicians are more concerned about the burden of taking call than about how much they get paid for providing coverage at hospital emergency departments, according to a survey by the American Medical Group Association and a consulting firm.

About 50 medical groups participated, primarily from independently owned, large, multispecialty groups. Dr. Donald W. Fisher, president and CEO of the AMGA, said that most of the data on physicians' opinions on call coverage have been anecdotal. The AMGA survey, conducted with ECG Management Consultants, quantifies better what is actually happening, he said.

ECG senior manager Sean T. Hartzell said in a statement that “the survey confirmed what we are seeing in the market, which is that the lifestyle intrusion of call is being tolerated less and less by physicians, and they are seeking ways to decrease their call coverage burden.”

According to the survey, when physicians were asked to choose between reduced call burden or payment, 58% of those surveyed said it was more important to reduce call burden. More than half the respondents said their call burden was high.

The survey also asked physicians for some potential solutions to reducing call burden.

Respondents said that the advent of hospitalists – which they regarded as favorable – was a potentially important way to reduce call burden. The majority of respondents said that use of nocturnists would be helpful. And 70% said that offering preferred scheduling on the day after call would be a good way to address call burden.

According to the AMGA, its members deliver health care to 110 million patients in 49 states.

Physicians are more concerned about the burden of taking call than about how much they get paid for providing coverage at hospital emergency departments, according to a survey by the American Medical Group Association and a consulting firm.

About 50 medical groups participated, primarily from independently owned, large, multispecialty groups. Dr. Donald W. Fisher, president and CEO of the AMGA, said that most of the data on physicians' opinions on call coverage have been anecdotal. The AMGA survey, conducted with ECG Management Consultants, quantifies better what is actually happening, he said.

ECG senior manager Sean T. Hartzell said in a statement that “the survey confirmed what we are seeing in the market, which is that the lifestyle intrusion of call is being tolerated less and less by physicians, and they are seeking ways to decrease their call coverage burden.”

According to the survey, when physicians were asked to choose between reduced call burden or payment, 58% of those surveyed said it was more important to reduce call burden. More than half the respondents said their call burden was high.

The survey also asked physicians for some potential solutions to reducing call burden.

Respondents said that the advent of hospitalists – which they regarded as favorable – was a potentially important way to reduce call burden. The majority of respondents said that use of nocturnists would be helpful. And 70% said that offering preferred scheduling on the day after call would be a good way to address call burden.

According to the AMGA, its members deliver health care to 110 million patients in 49 states.

Physicians are more concerned about the burden of taking call than about how much they get paid for providing coverage at hospital emergency departments, according to a survey by the American Medical Group Association and a consulting firm.

About 50 medical groups participated, primarily from independently owned, large, multispecialty groups. Dr. Donald W. Fisher, president and CEO of the AMGA, said that most of the data on physicians' opinions on call coverage have been anecdotal. The AMGA survey, conducted with ECG Management Consultants, quantifies better what is actually happening, he said.

ECG senior manager Sean T. Hartzell said in a statement that “the survey confirmed what we are seeing in the market, which is that the lifestyle intrusion of call is being tolerated less and less by physicians, and they are seeking ways to decrease their call coverage burden.”

According to the survey, when physicians were asked to choose between reduced call burden or payment, 58% of those surveyed said it was more important to reduce call burden. More than half the respondents said their call burden was high.

The survey also asked physicians for some potential solutions to reducing call burden.

Respondents said that the advent of hospitalists – which they regarded as favorable – was a potentially important way to reduce call burden. The majority of respondents said that use of nocturnists would be helpful. And 70% said that offering preferred scheduling on the day after call would be a good way to address call burden.

According to the AMGA, its members deliver health care to 110 million patients in 49 states.

WASHINGTON – Republicans and Democrats found little consensus on reforming the medical malpractice system during a House hearing on legislation to institute a federal torts policy.

The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) was introduced in January by Rep. Phil Gingrey (R-Ga.), who is a physician. It has 122 cosponsors so far, as well as the backing of most major medical professional societies.

But at the hearing, Democrats said they could not support the bill for a number of reasons. “This is a bill we've heard before, a bill on which we've disagreed before,” said Rep. Lois Capps (D-Calif.). She said that Democrats support the Republicans' goal of overhauling the malpractice system, but that “it is also clear that differences in our [approaches] remain.”

Rep. Frank Pallone (D-N.J.), the subcommittee's ranking minority member, said, “I can't support and never have supported H.R. 5.” He agreed that the malpractice issue needed attention, but said he objected to the bill's extension to cover drug and device companies, and also to the bill's cap on noneconomic damages. Rep. Pallone said it would be more important to control malpractice premiums directly.

Democrats also said the bill would preempt the states' ability to make policy and regulate the insurance business. Rep. Henry Waxman (D-Calif.) released an April 4 letter from the National Conference of State Legislatures that was sent to the subcommittee expressing its opposition to H.R. 5. It is the NCSL malpractice policy that federalism “contemplates diversity among the states in establishing rules,” said the letter. “The adoption of a one-size-fits-all approach to medical malpractice envisioned in H.R. 5 and other related measures would undermine that diversity and disregard factors unique to each particular state.”

Republicans, however, said that H.R. 5 is modeled on what they deemed successful state models in California and Texas. “I do not believe we need to study this anymore,” said Rep. Michael Burgess (R-Tex.). “In Texas, we know what works,” he said, citing gains in the number of new physicians practicing in the state and reductions in malpractice litigation since a reform model was put into place in 2003.

Dr. Troy Tippett, a Florida neurosurgeon who spoke on behalf of the Health Coalition on Liability and Access, said that the group “believes there can be no real health care reform without meaningful medical liability reform.”

H.R. 5 would limit lawsuits to within 3 years after an injury, cap noneconomic damages at $250,000, limit attorneys' fees, and eliminate the concept of joint and several liability, which means that the plaintiff could not sue all the potential parties responsible for the injury. The bill would extend the protections to drug and device manufacturers, nursing homes, and other health care providers.

Rep. Waxman and several other Democrats said that the insurance industry was to blame for much of the malpractice climate.

Dr. Allen Kachalia, a hospitalist at Brigham and Women's Hospital in Boston, said that he agreed that the system was rife with problems, especially on the insurance side. Dr. Kachalia, who also has a law degree and studies medicolegal issues, said that recent studies show that almost 60% of malpractice claims contain an error, but that the claims are not properly adjudicated about 25% of the time.

“This means that in about a quarter of the claims in which there is an error, patients may not be receiving payment, and in a quarter of the claims in which there is no error, patients may still receive payment,” Dr. Kachalia testified. “This type of inaccuracy can undermine both patient and physician faith in the malpractice system.”

He also said that a majority of premium dollars are spent on overhead, whereas only about 46 cents per dollar are paid out to injured patients.

The data are mixed on damage caps, he testified. They may lower the size of claims paid and may translate into lower premiums paid by physicians, but they may not lower the number of claims filed. Caps may also lead to less defensive medicine, “but their effect on the overall quality of care is unknown,” said Dr. Kachalia.

The House Judiciary Committee has passed a version of H.R. 5, and the full Energy and Commerce Committee was due to consider the legislation in mid-May. A Senate companion bill (S. 218) has only two cosponsors and is awaiting consideration by the Senate Judiciary Committee.

WASHINGTON – Republicans and Democrats found little consensus on reforming the medical malpractice system during a House hearing on legislation to institute a federal torts policy.

The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) was introduced in January by Rep. Phil Gingrey (R-Ga.), who is a physician. It has 122 cosponsors so far, as well as the backing of most major medical professional societies.

But at the hearing, Democrats said they could not support the bill for a number of reasons. “This is a bill we've heard before, a bill on which we've disagreed before,” said Rep. Lois Capps (D-Calif.). She said that Democrats support the Republicans' goal of overhauling the malpractice system, but that “it is also clear that differences in our [approaches] remain.”

Rep. Frank Pallone (D-N.J.), the subcommittee's ranking minority member, said, “I can't support and never have supported H.R. 5.” He agreed that the malpractice issue needed attention, but said he objected to the bill's extension to cover drug and device companies, and also to the bill's cap on noneconomic damages. Rep. Pallone said it would be more important to control malpractice premiums directly.

Democrats also said the bill would preempt the states' ability to make policy and regulate the insurance business. Rep. Henry Waxman (D-Calif.) released an April 4 letter from the National Conference of State Legislatures that was sent to the subcommittee expressing its opposition to H.R. 5. It is the NCSL malpractice policy that federalism “contemplates diversity among the states in establishing rules,” said the letter. “The adoption of a one-size-fits-all approach to medical malpractice envisioned in H.R. 5 and other related measures would undermine that diversity and disregard factors unique to each particular state.”

Republicans, however, said that H.R. 5 is modeled on what they deemed successful state models in California and Texas. “I do not believe we need to study this anymore,” said Rep. Michael Burgess (R-Tex.). “In Texas, we know what works,” he said, citing gains in the number of new physicians practicing in the state and reductions in malpractice litigation since a reform model was put into place in 2003.

Dr. Troy Tippett, a Florida neurosurgeon who spoke on behalf of the Health Coalition on Liability and Access, said that the group “believes there can be no real health care reform without meaningful medical liability reform.”

H.R. 5 would limit lawsuits to within 3 years after an injury, cap noneconomic damages at $250,000, limit attorneys' fees, and eliminate the concept of joint and several liability, which means that the plaintiff could not sue all the potential parties responsible for the injury. The bill would extend the protections to drug and device manufacturers, nursing homes, and other health care providers.

Rep. Waxman and several other Democrats said that the insurance industry was to blame for much of the malpractice climate.

Dr. Allen Kachalia, a hospitalist at Brigham and Women's Hospital in Boston, said that he agreed that the system was rife with problems, especially on the insurance side. Dr. Kachalia, who also has a law degree and studies medicolegal issues, said that recent studies show that almost 60% of malpractice claims contain an error, but that the claims are not properly adjudicated about 25% of the time.

“This means that in about a quarter of the claims in which there is an error, patients may not be receiving payment, and in a quarter of the claims in which there is no error, patients may still receive payment,” Dr. Kachalia testified. “This type of inaccuracy can undermine both patient and physician faith in the malpractice system.”

He also said that a majority of premium dollars are spent on overhead, whereas only about 46 cents per dollar are paid out to injured patients.

The data are mixed on damage caps, he testified. They may lower the size of claims paid and may translate into lower premiums paid by physicians, but they may not lower the number of claims filed. Caps may also lead to less defensive medicine, “but their effect on the overall quality of care is unknown,” said Dr. Kachalia.

The House Judiciary Committee has passed a version of H.R. 5, and the full Energy and Commerce Committee was due to consider the legislation in mid-May. A Senate companion bill (S. 218) has only two cosponsors and is awaiting consideration by the Senate Judiciary Committee.

WASHINGTON – Republicans and Democrats found little consensus on reforming the medical malpractice system during a House hearing on legislation to institute a federal torts policy.

The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) was introduced in January by Rep. Phil Gingrey (R-Ga.), who is a physician. It has 122 cosponsors so far, as well as the backing of most major medical professional societies.

But at the hearing, Democrats said they could not support the bill for a number of reasons. “This is a bill we've heard before, a bill on which we've disagreed before,” said Rep. Lois Capps (D-Calif.). She said that Democrats support the Republicans' goal of overhauling the malpractice system, but that “it is also clear that differences in our [approaches] remain.”

Rep. Frank Pallone (D-N.J.), the subcommittee's ranking minority member, said, “I can't support and never have supported H.R. 5.” He agreed that the malpractice issue needed attention, but said he objected to the bill's extension to cover drug and device companies, and also to the bill's cap on noneconomic damages. Rep. Pallone said it would be more important to control malpractice premiums directly.

Democrats also said the bill would preempt the states' ability to make policy and regulate the insurance business. Rep. Henry Waxman (D-Calif.) released an April 4 letter from the National Conference of State Legislatures that was sent to the subcommittee expressing its opposition to H.R. 5. It is the NCSL malpractice policy that federalism “contemplates diversity among the states in establishing rules,” said the letter. “The adoption of a one-size-fits-all approach to medical malpractice envisioned in H.R. 5 and other related measures would undermine that diversity and disregard factors unique to each particular state.”

Republicans, however, said that H.R. 5 is modeled on what they deemed successful state models in California and Texas. “I do not believe we need to study this anymore,” said Rep. Michael Burgess (R-Tex.). “In Texas, we know what works,” he said, citing gains in the number of new physicians practicing in the state and reductions in malpractice litigation since a reform model was put into place in 2003.

Dr. Troy Tippett, a Florida neurosurgeon who spoke on behalf of the Health Coalition on Liability and Access, said that the group “believes there can be no real health care reform without meaningful medical liability reform.”

H.R. 5 would limit lawsuits to within 3 years after an injury, cap noneconomic damages at $250,000, limit attorneys' fees, and eliminate the concept of joint and several liability, which means that the plaintiff could not sue all the potential parties responsible for the injury. The bill would extend the protections to drug and device manufacturers, nursing homes, and other health care providers.

Rep. Waxman and several other Democrats said that the insurance industry was to blame for much of the malpractice climate.

Dr. Allen Kachalia, a hospitalist at Brigham and Women's Hospital in Boston, said that he agreed that the system was rife with problems, especially on the insurance side. Dr. Kachalia, who also has a law degree and studies medicolegal issues, said that recent studies show that almost 60% of malpractice claims contain an error, but that the claims are not properly adjudicated about 25% of the time.

“This means that in about a quarter of the claims in which there is an error, patients may not be receiving payment, and in a quarter of the claims in which there is no error, patients may still receive payment,” Dr. Kachalia testified. “This type of inaccuracy can undermine both patient and physician faith in the malpractice system.”

He also said that a majority of premium dollars are spent on overhead, whereas only about 46 cents per dollar are paid out to injured patients.

The data are mixed on damage caps, he testified. They may lower the size of claims paid and may translate into lower premiums paid by physicians, but they may not lower the number of claims filed. Caps may also lead to less defensive medicine, “but their effect on the overall quality of care is unknown,” said Dr. Kachalia.

The House Judiciary Committee has passed a version of H.R. 5, and the full Energy and Commerce Committee was due to consider the legislation in mid-May. A Senate companion bill (S. 218) has only two cosponsors and is awaiting consideration by the Senate Judiciary Committee.

Ninety percent of hospitals experienced a drug shortage in the last half of 2010, and 80% said that the shortages had resulted in a delay or cancellation of a patient intervention, according to a survey by Premier Inc., a voluntary hospital and health care alliance and group purchasing organization.

Emergency departments are not immune from the shortages. Among other medications, the short-acting sedative propofol has been difficult to get for at least a year, said Dr. Michael L. Carius, chair of the emergency department at Norwalk (Conn.) Hospital.

Premier surveyed 311 pharmacy experts from hospitals; infusion centers; oncology and surgery centers; outpatient and retail pharmacies; and long-term care facilities during the period of July-December 2010. The results were released in a telephone briefing.

Not only did the majority report trouble accessing critical drugs, but at least a third reported experiencing access problems more than six times. According to Premier, shortages are at an all-time high. The Food and Drug Administration, the American Society of Health System Pharmacists, and other groups have been closely tracking the shortage problem over the last year.

In emergency departments, the shortages are “a significant problem” that “has a lot of potential downside,” Dr. Carius said in an interview after the briefing.

With propofol, for instance, there are alternatives, but when physicians switch to a drug that is less familiar, he said, it increases the potential for a bad result.

The propofol shortage began in the fall of 2009, when two manufacturers halted distribution due to manufacturing problems, the FDA reports on a Web page devoted to the propofol shortage. It has continued as one manufacturer dropped out and the others have struggled to meet demand, according to the agency.

Caring for patients with acute myocardial infarction also has gotten more complicated as nurses have had to switch from prefilled syringes of epinephrine, which are in short supply, to filling their own syringes. “It adds steps to the process and [to] the potential for error,” Dr. Carius said.

Over the second half of 2010, more than 240 drugs were in short supply or unavailable, and more than 400 generic drugs were back-ordered for 5 days or longer, according to Premier's analysis. Many of those drugs still are not available.

The shortages are costing American hospitals at least $200 million a year, largely because the facilities have to buy more expensive alternatives or therapeutic equivalents. Hospitals are paying an average 11% more for these products, but sometimes more. The $200 million figure does not include additional labor for new dispensing systems and compounding, or the added expense for delays and disruptions in patient care, said Blair Childs, senior vice president of public affairs at Premier.

There are multiple reasons for the shortages, according to Premier's analysis, but a major one is market consolidation. When the single supplier of a particular product has materials or manufacturing problems, no other manufacturers can take up the slack, Mr. Childs said.

Compounding the situation is the fact that many manufacturers, particularly of generic drugs, have ceased making products deemed no longer profitable. And some distributors are buying up available supplies and instituting huge price increases, said Mike Alkire, president of Premier Purchasing Partners. He noted, for instance, that the diuretic furosemide has gone from $1.21 to $195 a vial.

Premier and many other stakeholders are supporting legislation introduced by Sen. Amy Klobuchar (D-Minn.), the Preserving Access to Life-Saving Medications Act (S. 296).

Among other things, her legislation would require a type of early-warning system from both manufacturers and the FDA. Drug makers would need to warn the FDA at least 6 months in advance of discontinuing a product or give immediate notification if there was an unanticipated event that could lead to a potential shortage.

Ninety percent of hospitals experienced a drug shortage in the last half of 2010, and 80% said that the shortages had resulted in a delay or cancellation of a patient intervention, according to a survey by Premier Inc., a voluntary hospital and health care alliance and group purchasing organization.

Emergency departments are not immune from the shortages. Among other medications, the short-acting sedative propofol has been difficult to get for at least a year, said Dr. Michael L. Carius, chair of the emergency department at Norwalk (Conn.) Hospital.

Premier surveyed 311 pharmacy experts from hospitals; infusion centers; oncology and surgery centers; outpatient and retail pharmacies; and long-term care facilities during the period of July-December 2010. The results were released in a telephone briefing.

Not only did the majority report trouble accessing critical drugs, but at least a third reported experiencing access problems more than six times. According to Premier, shortages are at an all-time high. The Food and Drug Administration, the American Society of Health System Pharmacists, and other groups have been closely tracking the shortage problem over the last year.

In emergency departments, the shortages are “a significant problem” that “has a lot of potential downside,” Dr. Carius said in an interview after the briefing.

With propofol, for instance, there are alternatives, but when physicians switch to a drug that is less familiar, he said, it increases the potential for a bad result.

The propofol shortage began in the fall of 2009, when two manufacturers halted distribution due to manufacturing problems, the FDA reports on a Web page devoted to the propofol shortage. It has continued as one manufacturer dropped out and the others have struggled to meet demand, according to the agency.

Caring for patients with acute myocardial infarction also has gotten more complicated as nurses have had to switch from prefilled syringes of epinephrine, which are in short supply, to filling their own syringes. “It adds steps to the process and [to] the potential for error,” Dr. Carius said.

Over the second half of 2010, more than 240 drugs were in short supply or unavailable, and more than 400 generic drugs were back-ordered for 5 days or longer, according to Premier's analysis. Many of those drugs still are not available.

The shortages are costing American hospitals at least $200 million a year, largely because the facilities have to buy more expensive alternatives or therapeutic equivalents. Hospitals are paying an average 11% more for these products, but sometimes more. The $200 million figure does not include additional labor for new dispensing systems and compounding, or the added expense for delays and disruptions in patient care, said Blair Childs, senior vice president of public affairs at Premier.

There are multiple reasons for the shortages, according to Premier's analysis, but a major one is market consolidation. When the single supplier of a particular product has materials or manufacturing problems, no other manufacturers can take up the slack, Mr. Childs said.

Compounding the situation is the fact that many manufacturers, particularly of generic drugs, have ceased making products deemed no longer profitable. And some distributors are buying up available supplies and instituting huge price increases, said Mike Alkire, president of Premier Purchasing Partners. He noted, for instance, that the diuretic furosemide has gone from $1.21 to $195 a vial.

Premier and many other stakeholders are supporting legislation introduced by Sen. Amy Klobuchar (D-Minn.), the Preserving Access to Life-Saving Medications Act (S. 296).

Among other things, her legislation would require a type of early-warning system from both manufacturers and the FDA. Drug makers would need to warn the FDA at least 6 months in advance of discontinuing a product or give immediate notification if there was an unanticipated event that could lead to a potential shortage.

Ninety percent of hospitals experienced a drug shortage in the last half of 2010, and 80% said that the shortages had resulted in a delay or cancellation of a patient intervention, according to a survey by Premier Inc., a voluntary hospital and health care alliance and group purchasing organization.

Emergency departments are not immune from the shortages. Among other medications, the short-acting sedative propofol has been difficult to get for at least a year, said Dr. Michael L. Carius, chair of the emergency department at Norwalk (Conn.) Hospital.

Premier surveyed 311 pharmacy experts from hospitals; infusion centers; oncology and surgery centers; outpatient and retail pharmacies; and long-term care facilities during the period of July-December 2010. The results were released in a telephone briefing.

Not only did the majority report trouble accessing critical drugs, but at least a third reported experiencing access problems more than six times. According to Premier, shortages are at an all-time high. The Food and Drug Administration, the American Society of Health System Pharmacists, and other groups have been closely tracking the shortage problem over the last year.

In emergency departments, the shortages are “a significant problem” that “has a lot of potential downside,” Dr. Carius said in an interview after the briefing.

With propofol, for instance, there are alternatives, but when physicians switch to a drug that is less familiar, he said, it increases the potential for a bad result.

The propofol shortage began in the fall of 2009, when two manufacturers halted distribution due to manufacturing problems, the FDA reports on a Web page devoted to the propofol shortage. It has continued as one manufacturer dropped out and the others have struggled to meet demand, according to the agency.

Caring for patients with acute myocardial infarction also has gotten more complicated as nurses have had to switch from prefilled syringes of epinephrine, which are in short supply, to filling their own syringes. “It adds steps to the process and [to] the potential for error,” Dr. Carius said.

Over the second half of 2010, more than 240 drugs were in short supply or unavailable, and more than 400 generic drugs were back-ordered for 5 days or longer, according to Premier's analysis. Many of those drugs still are not available.

The shortages are costing American hospitals at least $200 million a year, largely because the facilities have to buy more expensive alternatives or therapeutic equivalents. Hospitals are paying an average 11% more for these products, but sometimes more. The $200 million figure does not include additional labor for new dispensing systems and compounding, or the added expense for delays and disruptions in patient care, said Blair Childs, senior vice president of public affairs at Premier.

There are multiple reasons for the shortages, according to Premier's analysis, but a major one is market consolidation. When the single supplier of a particular product has materials or manufacturing problems, no other manufacturers can take up the slack, Mr. Childs said.

Compounding the situation is the fact that many manufacturers, particularly of generic drugs, have ceased making products deemed no longer profitable. And some distributors are buying up available supplies and instituting huge price increases, said Mike Alkire, president of Premier Purchasing Partners. He noted, for instance, that the diuretic furosemide has gone from $1.21 to $195 a vial.

Premier and many other stakeholders are supporting legislation introduced by Sen. Amy Klobuchar (D-Minn.), the Preserving Access to Life-Saving Medications Act (S. 296).

Among other things, her legislation would require a type of early-warning system from both manufacturers and the FDA. Drug makers would need to warn the FDA at least 6 months in advance of discontinuing a product or give immediate notification if there was an unanticipated event that could lead to a potential shortage.

The Food and Drug Administration announced the approval of an extended-release form of gabapentin for moderate to severe restless legs syndrome.

The drug, known as Horizant (gabapentin enacarbil), is a prodrug of gabapentin. It was developed by XenoPort Inc. of Santa Clara, Calif., and GlaxoSmithKline.

“People with restless legs syndrome can experience considerable distress from their symptoms,” said Dr. Russell Katz, director of the FDA's Division of Neurology Products at the agency's Center for Drug Evaluation and Research, in a statement. “Horizant provides significant help in treating these symptoms.”

According to the National Institute of Neurological Disorders and Stroke, restless legs syndrome (RLS) is a neurologic disorder that is “characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief.” Mild to moderate cases are treated with lifestyle and behavioral changes. More severe cases warrant therapies such as dopaminergics, benzodiazepines, opioids, and anticonvulsants.

Two other drugs were approved for the condition for moderate to severe RLS: Requip (ropinirole) in 2005 and Mirapex (pramipexole) in 2006.

The prevalence and incidence rates of RLS are currently not well known, according to the Restless Legs Syndrome Foundation. There is no cure and symptoms can worsen with age. The manufacturers estimate that 1%-3% of the U.S. population is symptomatic.

RLS remains underrecognized, “and many patients go untreated as a result,” said Dr. Atul Pande, senior vice president at GlaxoSmithKline Neurosciences Medicine Development Center. “GSK has been committed to helping patients and healthcare professionals better understand and treat this condition. We are pleased to provide a new treatment” for moderate to severe primary RLS, he said in a statement.

XenoPort CEO Ronald W. Barrett said that Horizant was the “culmination of XenoPort's efforts to develop a nondopaminergic therapy” for patients with RLS.

Horizant carries a number of risks and contraindications. Even at the once-daily dose of 600 mg, it can cause somnolence and “significant driving impairment,” according to GSK and XenoPort.

It is an antiepileptic, and that class of drugs has been shown to increase the risk of suicidal thoughts or behaviors. Horizant also increases this risk, and will carry such a warning, said the companies and the FDA.

The dosage also needs to be adjusted for patients with renal impairment.

The Food and Drug Administration announced the approval of an extended-release form of gabapentin for moderate to severe restless legs syndrome.

The drug, known as Horizant (gabapentin enacarbil), is a prodrug of gabapentin. It was developed by XenoPort Inc. of Santa Clara, Calif., and GlaxoSmithKline.

“People with restless legs syndrome can experience considerable distress from their symptoms,” said Dr. Russell Katz, director of the FDA's Division of Neurology Products at the agency's Center for Drug Evaluation and Research, in a statement. “Horizant provides significant help in treating these symptoms.”

According to the National Institute of Neurological Disorders and Stroke, restless legs syndrome (RLS) is a neurologic disorder that is “characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief.” Mild to moderate cases are treated with lifestyle and behavioral changes. More severe cases warrant therapies such as dopaminergics, benzodiazepines, opioids, and anticonvulsants.

Two other drugs were approved for the condition for moderate to severe RLS: Requip (ropinirole) in 2005 and Mirapex (pramipexole) in 2006.

The prevalence and incidence rates of RLS are currently not well known, according to the Restless Legs Syndrome Foundation. There is no cure and symptoms can worsen with age. The manufacturers estimate that 1%-3% of the U.S. population is symptomatic.

RLS remains underrecognized, “and many patients go untreated as a result,” said Dr. Atul Pande, senior vice president at GlaxoSmithKline Neurosciences Medicine Development Center. “GSK has been committed to helping patients and healthcare professionals better understand and treat this condition. We are pleased to provide a new treatment” for moderate to severe primary RLS, he said in a statement.

XenoPort CEO Ronald W. Barrett said that Horizant was the “culmination of XenoPort's efforts to develop a nondopaminergic therapy” for patients with RLS.

Horizant carries a number of risks and contraindications. Even at the once-daily dose of 600 mg, it can cause somnolence and “significant driving impairment,” according to GSK and XenoPort.

It is an antiepileptic, and that class of drugs has been shown to increase the risk of suicidal thoughts or behaviors. Horizant also increases this risk, and will carry such a warning, said the companies and the FDA.

The dosage also needs to be adjusted for patients with renal impairment.

The Food and Drug Administration announced the approval of an extended-release form of gabapentin for moderate to severe restless legs syndrome.

The drug, known as Horizant (gabapentin enacarbil), is a prodrug of gabapentin. It was developed by XenoPort Inc. of Santa Clara, Calif., and GlaxoSmithKline.

“People with restless legs syndrome can experience considerable distress from their symptoms,” said Dr. Russell Katz, director of the FDA's Division of Neurology Products at the agency's Center for Drug Evaluation and Research, in a statement. “Horizant provides significant help in treating these symptoms.”

According to the National Institute of Neurological Disorders and Stroke, restless legs syndrome (RLS) is a neurologic disorder that is “characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief.” Mild to moderate cases are treated with lifestyle and behavioral changes. More severe cases warrant therapies such as dopaminergics, benzodiazepines, opioids, and anticonvulsants.

Two other drugs were approved for the condition for moderate to severe RLS: Requip (ropinirole) in 2005 and Mirapex (pramipexole) in 2006.

The prevalence and incidence rates of RLS are currently not well known, according to the Restless Legs Syndrome Foundation. There is no cure and symptoms can worsen with age. The manufacturers estimate that 1%-3% of the U.S. population is symptomatic.

RLS remains underrecognized, “and many patients go untreated as a result,” said Dr. Atul Pande, senior vice president at GlaxoSmithKline Neurosciences Medicine Development Center. “GSK has been committed to helping patients and healthcare professionals better understand and treat this condition. We are pleased to provide a new treatment” for moderate to severe primary RLS, he said in a statement.

XenoPort CEO Ronald W. Barrett said that Horizant was the “culmination of XenoPort's efforts to develop a nondopaminergic therapy” for patients with RLS.

Horizant carries a number of risks and contraindications. Even at the once-daily dose of 600 mg, it can cause somnolence and “significant driving impairment,” according to GSK and XenoPort.

It is an antiepileptic, and that class of drugs has been shown to increase the risk of suicidal thoughts or behaviors. Horizant also increases this risk, and will carry such a warning, said the companies and the FDA.

The dosage also needs to be adjusted for patients with renal impairment.

About $234 million in bonuses under the Physician Quality Reporting System and $148 million in incentives for ePrescribing were paid out in 2009, according to the Centers for Medicare and Medicaid Services.

Participation in the now-voluntary PQRS has grown 50% per year since the program started in 2007 and currently includes one in five eligible health care professionals. In 2009, some 210,000 physicians and other eligible health care professionals participated, but just 119,804 clinicians reported data in a manner consistent with the necessary criteria for incentive payouts, the CMS said.

Emergency medicine physicians had the highest rate of satisfactory reporting, the CMS said. In 2009, 31,000 reported on at least one quality measure and 79% received an incentive payment.

“Although participation in our pay-for-reporting programs is optional now, it should be regarded as imperative in terms of medical professionals' shared goal of improving quality of care and patient safety,” CMS Administrator Donald Berwick said in a statement.

The average payment per professional was $1,956 and the average payment per practice was $18,525, according to the CMS.

Payments, which were sent in the fall of 2010, were equal to 2% of total estimated charges under Medicare Part B.

Physicians and health professionals could report on 194 measures. The three most frequently reported quality measures were performing electrocardiograms in the emergency department to diagnose chest pain; using electronic health records to organize and manage care; and working with diabetics to control blood glucose levels.

Some of the notable improvements since the program's inception included a near doubling of the number of physicians reporting that they had talked with diabetic patients about eye-related complications – 93% in 2009 as compared to 52% in 2007.

Also, beta-blockers were recommended to patients with left ventricular systolic dysfunction by 95% of reporting physicians in 2009, as compared to 64% in 2007.

The PQRS program will remain voluntary until 2015, when the Medicare program will start withholding payments for lack of participation.

The first year of the ePrescribing program was 2009. That year, 48,354 physicians received an ePrescribing incentive payment, with an average payment of $3,000 per individual and $14,501 per practice.

The deadline for participation in the ePrescribing program is much sooner than that for the PQRS program. Physicians will see pay reductions beginning in 2012 if they don't participate in ePrescribing.

For more information on how to participate in the PQRS program, visit www.cms.gov/PQRS/

About $234 million in bonuses under the Physician Quality Reporting System and $148 million in incentives for ePrescribing were paid out in 2009, according to the Centers for Medicare and Medicaid Services.

Participation in the now-voluntary PQRS has grown 50% per year since the program started in 2007 and currently includes one in five eligible health care professionals. In 2009, some 210,000 physicians and other eligible health care professionals participated, but just 119,804 clinicians reported data in a manner consistent with the necessary criteria for incentive payouts, the CMS said.

Emergency medicine physicians had the highest rate of satisfactory reporting, the CMS said. In 2009, 31,000 reported on at least one quality measure and 79% received an incentive payment.

“Although participation in our pay-for-reporting programs is optional now, it should be regarded as imperative in terms of medical professionals' shared goal of improving quality of care and patient safety,” CMS Administrator Donald Berwick said in a statement.

The average payment per professional was $1,956 and the average payment per practice was $18,525, according to the CMS.

Payments, which were sent in the fall of 2010, were equal to 2% of total estimated charges under Medicare Part B.

Physicians and health professionals could report on 194 measures. The three most frequently reported quality measures were performing electrocardiograms in the emergency department to diagnose chest pain; using electronic health records to organize and manage care; and working with diabetics to control blood glucose levels.

Some of the notable improvements since the program's inception included a near doubling of the number of physicians reporting that they had talked with diabetic patients about eye-related complications – 93% in 2009 as compared to 52% in 2007.

Also, beta-blockers were recommended to patients with left ventricular systolic dysfunction by 95% of reporting physicians in 2009, as compared to 64% in 2007.

The PQRS program will remain voluntary until 2015, when the Medicare program will start withholding payments for lack of participation.

The first year of the ePrescribing program was 2009. That year, 48,354 physicians received an ePrescribing incentive payment, with an average payment of $3,000 per individual and $14,501 per practice.

The deadline for participation in the ePrescribing program is much sooner than that for the PQRS program. Physicians will see pay reductions beginning in 2012 if they don't participate in ePrescribing.

For more information on how to participate in the PQRS program, visit www.cms.gov/PQRS/

About $234 million in bonuses under the Physician Quality Reporting System and $148 million in incentives for ePrescribing were paid out in 2009, according to the Centers for Medicare and Medicaid Services.

Participation in the now-voluntary PQRS has grown 50% per year since the program started in 2007 and currently includes one in five eligible health care professionals. In 2009, some 210,000 physicians and other eligible health care professionals participated, but just 119,804 clinicians reported data in a manner consistent with the necessary criteria for incentive payouts, the CMS said.

Emergency medicine physicians had the highest rate of satisfactory reporting, the CMS said. In 2009, 31,000 reported on at least one quality measure and 79% received an incentive payment.

“Although participation in our pay-for-reporting programs is optional now, it should be regarded as imperative in terms of medical professionals' shared goal of improving quality of care and patient safety,” CMS Administrator Donald Berwick said in a statement.

The average payment per professional was $1,956 and the average payment per practice was $18,525, according to the CMS.

Payments, which were sent in the fall of 2010, were equal to 2% of total estimated charges under Medicare Part B.

Physicians and health professionals could report on 194 measures. The three most frequently reported quality measures were performing electrocardiograms in the emergency department to diagnose chest pain; using electronic health records to organize and manage care; and working with diabetics to control blood glucose levels.

Some of the notable improvements since the program's inception included a near doubling of the number of physicians reporting that they had talked with diabetic patients about eye-related complications – 93% in 2009 as compared to 52% in 2007.

Also, beta-blockers were recommended to patients with left ventricular systolic dysfunction by 95% of reporting physicians in 2009, as compared to 64% in 2007.

The PQRS program will remain voluntary until 2015, when the Medicare program will start withholding payments for lack of participation.

The first year of the ePrescribing program was 2009. That year, 48,354 physicians received an ePrescribing incentive payment, with an average payment of $3,000 per individual and $14,501 per practice.

The deadline for participation in the ePrescribing program is much sooner than that for the PQRS program. Physicians will see pay reductions beginning in 2012 if they don't participate in ePrescribing.

For more information on how to participate in the PQRS program, visit www.cms.gov/PQRS/

The Centers for Medicare and Medicaid Services issued its final rule on outpatient and ambulatory surgery center payments for 2011, clearing the way for beneficiaries to receive cost-free preventive screenings.

The elimination of cost-sharing is among the provisions of the Affordable Care Act being implemented through the outpatient and ambulatory surgical center (ASC) rule.

“We know that prevention, early detection, and early treatment of diseases can promote better outcomes for patients and lower long-term health spending,” said Dr. Donald Berwick, CMS administrator.

The rule prohibits development of new physician-owned hospitals or expansion of existing physician-owned facilities.

The agency is proposing to cut payments for radiology services by 10%. The reduction is based on the assumption that imaging equipment is now being used at a higher rate to calculate payments, according to the agency.

Radiation therapy, however, received a slight bump up in pay.

Overall, the CMS estimates that it will pay $39 billion in 2011 for outpatient services, and another $4 billion for services delivered to Medicare beneficiaries in ASCs. The nation's 5,000 ASCs will be paid for the first time under a revised rate system that more closely aligns reimbursement with hospital outpatient pay.

The agency issued some new quality reporting requirements for outpatient services. Providers now have 4 new quality measures to report on, added to the 11 already required. Another eight measures will be added in 2012.

The Centers for Medicare and Medicaid Services issued its final rule on outpatient and ambulatory surgery center payments for 2011, clearing the way for beneficiaries to receive cost-free preventive screenings.

The elimination of cost-sharing is among the provisions of the Affordable Care Act being implemented through the outpatient and ambulatory surgical center (ASC) rule.

“We know that prevention, early detection, and early treatment of diseases can promote better outcomes for patients and lower long-term health spending,” said Dr. Donald Berwick, CMS administrator.

The rule prohibits development of new physician-owned hospitals or expansion of existing physician-owned facilities.

The agency is proposing to cut payments for radiology services by 10%. The reduction is based on the assumption that imaging equipment is now being used at a higher rate to calculate payments, according to the agency.

Radiation therapy, however, received a slight bump up in pay.

Overall, the CMS estimates that it will pay $39 billion in 2011 for outpatient services, and another $4 billion for services delivered to Medicare beneficiaries in ASCs. The nation's 5,000 ASCs will be paid for the first time under a revised rate system that more closely aligns reimbursement with hospital outpatient pay.

The agency issued some new quality reporting requirements for outpatient services. Providers now have 4 new quality measures to report on, added to the 11 already required. Another eight measures will be added in 2012.

The Centers for Medicare and Medicaid Services issued its final rule on outpatient and ambulatory surgery center payments for 2011, clearing the way for beneficiaries to receive cost-free preventive screenings.

The elimination of cost-sharing is among the provisions of the Affordable Care Act being implemented through the outpatient and ambulatory surgical center (ASC) rule.

“We know that prevention, early detection, and early treatment of diseases can promote better outcomes for patients and lower long-term health spending,” said Dr. Donald Berwick, CMS administrator.

The rule prohibits development of new physician-owned hospitals or expansion of existing physician-owned facilities.

The agency is proposing to cut payments for radiology services by 10%. The reduction is based on the assumption that imaging equipment is now being used at a higher rate to calculate payments, according to the agency.

Radiation therapy, however, received a slight bump up in pay.

Overall, the CMS estimates that it will pay $39 billion in 2011 for outpatient services, and another $4 billion for services delivered to Medicare beneficiaries in ASCs. The nation's 5,000 ASCs will be paid for the first time under a revised rate system that more closely aligns reimbursement with hospital outpatient pay.

The agency issued some new quality reporting requirements for outpatient services. Providers now have 4 new quality measures to report on, added to the 11 already required. Another eight measures will be added in 2012.