User login
Too high to drive: States grapple with setting limits on weed use behind wheel
It used to be the stuff of stoner comedies and “Just Say No” campaigns. Today, marijuana is becoming mainstream as voters across the country approve ballot questions for legalization or medical use.
In response, state governments are testing ways to ensure that the integration of this once-illicit substance into everyday life doesn’t create new public health risks. These efforts are sparking a difficult question: At what point is someone too high to get behind the wheel?
The answer is complicated. Brain scientists and pharmacologists don’t know how to measure if and to what extent marijuana causes impairment.
The reason: Existing blood and urine tests can detect marijuana use, but, because traces of the drug stay in the human body for a long time, those tests can’t specify whether the use occurred earlier that day or that month. They also don’t indicate the level at which a driver would be considered “under the influence.”
“It’s a really hard problem,” said Keith Humphreys, a psychiatry professor and drug policy expert at Stanford University (Calif.), the first state to legalize medical marijuana and where recreational pot use among adults became legal in 2016. “We don’t really have good evidence – even if we know someone has been using – [to gauge] what their level of impairment is.”
Marijuana is now legal for recreational use in 10 states and the District of Columbia – including Michigan, where a ballot initiative passed in November 2018 took effect Dec. 6. In New York, the governor said Dec. 17 that legalization would be a top priority for 2019. And nearly three dozen states have cleared the use of medical cannabis.
For alcohol, there is a clear, national standard. If your blood alcohol content is 0.08% or higher, you’re considered cognitively impaired at a level that is unsafe to drive. Extensive research supports this determination, and the clarity makes enforcement of drunken-driving laws easier.
Setting a marijuana-related impairment level is a much murkier proposition. But states that have legalized pot have to figure it out, experts said.
“You can’t legalize a substance and not have a coherent policy for controlling driving under the influence of that substance,” said Steven Davenport, an assistant policy researcher at the nonprofit Rand Corporation, who specializes in marijuana research.
Marijuana, after all, weakens a driver’s ability to maintain focus, and it slows reflexes. But regulators are “playing catch-up,” suggested Thomas Marcotte, a psychiatry professor at the University of California, San Diego, and one of a number of academics around the country who is researching driving while high.
States have put forth a bevy of approaches. At least five have what’s called a “per se” law, which outlaws driving if someone’s blood level of tetrahydrocannabinol, or THC, exceeds a set amount. THC is marijuana’s main intoxicant.
Colorado, where voters approved legalization of recreational marijuana in 2012, has this type of driving law on the books. It took 3 years to pass amid fiery debate and deems “intoxicated” any driver who tests higher than 5 ng of THC per milliliter of blood.
Indiana, Pennsylvania and Rhode Island are among states that forbid driving at any THC level. Still others say drivers should be penalized only if they are impaired by the chemical – a standard that sounds reasonable but quickly gets difficult to measure or even define.
None of these approaches offers an ideal solution, experts said.
“We’re still definitely evaluating which policies are the most effective,” said Ann Kitch, who tracks the marijuana and driving issue for the National Conference of State Legislatures.
States that set a THC-level standard confront weak technology and limited science. THC testing is imprecise at best, since the chemical can stay in someone’s bloodstream for weeks after it was ingested. Someone could legally smoke a joint and still have THC appear in blood or urine samples long after the high passes.
There’s general agreement that driving while high is bad, but there’s no linear relationship between THC levels and degree of impairment. States that have picked a number to reflect when THC in the bloodstream becomes a hazard have “made it up,” argued Dr. Humphreys.
“The ones who wrote [a number] into legislation felt they had to say something,” he said. But “we don’t know what would be the analogy. Is the legal amount [of THC] equal to a beer? Is that how impaired you are? Is it a six-pack?”
Roadside testing for THC is also logistically difficult. Blood, for instance, needs to be analyzed in a lab, and collecting urine gets ... complicated.
In Canada, which legalized recreational pot just this year, law enforcement will test drivers with a saliva test called the Dräger DrugTest 5000, but that isn’t perfect, either.
Some private companies are trying to develop a sort of breathalyzer for marijuana. But Jonathan Caulkins, a drug policy researcher at Carnegie Mellon University, Pittsburgh, said, “There are fundamental issues with the chemistry and pharmacokinetics. It’s really hard to have an objective, easy-to-administer roadside test.”
Some states rely on law enforcement to assess whether someone’s driving appears impaired and ascertain after the fact if marijuana was involved.
In California, every highway patrol member learns to administer “field sobriety tests” – undergoing an extra 16 hours of training to recognize the influence of different drugs, including marijuana. Because medical marijuana has been legal there since 1996, officers are “very used” to recognizing its influence, said Glenn Glazer, the state’s coordinator for its drug recognition expert training program.
That kind of training is taking off in other states, too, Ms. Kitch said. Lobbying groups such as Mothers Against Drunk Driving are pushing to bump up law enforcement training and rely on officers to assess whether a driver is impaired.
These tests, though, risk their own kind of error.
“They are subjective,” Mr. Davenport warned.
For one thing, officer-administered tests can be influenced by racial bias. Someone who has previously had poor experiences with law enforcement may also perform worse, not because of greater impairment but because of nervousness.
Indeed, relying on more subjective testing is in some ways the direct opposite of conventional wisdom.
“A general pattern of the last ... 40 years is to try to take human judgment out of decision making processes when possible. Because we fear exactly these issues,” Mr. Caulkins said. “The idea that you could come up with a completely objective test of performance ... is ambitious.”
Researchers like Dr. Marcotte are trying to devise some kind of test that can, in fact, gauge whether someone is showing signs of marijuana impairment. But that could take years.
In the meantime, the public health threat is real. States with legalized pot do appear to experience more car crashes, though the relationship is muddled. “This is going to be a headache of an issue for a decade,” Mr. Caulkins said.
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
It used to be the stuff of stoner comedies and “Just Say No” campaigns. Today, marijuana is becoming mainstream as voters across the country approve ballot questions for legalization or medical use.
In response, state governments are testing ways to ensure that the integration of this once-illicit substance into everyday life doesn’t create new public health risks. These efforts are sparking a difficult question: At what point is someone too high to get behind the wheel?
The answer is complicated. Brain scientists and pharmacologists don’t know how to measure if and to what extent marijuana causes impairment.
The reason: Existing blood and urine tests can detect marijuana use, but, because traces of the drug stay in the human body for a long time, those tests can’t specify whether the use occurred earlier that day or that month. They also don’t indicate the level at which a driver would be considered “under the influence.”
“It’s a really hard problem,” said Keith Humphreys, a psychiatry professor and drug policy expert at Stanford University (Calif.), the first state to legalize medical marijuana and where recreational pot use among adults became legal in 2016. “We don’t really have good evidence – even if we know someone has been using – [to gauge] what their level of impairment is.”
Marijuana is now legal for recreational use in 10 states and the District of Columbia – including Michigan, where a ballot initiative passed in November 2018 took effect Dec. 6. In New York, the governor said Dec. 17 that legalization would be a top priority for 2019. And nearly three dozen states have cleared the use of medical cannabis.
For alcohol, there is a clear, national standard. If your blood alcohol content is 0.08% or higher, you’re considered cognitively impaired at a level that is unsafe to drive. Extensive research supports this determination, and the clarity makes enforcement of drunken-driving laws easier.
Setting a marijuana-related impairment level is a much murkier proposition. But states that have legalized pot have to figure it out, experts said.
“You can’t legalize a substance and not have a coherent policy for controlling driving under the influence of that substance,” said Steven Davenport, an assistant policy researcher at the nonprofit Rand Corporation, who specializes in marijuana research.
Marijuana, after all, weakens a driver’s ability to maintain focus, and it slows reflexes. But regulators are “playing catch-up,” suggested Thomas Marcotte, a psychiatry professor at the University of California, San Diego, and one of a number of academics around the country who is researching driving while high.
States have put forth a bevy of approaches. At least five have what’s called a “per se” law, which outlaws driving if someone’s blood level of tetrahydrocannabinol, or THC, exceeds a set amount. THC is marijuana’s main intoxicant.
Colorado, where voters approved legalization of recreational marijuana in 2012, has this type of driving law on the books. It took 3 years to pass amid fiery debate and deems “intoxicated” any driver who tests higher than 5 ng of THC per milliliter of blood.
Indiana, Pennsylvania and Rhode Island are among states that forbid driving at any THC level. Still others say drivers should be penalized only if they are impaired by the chemical – a standard that sounds reasonable but quickly gets difficult to measure or even define.
None of these approaches offers an ideal solution, experts said.
“We’re still definitely evaluating which policies are the most effective,” said Ann Kitch, who tracks the marijuana and driving issue for the National Conference of State Legislatures.
States that set a THC-level standard confront weak technology and limited science. THC testing is imprecise at best, since the chemical can stay in someone’s bloodstream for weeks after it was ingested. Someone could legally smoke a joint and still have THC appear in blood or urine samples long after the high passes.
There’s general agreement that driving while high is bad, but there’s no linear relationship between THC levels and degree of impairment. States that have picked a number to reflect when THC in the bloodstream becomes a hazard have “made it up,” argued Dr. Humphreys.
“The ones who wrote [a number] into legislation felt they had to say something,” he said. But “we don’t know what would be the analogy. Is the legal amount [of THC] equal to a beer? Is that how impaired you are? Is it a six-pack?”
Roadside testing for THC is also logistically difficult. Blood, for instance, needs to be analyzed in a lab, and collecting urine gets ... complicated.
In Canada, which legalized recreational pot just this year, law enforcement will test drivers with a saliva test called the Dräger DrugTest 5000, but that isn’t perfect, either.
Some private companies are trying to develop a sort of breathalyzer for marijuana. But Jonathan Caulkins, a drug policy researcher at Carnegie Mellon University, Pittsburgh, said, “There are fundamental issues with the chemistry and pharmacokinetics. It’s really hard to have an objective, easy-to-administer roadside test.”
Some states rely on law enforcement to assess whether someone’s driving appears impaired and ascertain after the fact if marijuana was involved.
In California, every highway patrol member learns to administer “field sobriety tests” – undergoing an extra 16 hours of training to recognize the influence of different drugs, including marijuana. Because medical marijuana has been legal there since 1996, officers are “very used” to recognizing its influence, said Glenn Glazer, the state’s coordinator for its drug recognition expert training program.
That kind of training is taking off in other states, too, Ms. Kitch said. Lobbying groups such as Mothers Against Drunk Driving are pushing to bump up law enforcement training and rely on officers to assess whether a driver is impaired.
These tests, though, risk their own kind of error.
“They are subjective,” Mr. Davenport warned.
For one thing, officer-administered tests can be influenced by racial bias. Someone who has previously had poor experiences with law enforcement may also perform worse, not because of greater impairment but because of nervousness.
Indeed, relying on more subjective testing is in some ways the direct opposite of conventional wisdom.
“A general pattern of the last ... 40 years is to try to take human judgment out of decision making processes when possible. Because we fear exactly these issues,” Mr. Caulkins said. “The idea that you could come up with a completely objective test of performance ... is ambitious.”
Researchers like Dr. Marcotte are trying to devise some kind of test that can, in fact, gauge whether someone is showing signs of marijuana impairment. But that could take years.
In the meantime, the public health threat is real. States with legalized pot do appear to experience more car crashes, though the relationship is muddled. “This is going to be a headache of an issue for a decade,” Mr. Caulkins said.
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
It used to be the stuff of stoner comedies and “Just Say No” campaigns. Today, marijuana is becoming mainstream as voters across the country approve ballot questions for legalization or medical use.
In response, state governments are testing ways to ensure that the integration of this once-illicit substance into everyday life doesn’t create new public health risks. These efforts are sparking a difficult question: At what point is someone too high to get behind the wheel?
The answer is complicated. Brain scientists and pharmacologists don’t know how to measure if and to what extent marijuana causes impairment.
The reason: Existing blood and urine tests can detect marijuana use, but, because traces of the drug stay in the human body for a long time, those tests can’t specify whether the use occurred earlier that day or that month. They also don’t indicate the level at which a driver would be considered “under the influence.”
“It’s a really hard problem,” said Keith Humphreys, a psychiatry professor and drug policy expert at Stanford University (Calif.), the first state to legalize medical marijuana and where recreational pot use among adults became legal in 2016. “We don’t really have good evidence – even if we know someone has been using – [to gauge] what their level of impairment is.”
Marijuana is now legal for recreational use in 10 states and the District of Columbia – including Michigan, where a ballot initiative passed in November 2018 took effect Dec. 6. In New York, the governor said Dec. 17 that legalization would be a top priority for 2019. And nearly three dozen states have cleared the use of medical cannabis.
For alcohol, there is a clear, national standard. If your blood alcohol content is 0.08% or higher, you’re considered cognitively impaired at a level that is unsafe to drive. Extensive research supports this determination, and the clarity makes enforcement of drunken-driving laws easier.
Setting a marijuana-related impairment level is a much murkier proposition. But states that have legalized pot have to figure it out, experts said.
“You can’t legalize a substance and not have a coherent policy for controlling driving under the influence of that substance,” said Steven Davenport, an assistant policy researcher at the nonprofit Rand Corporation, who specializes in marijuana research.
Marijuana, after all, weakens a driver’s ability to maintain focus, and it slows reflexes. But regulators are “playing catch-up,” suggested Thomas Marcotte, a psychiatry professor at the University of California, San Diego, and one of a number of academics around the country who is researching driving while high.
States have put forth a bevy of approaches. At least five have what’s called a “per se” law, which outlaws driving if someone’s blood level of tetrahydrocannabinol, or THC, exceeds a set amount. THC is marijuana’s main intoxicant.
Colorado, where voters approved legalization of recreational marijuana in 2012, has this type of driving law on the books. It took 3 years to pass amid fiery debate and deems “intoxicated” any driver who tests higher than 5 ng of THC per milliliter of blood.
Indiana, Pennsylvania and Rhode Island are among states that forbid driving at any THC level. Still others say drivers should be penalized only if they are impaired by the chemical – a standard that sounds reasonable but quickly gets difficult to measure or even define.
None of these approaches offers an ideal solution, experts said.
“We’re still definitely evaluating which policies are the most effective,” said Ann Kitch, who tracks the marijuana and driving issue for the National Conference of State Legislatures.
States that set a THC-level standard confront weak technology and limited science. THC testing is imprecise at best, since the chemical can stay in someone’s bloodstream for weeks after it was ingested. Someone could legally smoke a joint and still have THC appear in blood or urine samples long after the high passes.
There’s general agreement that driving while high is bad, but there’s no linear relationship between THC levels and degree of impairment. States that have picked a number to reflect when THC in the bloodstream becomes a hazard have “made it up,” argued Dr. Humphreys.
“The ones who wrote [a number] into legislation felt they had to say something,” he said. But “we don’t know what would be the analogy. Is the legal amount [of THC] equal to a beer? Is that how impaired you are? Is it a six-pack?”
Roadside testing for THC is also logistically difficult. Blood, for instance, needs to be analyzed in a lab, and collecting urine gets ... complicated.
In Canada, which legalized recreational pot just this year, law enforcement will test drivers with a saliva test called the Dräger DrugTest 5000, but that isn’t perfect, either.
Some private companies are trying to develop a sort of breathalyzer for marijuana. But Jonathan Caulkins, a drug policy researcher at Carnegie Mellon University, Pittsburgh, said, “There are fundamental issues with the chemistry and pharmacokinetics. It’s really hard to have an objective, easy-to-administer roadside test.”
Some states rely on law enforcement to assess whether someone’s driving appears impaired and ascertain after the fact if marijuana was involved.
In California, every highway patrol member learns to administer “field sobriety tests” – undergoing an extra 16 hours of training to recognize the influence of different drugs, including marijuana. Because medical marijuana has been legal there since 1996, officers are “very used” to recognizing its influence, said Glenn Glazer, the state’s coordinator for its drug recognition expert training program.
That kind of training is taking off in other states, too, Ms. Kitch said. Lobbying groups such as Mothers Against Drunk Driving are pushing to bump up law enforcement training and rely on officers to assess whether a driver is impaired.
These tests, though, risk their own kind of error.
“They are subjective,” Mr. Davenport warned.
For one thing, officer-administered tests can be influenced by racial bias. Someone who has previously had poor experiences with law enforcement may also perform worse, not because of greater impairment but because of nervousness.
Indeed, relying on more subjective testing is in some ways the direct opposite of conventional wisdom.
“A general pattern of the last ... 40 years is to try to take human judgment out of decision making processes when possible. Because we fear exactly these issues,” Mr. Caulkins said. “The idea that you could come up with a completely objective test of performance ... is ambitious.”
Researchers like Dr. Marcotte are trying to devise some kind of test that can, in fact, gauge whether someone is showing signs of marijuana impairment. But that could take years.
In the meantime, the public health threat is real. States with legalized pot do appear to experience more car crashes, though the relationship is muddled. “This is going to be a headache of an issue for a decade,” Mr. Caulkins said.
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
EHRs and Burnout
Also today, a new risk-prediction model for diabetes under development, firibastat is looking good for difficult-to-treat hypertension, and differences in gut bacteria can distinguish IBD from IBS.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, a new risk-prediction model for diabetes under development, firibastat is looking good for difficult-to-treat hypertension, and differences in gut bacteria can distinguish IBD from IBS.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, a new risk-prediction model for diabetes under development, firibastat is looking good for difficult-to-treat hypertension, and differences in gut bacteria can distinguish IBD from IBS.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Best of Psychopharmacology: Stimulants, ketamine, benzodiazapines
In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
Amazon
Apple
Google
Spotify
In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
Amazon
Apple
Google
Spotify
In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
Amazon
Apple
Google
Spotify
ICYMI: EP 01 Lorenzo Norris
Gut bacteria distinguish IBD and IBS
Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Healthcare.gov activity surged in last week of open enrollment
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
Next legal ruling on ACA could come on New Year’s Eve
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
Insulin loses its starting spot
, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Texas judge strikes down ACA putting law in peril — again
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Class-action suit filed against ABIM over MOC
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
