11.06.14
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How Much Is That MRI, Really? Massachusetts Shines A Light

The kids are asleep, and I’ve settled into a comfy armchair in the corner of my New England living room, one of my favorite spots for shopping online. I’ve got my laptop open and I’m ready to search for a bone density test.

Hmmm … looks like the price that my insurer pays for that test varies from $190 at Harvard Vanguard to $445 at Brigham and Women’s Hospital.

Really? I’m calm, but this is a seismic moment. In most of the country, it is still nearly impossible to compare the price and quality of anything in health care. Ten years ago, I tried filing Freedom of Information Act requests to get this information and got nothing. Occasionally, sources would leak me spread sheets from one hospital or another.

Websites that mine such data are springing up to fill the void, revealing price tags on everything from an office visit to a cesarean section. But thanks to a law enacted in October, Massachusetts health insurers now have to make all their prices public – in advance.

“This is a very big deal,” says Barbara Anthony, undersecretary for consumer affairs in Massachusetts. “We’re letting the light shine in.”

The online tools also calculate your cost, based on your plan. Anthony’s office has launched an ad campaign, urging patients to shop around. She says doctors and hospitals are becoming frequent users of the online cost tools, too.

“They’re already saying, ‘I don’t want to be the highest priced provider on your website — I thought I was lower than my competitors.’ That’s exactly the kind of reaction we want to see,” she says.

It’s key to getting at why one hospital charges three, four or five times more than its competitors, she says, and to seeing if exposing these differences will drive down prices.

“I’m just talking about sensible, rational pricing,” Anthony says, “and right now, health prices are anything but that.”

Take, for example, the cost in Boston of an MRI of the upper back, which, the numbers show can range from $614 to $1,800.

“That to me is a very big range,” says Sue Amsel, who oversees the shopping tool at the insurer, Harvard Pilgrim Health Care.

In this case, the most expensive MRI is at Boston Children’s Hospital — and the option of lowest cost is at New England Baptist, a hospital that specializes in orthopedics. The total cost of most surgeries is not yet available, but Amsel says you can now search for hundreds of tests, procedures and office visits.

“It’s eye opening,” she says. “I’m always surprised at the difference between providers.”

Now, most of us don’t have a strong incentive to shop. We pay the same $25 or $30 co-pay, no matter where we get an MRI. But more and more people have high-deductible plans, says Amsel, where patients pay the full cost of an office visit or test, up to the amount of their deductible.

The benefit’s not just in getting to choose, Amsel says. “It’s primarily for getting you the information about whatever you’re having done, so you can plan for it.”

After spending a lot of time window shopping for common tests, I have some tips: There are no uniform prices; they vary from one insurer to the next. And you have to read the fine print on these sites to know what is and is not included in the dollar figure you’ll see online.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

11.06.14
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ANA on Ebola Funding

The American Nurses Association (ANA) commends today’s announcement by the Obama administration of an emergency funding request to Congress of  $6.18 billion to enhance its efforts in the U.S. and West Africa to respond to Ebola. The comprehensive funding request outlines immediate and long-term activities designed to protect the American public from Ebola and other infectious diseases, and to control the current epidemic in West Africa.

“We support the administration’s request and urge Congress to act swiftly to provide the necessary resources to effectively manage Ebola and other infectious diseases in the U.S., and to contain the current Ebola outbreak in West Africa,” said American Nurses Association President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

As this funding is distributed, ANA encourages the administration to be mindful of the needs of registered nurses and other health care workers with regard to training and overall preparedness.

FACT SHEET: EMERGENCY FUNDING REQUEST TO ENHANCE THE U.S. GOVERNMENT’S RESPONSE TO EBOLA AT HOME AND ABROAD

Since the first cases of Ebola were reported in West Africa in March 2014, the United States has mounted a whole-of-government response to contain and eliminate the epidemic at its source, while also taking prudent measures to protect the American people.

Today, the Administration announced it is seeking $6.18 billion through an emergency funding request to Congress to enhance our comprehensive efforts to address this urgent situation.  To help meet both immediate and longer-term requirements, $4.64 billion is requested for immediate response and $1.54 billion is requested as a Contingency Fund to ensure that there are resources available to meet the evolving nature of the epidemic.

The $4.64 billion for the Administration’s immediate response, as outlined below, is designed to fortify domestic public health systems, contain and mitigate the epidemic in West Africa, speed the procurement and testing of vaccines and therapeutics, and strengthen global health security by reducing risks to Americans by enhancing capacity for vulnerable countries to prevent disease outbreaks, detect them early, and swiftly respond before they become epidemics that threaten our national security.  These are the same activities that are necessary to combat the spread of Ebola and reduce the potential for future outbreaks of infectious diseases that could follow a similarly devastating, costly, and destabilizing trajectory.

Department of Health and Human Services (HHS) – $2.43 billion:

Centers for Disease Control and Prevention (CDC) – $1.83 billion. The request includes funding to prevent, detect, and respond to the Ebola epidemic and other infectious diseases and public health emergencies both at home and abroad for the following activities:

  • Fortify domestic public health systems and advance U.S. preparedness with support to more than 50 Ebola Treatment Centers through state and local public health departments.
  • Improve Ebola readiness within State and local public health departments and laboratories.
  • Procure personal protective equipment (PPE) for the Strategic National Stockpile.
  • Increase support for monitoring of travelers at U.S. airports.
  • Control the epidemic in the hardest hit countries in Africa by funding activities including: infection control, contact tracing and laboratory surveillance and training; emergency operation centers and preparedness; and education and outreach.
  • Conduct evaluations of clinical trials in affected countries to assess safety and efficacy of vaccine candidates.
  • Establish global health security capacity in vulnerable countries to prevent, detect, and rapidly respond to outbreaks before they become epidemics by standing up emergency operations centers; providing equipment and training needed to test patients and report data in real-time; providing safe and secure laboratory capacity; and developing a trained workforce to track and end outbreaks before they become epidemics.  These are the same activities that are necessary to combat the spread of Ebola and reduce the potential for future outbreaks of infectious diseases that could follow a similarly devastating, costly, and destabilizing trajectory.

Public Health and Social Services Emergency Fund (PHSSEF) – $333 million.  The request includes $166 million for PHSSEF to immediately respond to patients with highly-infectious diseases such as Ebola, including for the purchase of and training on the use of PPE at hospitals across the United States and to support more than 50 Ebola Treatment Centers.  These Ebola Treatment Centers would be able to provide a higher level of definitive care in an isolated setting with point-of-care laboratory testing.  In addition, the request includes $157 million for the Biomedical Advanced Research and Development Authority (BARDA) for immediate response to manufacture vaccines and synthetic therapeutics for use in clinical trials.  The request also includes $10 million to aid in modeling and genetic sequencing of the Ebola virus.

National Institutes of Health – $238 million.  The request includes funding for immediate response for advanced clinical trials to evaluate the safety and efficacy of investigational vaccines and therapeutics.

Food and Drug Administration – $25 million.  The request includes funding for immediate response for development, review, regulation, and post-market surveillance of an Ebola vaccine and therapeutics.

U.S. Agency for International Development – $1.98 billion:

The request includes funding for USAID to scale up the U.S. foreign assistance response to contain the Ebola crisis in West Africa and assist in the region’s recovery from the epidemic.  USAID is the lead agency for the overall U.S. response to the Ebola epidemic in West Africa, partnering with CDC, which is the medical lead.  USAID’s request expands emergency assistance to contain the epidemic, address humanitarian needs and support the recovery of affected countries in the region.  The request supports the medical and non-medical management of Ebola treatment units and community care facilities; provides them with PPE and supplies; helps establish the regional logistics network needed to support the international crisis response; increases the number of safe burial teams; addresses food insecurity and other second-order impacts in affected communities, such as adverse effects on maternal and child health; and bolsters community education efforts critical to prevent the spread of the disease.

The request also expands global health security activities to prevent Ebola from spreading, enhance local health care systems’ ability to report threats in real-time, and establish needed capability for expert personnel and equipment to stop health emergencies before they become epidemics.  This will help limit the spread of Ebola beyond Liberia, Sierra Leone, and Guinea to other vulnerable nations and will increase preparedness and response capacity for future outbreaks.

Department of State – $127 million: 

The request includes funding to expand the Department’s medical support and evacuation capacity to overseas posts in the affected region, provide additional repatriation assistance, and support other diplomatic operational needs including an Ebola Coordination Unit.

The request also includes resources to fund estimated U.S. contributions to the new United Nations Mission for Ebola Emergency Response (UNMEER) and provide a voluntary contribution to the World Health Organization (WHO) to enable it to continue to provide essential technical support for overall coordination, surveillance, and data collection in each Ebola-affected country.

Lastly, the request includes funding for biosafety training efforts as well as training for civil aviation staff to implement sound screening procedures in West African countries.

Department of Defense – $112 million:

The request includes funding for the Defense Advanced Research Projects Agency (DARPA) to support immediate efforts aimed at developing technologies that are relevant to the Ebola crisis, such as providing immediate temporary immunity, including through the use of antibodies from survivors of Ebola and other infectious diseases that will help provide a stop gap until an effective vaccine is available, and developing new technologies that could shorten the vaccine development timeline from years to months.

Contingency Fund:

The Administration is requesting $1.54 billion for a Contingency Fund, with $751 million for HHS and $792 million for USAID and the Department of State.

Given the changing nature of the Ebola epidemic, the Contingency Fund is requested to ensure that there are resources available to respond to the evolving situation.  If necessary, the Contingency Fund could support increased domestic efforts, such as expanded monitoring; a limited vaccination campaign that could target health care workers treating infected patients (if a vaccine is proven safe and effective); an expanded response in Guinea, Sierra Leone or other countries if the virus spreads; and, enhanced global health security efforts.  As the rapidly evolving and unpredictable outbreak progresses, it is necessary to have maximum flexibility to respond quickly.

Ongoing Activities:

The emergency funding requested today complements the ongoing efforts to combat the spread of Ebola, which includes deploying key medical and expert personnel to the affected countries, increasing the Department of Defense’s deployed presence of up to 4,000 service members, building a new hospital for infected health care workers, building Ebola Treatment Units, and reaching out to communities assisting with safe burials. Domestically, this funding expands upon the existing system that screens entrants from West Africa for Ebola symptoms, monitors at-risk individuals, identifies and treats Ebola patients at selected hospitals. Without these additional resources, agencies will be unable to help control the epidemic, mitigate economic, social and political impacts of the crisis, ensure adequate domestic preparedness, develop safe and effective treatments and vaccines or expedite global health security capacity to prevent, detect, and rapidly respond to outbreaks before they become epidemics.  For these reasons, this emergency funding is needed to enhance the Administration’s current whole-of-government response to help end the Ebola outbreak in West Africa and support increased domestic preparedness.

11.06.14
by

ANA on Ebola Funding

The American Nurses Association (ANA) commends today’s announcement by the Obama administration of an emergency funding request to Congress of  $6.18 billion to enhance its efforts in the U.S. and West Africa to respond to Ebola. The comprehensive funding request outlines immediate and long-term activities designed to protect the American public from Ebola and other infectious diseases, and to control the current epidemic in West Africa.

“We support the administration’s request and urge Congress to act swiftly to provide the necessary resources to effectively manage Ebola and other infectious diseases in the U.S., and to contain the current Ebola outbreak in West Africa,” said American Nurses Association President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

As this funding is distributed, ANA encourages the administration to be mindful of the needs of registered nurses and other health care workers with regard to training and overall preparedness.

FACT SHEET: EMERGENCY FUNDING REQUEST TO ENHANCE THE U.S. GOVERNMENT’S RESPONSE TO EBOLA AT HOME AND ABROAD

Since the first cases of Ebola were reported in West Africa in March 2014, the United States has mounted a whole-of-government response to contain and eliminate the epidemic at its source, while also taking prudent measures to protect the American people.

Today, the Administration announced it is seeking $6.18 billion through an emergency funding request to Congress to enhance our comprehensive efforts to address this urgent situation.  To help meet both immediate and longer-term requirements, $4.64 billion is requested for immediate response and $1.54 billion is requested as a Contingency Fund to ensure that there are resources available to meet the evolving nature of the epidemic.

The $4.64 billion for the Administration’s immediate response, as outlined below, is designed to fortify domestic public health systems, contain and mitigate the epidemic in West Africa, speed the procurement and testing of vaccines and therapeutics, and strengthen global health security by reducing risks to Americans by enhancing capacity for vulnerable countries to prevent disease outbreaks, detect them early, and swiftly respond before they become epidemics that threaten our national security.  These are the same activities that are necessary to combat the spread of Ebola and reduce the potential for future outbreaks of infectious diseases that could follow a similarly devastating, costly, and destabilizing trajectory.

Department of Health and Human Services (HHS) – $2.43 billion:

Centers for Disease Control and Prevention (CDC) – $1.83 billion. The request includes funding to prevent, detect, and respond to the Ebola epidemic and other infectious diseases and public health emergencies both at home and abroad for the following activities:

  • Fortify domestic public health systems and advance U.S. preparedness with support to more than 50 Ebola Treatment Centers through state and local public health departments.
  • Improve Ebola readiness within State and local public health departments and laboratories.
  • Procure personal protective equipment (PPE) for the Strategic National Stockpile.
  • Increase support for monitoring of travelers at U.S. airports.
  • Control the epidemic in the hardest hit countries in Africa by funding activities including: infection control, contact tracing and laboratory surveillance and training; emergency operation centers and preparedness; and education and outreach.
  • Conduct evaluations of clinical trials in affected countries to assess safety and efficacy of vaccine candidates.
  • Establish global health security capacity in vulnerable countries to prevent, detect, and rapidly respond to outbreaks before they become epidemics by standing up emergency operations centers; providing equipment and training needed to test patients and report data in real-time; providing safe and secure laboratory capacity; and developing a trained workforce to track and end outbreaks before they become epidemics.  These are the same activities that are necessary to combat the spread of Ebola and reduce the potential for future outbreaks of infectious diseases that could follow a similarly devastating, costly, and destabilizing trajectory.

Public Health and Social Services Emergency Fund (PHSSEF) – $333 million.  The request includes $166 million for PHSSEF to immediately respond to patients with highly-infectious diseases such as Ebola, including for the purchase of and training on the use of PPE at hospitals across the United States and to support more than 50 Ebola Treatment Centers.  These Ebola Treatment Centers would be able to provide a higher level of definitive care in an isolated setting with point-of-care laboratory testing.  In addition, the request includes $157 million for the Biomedical Advanced Research and Development Authority (BARDA) for immediate response to manufacture vaccines and synthetic therapeutics for use in clinical trials.  The request also includes $10 million to aid in modeling and genetic sequencing of the Ebola virus.

National Institutes of Health – $238 million.  The request includes funding for immediate response for advanced clinical trials to evaluate the safety and efficacy of investigational vaccines and therapeutics.

Food and Drug Administration – $25 million.  The request includes funding for immediate response for development, review, regulation, and post-market surveillance of an Ebola vaccine and therapeutics.

U.S. Agency for International Development – $1.98 billion:

The request includes funding for USAID to scale up the U.S. foreign assistance response to contain the Ebola crisis in West Africa and assist in the region’s recovery from the epidemic.  USAID is the lead agency for the overall U.S. response to the Ebola epidemic in West Africa, partnering with CDC, which is the medical lead.  USAID’s request expands emergency assistance to contain the epidemic, address humanitarian needs and support the recovery of affected countries in the region.  The request supports the medical and non-medical management of Ebola treatment units and community care facilities; provides them with PPE and supplies; helps establish the regional logistics network needed to support the international crisis response; increases the number of safe burial teams; addresses food insecurity and other second-order impacts in affected communities, such as adverse effects on maternal and child health; and bolsters community education efforts critical to prevent the spread of the disease.

The request also expands global health security activities to prevent Ebola from spreading, enhance local health care systems’ ability to report threats in real-time, and establish needed capability for expert personnel and equipment to stop health emergencies before they become epidemics.  This will help limit the spread of Ebola beyond Liberia, Sierra Leone, and Guinea to other vulnerable nations and will increase preparedness and response capacity for future outbreaks.

Department of State – $127 million: 

The request includes funding to expand the Department’s medical support and evacuation capacity to overseas posts in the affected region, provide additional repatriation assistance, and support other diplomatic operational needs including an Ebola Coordination Unit.

The request also includes resources to fund estimated U.S. contributions to the new United Nations Mission for Ebola Emergency Response (UNMEER) and provide a voluntary contribution to the World Health Organization (WHO) to enable it to continue to provide essential technical support for overall coordination, surveillance, and data collection in each Ebola-affected country.

Lastly, the request includes funding for biosafety training efforts as well as training for civil aviation staff to implement sound screening procedures in West African countries.

Department of Defense – $112 million:

The request includes funding for the Defense Advanced Research Projects Agency (DARPA) to support immediate efforts aimed at developing technologies that are relevant to the Ebola crisis, such as providing immediate temporary immunity, including through the use of antibodies from survivors of Ebola and other infectious diseases that will help provide a stop gap until an effective vaccine is available, and developing new technologies that could shorten the vaccine development timeline from years to months.

Contingency Fund:

The Administration is requesting $1.54 billion for a Contingency Fund, with $751 million for HHS and $792 million for USAID and the Department of State.

Given the changing nature of the Ebola epidemic, the Contingency Fund is requested to ensure that there are resources available to respond to the evolving situation.  If necessary, the Contingency Fund could support increased domestic efforts, such as expanded monitoring; a limited vaccination campaign that could target health care workers treating infected patients (if a vaccine is proven safe and effective); an expanded response in Guinea, Sierra Leone or other countries if the virus spreads; and, enhanced global health security efforts.  As the rapidly evolving and unpredictable outbreak progresses, it is necessary to have maximum flexibility to respond quickly.

Ongoing Activities:

The emergency funding requested today complements the ongoing efforts to combat the spread of Ebola, which includes deploying key medical and expert personnel to the affected countries, increasing the Department of Defense’s deployed presence of up to 4,000 service members, building a new hospital for infected health care workers, building Ebola Treatment Units, and reaching out to communities assisting with safe burials. Domestically, this funding expands upon the existing system that screens entrants from West Africa for Ebola symptoms, monitors at-risk individuals, identifies and treats Ebola patients at selected hospitals. Without these additional resources, agencies will be unable to help control the epidemic, mitigate economic, social and political impacts of the crisis, ensure adequate domestic preparedness, develop safe and effective treatments and vaccines or expedite global health security capacity to prevent, detect, and rapidly respond to outbreaks before they become epidemics.  For these reasons, this emergency funding is needed to enhance the Administration’s current whole-of-government response to help end the Ebola outbreak in West Africa and support increased domestic preparedness.

11.05.14
by

Soda Tax Succeeds In Berkeley, Fizzles In San Francisco

Voters in Berkeley, Calif., have passed the nation’s first soda tax with a resounding 75 percent of the vote. The measure aims to reduce the effects of sugar consumption on health, especially increased rates of obesity and diabetes.

Across the bay in San Francisco, however, a similar proposal failed to get the two-thirds supermajority it needed.

More than 30 cities and states across the country have attempted but failed to enact such a tax, at least in part because of well-funded opposition from the soda industry.

Berkeley’s Measure D needed only a simple majority to pass. It will levy a penny-per-ounce tax on most sugar-sweetened beverages and is estimated to raise more than $1 million per year. Proceeds will go to the general fund; Measure D calls for the creation of a health panel to advise Berkeley’s City Council on appropriate health programs to receive funding.

Campaign Co-Chair Josh Daniels called Berkeley’s win a tipping point. “I think you will now see many, many other cities and communities around the country looking at this as a genuine public policy to address the diabetes and obesity crisis that we face,” he said.

While the San Francisco proposition did not pass, supporters there declared a victory of their own: More than half the voters approved the tax despite millions spent by the American Beverage Association to defeat it.

“So the fact that we were able to overcome $10 million,” said Proposition E coauthor Scott Wiener, a member of the San Francisco Board of Supervisors, “and it looks like a majority of San Franciscans – despite that $10 million – will vote ‘yes,’ is pretty extraordinary.”

The opposition campaigns, funded primarily by the beverage association, argued that the measures were riddled with loopholes and wouldn’t accomplish their health goals. Roger Salazar, a spokesman for the campaigns, pointed to the 30 failed measures from around the country and called Berkeley “an anomaly.” He said that to expect to pass such a tax elsewhere in California was “foolhardy.”

Advocates are convinced he’s wrong. Harold Goldstein, executive director of the California Center for Public Health Advocacy, called the measure’s passage “remarkable.”

“What we learned here in Berkeley,” he said, “is that when voters learn the truth about sugary beverages, when they learn that they are one of the central causes of the growing diabetes epidemic, they want to tax it, they want to regulate these products.”

Sodas are the primary source of added sugar in the American diet and that added sugar is linked to increasing rates of diabetes.

Berkeley has a history of being first to a new cause that’s later embraced more broadly, said Lori Dorfman, executive director for the Berkeley Media Studies Group. “In the mid-70s, Berkeley made the first ‘curb cut,’ and now people in wheelchairs all over the country are not trapped in their homes anymore.” She noted that Berkeley was also the first city to pass a clean indoor air ordinance.

Mexico enacted a national soda tax on January 1, and by summer, consumption had dropped 10 percent.

Kelly Brownell, dean of Duke University’s school of public policy first proposed a soda tax in the early 1990s. He called the votes in both Berkeley and San Francisco “historic” and, like other advocates, predicted other cities will soon follow suit and that soda companies are bracing for that.

“My guess is that inside their boardrooms, they know very well these taxes are the beginning of the future,” he said. “This is a wave starting to crest.”

Brownell said that half the costs of diabetes and obesity are born by taxpayers, through government health insurance programs Medicare and Medicaid. Those public costs “justify the government getting involved, just like tobacco taxes,” he said.

This story is part of a reporting partnership that includes KQED, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

11.05.14
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Voters Provide Mixed Messages On Health Ballot Measures

The Affordable Care Act wasn’t directly on the ballot in any state, but voters did decide a host of health-related issues in Tuesday’s elections.  And there was no clear theme to what won and lost.

For example, voters in two states – North Dakota and Colorado – rejected so-called “personhood” amendments that would have recognized rights for unborn fetuses.

It was the third time since 2008 Colorado voters faced – and voted down – language to amend the state constitution to enshrine as a “person” those not yet born, sometimes from the moment of conception. This year’s version was slightly different. It would have written “unborn human beings” into the state’s criminal code and its Wrongful Death Act. As with the past two efforts, voters rejected this version 64 to 36 percent with 73 percent of the vote counted.

The North Dakota amendment, by contrast, would have added language to the state constitution stating, “The inalienable right to life of every human being at any stage of development must be recognized and protected.” It failed 64 to 36 percent.

Efforts to establish rights for the unborn have failed regularly even in very conservative places, as opponents have argued that such “personhood” measures could outlaw not only abortion, but some forms of birth control or in vitro fertilization.

Abortion opponents did not come away empty-handed, however. In Tennessee voters approved a measure that would effectively overturn a 2000 state Supreme Court decision that found the state’s constitution guaranteed a right to abortion and prohibited most state restrictions.

The amendment, stating that “Nothing in this Constitution secures or protects a right to abortion or requires the funding of an abortion,” was approved with 53 percent of the vote. It is expected to touch off a round of new restrictions when the Republican-dominated state legislature reconvenes next year.

In Arizona, voters, as expected, supported a “right to try” ballot measure that would allow, but not require, drug makers to provide not-yet-approved drugs to people with terminal illnesses. Colorado became the first state with a right-to-try law earlier this year.

The effort has been pushed by the Libertarian Goldwater Institute, based in Arizona. Critics have worried that the laws could give those with terminal illnesses false hope, particularly because drug makers are loathe to provide experimental drugs to those near death, since that could reflect badly on the drug.

Meanwhile, in California, two highly-publicized, health-related ballot measures went down to defeat.

One, Proposition 45, would have imposed the same public notice and transparency requirements for health insurance premium rates as voters approved for auto and homeowners insurance in 1988. It would also have given the state’s insurance commissioner the right to reject rate hikes deemed “excessive.”

The proposal was fiercely opposed by the health insurance industry, which raised more than $50 million to fight it. Opponents argued, among other things, that the proposal would have given too much power to the state’s elected insurance commissioner. With 95 percent of the votes counted, Proposition 45 was losing 60 to 40 percent.

California voters also turned back, 67 to 33 percent, an effort to raise the caps on damage awards for non-economic “pain and suffering” in medical malpractice cases. The $250,000 maximum had not been raised since the California malpractice law was originally written in 1975.

But Proposition 46 would also have made California the first state to require random drug and alcohol testing for physicians. That part of the proposal prompted many newspaper editorial boards to turn against it.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.