The industry that makes medical devices from artificial hips to miniature pumps for IV drips is looking for a fallback plan to repeal a widely reviled sales tax that almost met its end in GOP health care legislation.

The 2.3 percent excise, one of several taxes and fees in the Affordable Care Act that pay for expanded insurance coverage, has been the subject of ferocious lobbying by manufacturers seeking its permanent death. Yet for now it's on track to be reinstated on Jan. 1 after a two-year hiatus, leaving industry leaders worried it will hurt employment and stifle development of innovative, even lifesaving products.

"We know it resulted in job loss when it was in effect and we also know it resulted in decreased investment and development," said Patrick Hope, executive director of the Medical Imaging & Technology Alliance, one of several trade groups fighting reinstatement of the tax.

The tax covers a range of medical equipment sold to hospitals and physicians but excludes consumer items such as eyeglasses, hearing aids and diabetes kits.

Various failed versions of Republican bills to repeal and replace the Obama health care law would have killed the tax that is also unpopular with many Democrats in Congress, some representing states with thriving clusters of medical device firms.

The U.S. medical device market was valued at nearly $148 billion in 2016 with projections it will increase to $173 billion by 2019, according to Emergo, a leading industry consultant.

Companies shed 29,000 jobs from 2013-2015 when the tax was in effect, according to government data cited by the Advanced Medical Technology Association, or AdvaMed. No corresponding employment data exists yet for 2016-2017 when the tax was suspended though another trade group, the Medical Device Manufacturers Association, said a member survey found 70 percent added jobs while R&D spending increased by 19 percent on average.

Skeptics argue it's impossible to draw a straight line from the tax to overall performance by the industry and point to a variety of other factors, from consolidation to global competition, that influence trends in employment and R&D commitment.

John McDonough, a professor of public health policy at Harvard University, said he doubted the tax seriously harmed most firms while it was in effect, or that it would wreak much havoc if reinstated next year.

"The medical device industry stands out in its determination to be the one industry to get off the hook," said McDonough, noting that insurers, drugmakers and hospitals were also assessed higher taxes and fees under the ACA.

Proponents of the tax, originally estimated to raise $29 billion in net revenue over 10 years, contend industry sales can only benefit from more Americans having access to health insurance. Still, the tax has long been targeted for repeal, not only by congressional Republicans but also many Democrats who strongly back the health care law and the other taxes that go with it.

Critics have cited a 2015 analysis by the Congressional Research Service that declared the levy "challenging to justify" in terms of traditional economic and tax policy. That same report, however, also projected "fairly minor" impacts on production and employment in the medical device industry.

Boston Scientific Corp., a leading maker of heart stents and other devices, said the two-year suspension allowed for a doubling of its collaboration with Mayo Clinic on projects to help cardiovascular patients.

Clinical Innovations, a privately-held medical device company in Salt Lake City, said tax savings of about $500,000 a year helped it speed up the redesign and launch of a balloon-like device that helps doctors manage potentially fatal occurrences of postpartum hemorrhaging in women.

"For a company like us, that's a significant savings, and frankly where we tend to cut if we have to pay a tax like that is on the development side," said Ken Reali, the firm's chief executive.

In 2015, 46 Democrats joined Republicans in approving a House bill to repeal the tax. That effort ultimately fell short, but Congress later added the two-year suspension of the tax to a budget bill.

Minnesota has about 27,000 people working in the sector with an average salary of $63,567, while in Massachusetts nearly 24,000 are employed in the industry and earn $66,787 on average, according to AdvaMed. Those states rank second and third behind California in medical device employment.

Minnesota's Democratic U.S. Sens. Al Franken and Amy Klobuchar have both voiced support for repealing the tax, as have Democratic Sens. Elizabeth Warren and Edward Markey of Massachusetts.

Yet many Democrats, Warren included, insist they would only vote to eliminate the tax if another revenue source for the ACA was available to replace it.

So how to halt the tax before January, absent a full repeal of the health care law?

Several possibilities exist. One option would be to include in an overhaul of the U.S. tax code sought by President Donald Trump. It could also be tied to efforts to stabilize insurance markets, or attached to other vehicles such as an appropriations bill or the pending reauthorization of a separate health insurance program for children. All come with procedural challenges and uncertainties.

"It's a full court press," said Greg Crist, a spokesman for AdvaMed.

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Health care divide leaves tax on path to reinstatement - ABC News

Holly Zachariah The Columbus Dispatch @hollyzachariah

MARYSVILLE Stephenie Headings, with the unchecked enthusiasm that only a 7-year-old could muster when facing a couple of hours of medical exams, asked the same questions time and again.

Is it my turn yet, Mom? she asked, bouncing on tiptoes in her cowboy boots and running over to peek in a room where a man in camouflage fatigues was testing someones hearing. Can I go in?

Rebekah Headings laughed. Dont worry, she told her youngest of four daughters as she corralled them through a free health-care clinic Saturday morning. Youll get to go in there, too.

The Headingses, a family of six, were among those who visited the Ohio National Guards GuardCare, an annual clinic presented each summer or fall in a different medically underserved community in the state in partnership with the Ohio Department of Health and local health departments.

This weekend, GuardCare is visiting the Union County Health Department, 940 London Ave. in Marysville; a similar event was held in Madison County this past weekend. The program continues from 8 a.m. to 3 p.m. Sunday and no appointment is necessary.

Anyone can make use of the services offered. No proof of income, insurance or residency is required. Thats not what GuardCare is about. Its about training. And so much more, said Maj. Gen. Mark E. Bartman, adjutant general of the Ohio National Guard.

He said most people know about the Guards federal and state missions to deploy overseas to assist a U.S. war effort and to help when called upon in state disasters. But thats not all.

Our third mission is our community mission. We have soldiers and airmen that live in almost every county in the state of Ohio," Bartman said. "GuardCare is an opportunity for them to give back to the community in which they live.

People this weekend can visit any or all of 17 medical stations set up in conference rooms, hallways and offices at the health department, depending on their needs. There are the routine screenings found at most health fairs: vital signs, blood work, hearing checks and the like. But the event in Marysville is expanded to include such things as dental exams, screening for sexually transmitted diseases, Pap tests and full general physicals.

Jennifer Thrush, spokeswoman for the Union County Health Department, said the departmentworked hard to make sure advertising reached particular groups such as the working poor, the self-employed, senior citizens and families with young children.

For so many hard workers, there still is a barrier to health care, Thrush said. High deductibles, not being able to find a primary-care physician, expensive co-pays. This event helps remove those and provides free access to health care and preventive services in our backyard, in one day, for everyone, anyone at all.

Union County health-care providers, medical students and others volunteered, along with more than 100 National Guard personnel, to deliver the services.

For the Headings family, the day couldnt have been more important.

ThoughRebekah's husband, Dennis, gets a stipend through his job, the family of cattle and sheep farmers from Plain City spends a lot out of pocket on health insurance, and last year, the children lost their insurance.

This is a huge deal for us, Rebekah Headings said about Saturday. She pointed to a nasty scar on the left knee of one of her girls, one that came from a fall in the barn in February. We can use our health savings account for the unexpected, stuff like that, and get our basic needs taken care of here.

Both parents got vaccines, and cholesterol and blood-sugar checks. Dennis had an EKG. The kids got vaccines, and one found out she has some cavities that need to be addressed. They also got physicals for the sports they play after school.

Attending the health program used up a few hours of a nearly perfect summer Saturday morning, but no one in the family minded. Their health, after all, comes first.

Were so grateful, Rebekah Headings said.

Stephenie, for her part, pretty much charmed her way through every station and delighted in the freebies everyone gave her, including a water bottle, a toothbrush and her favorite a purple latex glove blown up like a balloon.

Ohio Army National Guard Spc. Adam Hagelberger administered her vision test even though she had to stretch her neck to reach the machine.

"OK. Read me the next line," he told her.

K-D-S-O-N

"And the next one?," he asked.

S-D-O-H-N.

Not perfect, he said. But good just the same.

She giggled.

Hagelberger, a combat medic with the Guard, said GuardCare each year is invaluable for him.

"You can sit through all the PowerPoint presentations in class that you want, but theres nothing that helps us more than hands-on training, he said. We are part of the U.S. Army, yes, but we are the Ohio National Guard. Thats important. Giving back to Ohio matters to us.

hzachariah@dispatch.com

@hollyzachariah

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Ohio National Guard brings health-care clinic to Marysville - The Columbus Dispatch

We need a clean, transparent election.

Recently there were statewide headlines raising concerns that Oregon Secretary of State Dennis Richardson has a serious conflict of interest issue in his role as the elections chief. I share those concerns and want to make sure more people are aware of them because the health care of hundreds of thousands of Oregonians like me is at risk.

Here is the issue: Julie Parrish, who serves both as a state representative and as Mr. Richardsons political consultant, is now wearing a third hat. She is the chief petitioner of Referendum 301, through which she will cut funding for the state reinsurance pool and the Medicaid program. If she is successful, Oregonians who buys their own health insurance as I do will see a premium increase. The reinsurance pool, according to state insurance regulators, reduced 2018 premiums for people like me by 6 percent. In addition to cutting funding for the reinsurance pool, Referendum 301 will cut $1.3 billion from the state Medicaid budget, which will result in the loss of health care of some 360,000 Oregonians. Our local representative, Cedric Hayden, is a co-petitioner as well, which is very disappointing.

I cannot afford that additional extra premium increase and as a cancer survivor, it is life threatening for me to go without insurance. I do not have insurance coverage through my job, as is the case for many Oregonians. Referendum 301 will unfairly target people like me. And as a personal support professional for people with physical and intellectual disabilities, I worry about what my clients will do if their health care is suddenly cut off.

With so much at stake, it is critical that everything relating to this referendum be by the book and held to the highest standard.

As media recently reported, Mr. Richardson has paid Rep. Parrish $330,000 and she continues to receive monthly payments from him through his political action committee even as she is gathering signatures on the health care referendum.

This creates an extraordinary situation: Mr. Richardson will be responsible for overseeing the signature verification for his consultants referendum. If Referendum 301 qualifies, he will be setting deadlines for the voters pamphlet statement and will be overseeing when and what the voters see about the referendum before they cast their ballots.

There are other red flags. Mr. Richardsons former communications director is being paid for work related to Referendum 301. And the top contributor to Referendum 301s political action committee is also a top contributor to both Richardson and Parrishs candidate committees, writing five-figure checks to each.

What other coordination is happening or will be happening between Mr. Richardson and the Referendum 301 campaign? Right now, theres no way to know short of filing costly, slow and cumbersome public records requests on a daily basis.

All of this news came out only after the Oregon Nurses Association, which is concerned about how Referendum 301 will affect patients, made a reasonable request. They asked Mr. Richardson and his team to act immediately to develop a full transparency policy regarding his communications with Representative Julie Parrish that includes all matters relating to the special election Referendum 301 to ensure that all matters are handled with an impartiality and in the full view of Oregon voters.

Mr. Richardson has so far ignored this fair request.

Oregonians deserve clean, fair and transparent elections at every step of the process. In order to avoid any real or perceived conflict of interest issues, Rep. Hayden should also call for a clean election and for Mr. Richardson to release all the records relating to his political consultant and the referendum.

For me, and for the people like me who cannot afford even higher premiums or to lose health care altogether, the stakes are very high. We just narrowly escaped an immediate rollback of health care coverage at the federal level. The fact we are facing similar cuts from our local politicians is incredibly disheartening and frightening. Secretary of State Richardson, Julie Parrish, and Cedric Hayden should hold themselves to the highest ethical standard in this election and be fully transparent and forthright about Richardsons conflict of interest issues.

Maleta Christian of Myrtle Creek is a personal support worker for people with intellectual and developmental disabilities.

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My health care is at stake - NRToday.com

Nearly a quarter of Americans said health care is the most important issue facing the country today, according to a new CNN poll conducted by SSRS. It beat out the economy (15%), immigration (11%), foreign policy (8%) and Donald Trump (8%). Fewer than 5% named each of several other issues, like the environment, civil rights, government spending and education.

About one-third of Democrats said health care was the top issue, while 22% of independents did, the CNN poll found. Only 18% of Republicans felt this way, even though Congressional Republicans spent much of this year trying to overhaul Obamacare. The effort stalled in the Senate last month.

In a Gallup poll also released Thursday, 17% of Americans identified health care as the nation's biggest problem. While dissatisfaction with the government/poor leadership took the top spot, health care beat out unemployment and jobs by more than two-to-one and the economy by nearly three-to-one.

Republicans and Democrats were nearly tied in naming health care as the most important problem, with 21% of the GOP and 19% of Democrats mentioning it, Gallup found.

Related: CNN Poll: Nearly seven in 10 judge Congress a failure so far

The majority of Americans (56%) want the two parties to work together to make changes to health care policy, according to CNN's survey. The rest are divided: Just over one in five said the GOP should both stop trying to repeal Obamacare completely (21%), and the same share said Republicans should keep trying to repeal it anyway (21%).

CNN's Ryan Struyk and Jennifer Agiesta contributed to this report.

CNNMoney (New York) First published August 10, 2017: 5:07 PM ET

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Health care is one of the nation's biggest problems: Polls - CNNMoney

A A

Dear Mr. Berko: In 2008, you referred me to a congressman who solved a problem I had with a stupid bureaucrat at the Financial Industry Regulatory Authority. It took several phone calls and letters, but two months later, it was fixed. I felt obligated to make annual contributions to his political action committee. We have become friendly and have lunch occasionally. At our most recent lunch, I asked why Congress cant put a health care bill together. His surprising answer was: Ask Berko!

C.S., no state

Dear C.S.: All members of Congress and their staffs enjoy a platinum-plated Cadillac health care plan which pays generously for everything, including rhinotillexomania, halitosis, alopecia, mythomania and mange. This let them eat cake Congress needs a taste of our medicine to understand our despair and distress.

Most politicians are molded from the contents of a colostomy bag. But Ive known this congressman for decades, and hes honest as a stone. What hes reluctant to tell you is that big money and special interest groups with big money always take precedence over the publics interest. So, what do 535 members of Congress have in common? Wanting to get re-elected!

Most folks dont know that there are over 9,000 pharmaceutical and biotech companies peddling products to American consumers. All have interests in our health care law. So they contribute hugely to influence how 535 members of Congress vote. They care about whats best for them.

There are 1.4 million physicians, 61,000 chiropractors, 14,000 podiatrists and 200,000 dentists who have an interest in our health care law. Their sizable contributions to Congress will influence their representatives votes. They care about whats best for them.

Its hard to believe there are just 35 health insurance companies in the U.S., though many different health plans (estimated at 4,700) under different names are divisions of major insurers. They have an interest in our health care law, not in your health. They spend millions influencing the votes of the 535 members of Congress. They care about whats best for them.

There are about 6,000 hospitals in the U.S., with over 1 million beds. They have an interest in our health care law. Sizable checks to members of Congress buy the votes they want. They care about whats best for them.

There are 12,000 lobbyists spending $6 billion on 535 members of Congress (thats $11.2 million per member), knowing their dollars will influence the outcome of health care legislation. Lobbyists care only about whats best for their clients.

Finally, there are 1.45 million lawyers, or 27,000 lawyers per member of Congress. Many earn their incomes suing/advising hospitals, drug companies, Medicaid, Medicare and the insurance industry. They contribute massive amounts of money to influence the health care legislation. They care about whats best for them.

Private-interest groups

These are the players who are important to Congress. Folks like us cant compete with their money, power and influence. The golden rule says, He who has the gold rules. House and Senate seats are costly, and private-interest groups that have the gold tell members of Congress how to vote.

In 2012, candidates who won House seats received an average of $1.7 million in contributions, while winning Senate candidates received an average of $10.5 million. Elizabeth Warren of Massachusetts sold her soul that year, sucking in $42 million to win her seat. Running for Congress takes big buckets of bucks. So incumbents must cater to special interest groups and their private agendas if they wish to be re-elected. Like sharks smelling blood, members of Congress smell money. Its money that buys the votes to keep them in office. And those dollars dont come from folks like us. So members of Congress learn to be Janus-faced; they excel at walking your walk and talking your talk, and then they follow the money. The common ruck like us doesnt have the green for $75,000-a-plate dinners or to make meaningful contributions to election campaigns. Members of Congress, beholden to special interest money and challenged by the publics needs, invariably choose the former. And in the process, theyve learned to imitate tested empathetic noises, convincing you theyre in Washington only to represent your interests. Congress has segued further into a sad comedy of baboons and buffoons.

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Berko: Here's why Congress can't make a health care bill - The Columbian

(CBS/WBTW) More Americans now have access to health care than in decades past, but the cost and quality of service can vary widely depending on where someone lives.

With the continuing battle in Washington over thefuture of health care in the United States, experts at personal-finance website WalletHub decided to do some digging into the quality of health care on a state-by-state basis.

According to the latest data from the Centers for Medicare & Medicaid Services, the average U.S. adult spends nearly $10,000 per year on personal health care, and that number is expected to continue to increase over time.

But as costs rise, the United States remains well behind other wealthy nations when it comes tolife expectancy, quality of life, and overall health coverage.

To determine in which states Americans receive the best and worst health care overall, the analysts at WalletHub compared all 50 states plus the District of Columbia across 35 measures of cost, accessibility, and outcome.

Among the factors they took into consideration were the cost of medical and dental visits; average monthly insurance premiums; quality of hospital care systems;life expectancy;cancer rates; heart disease rates; and infant, child, andmaternal mortalityrates.

Hawaii topped the list with the lowest heart disease rate in the nation and a particularly high number of insured adults aged 18 to 64. Iowa, Minnesota, and New Hampshire also ranked high on the list.

According to the analysis, the top 10 best states for health care are:

In contrast, Louisiana was rated the worst state for health care overall, with the highestheart diseaserate in the nation, the third highest cancer rate, and a low number of dentists per capita.

North Carolina ranked 5th on the worst state list (47th overall), with the highest average monthly insurance premiums.

South Carolina ranked 7th on the worst state list (45th overall), but WalletHub offered no explanation as to why.

The 10 worst states for health care include:

To see how the other states stack up, seeWalletHubs full report.

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SC, NC rank among 10 worst states for healthcare - WBTW - Myrtle Beach and Florence SC

Former Hong Kong finance minister Antony Leung Kam-chung has launched an ambitious project to recruit the citys talent to train health care professionals on the mainland, which is experiencing a serious shortage of high-quality carers.

Leung is trying to reverse the trend through his leadership of New Frontier, an investment group that owns Care Alliance, which operates a number of mainland health care facilities, including for the elderly and rehabilitation.

There is great demand for rehabilitation on the mainland, which is still looking at standards and the operation of services. But in Hong Kong the level of our services is relatively mature, Leung said, adding that Beijing, Shanghai, Guangzhou and Shenzhen faced a shortage of one million carers.

How could we help to set and raise standards of rehabilitation on the mainland? I think Hong Kong could certainly help in the future, Leung said.

New Frontier said it would pump 1 billion yuan (HK$1.17 billion) into healthcare projects in southwestern parts of the mainland. This comes after it earlier this year pledged to inject at least 1 billion yuan into a Shenzhen-based medical group so it can take part in the Greater Bay Area plan, an integration scheme involving Hong Kong, Macau and nine Pearl River Delta cities.

Leung met Hong Kong journalists in Chengdu last week to introduce the Care Alliance Rehabilitation Hospital, a new facility in which New Frontier has invested more than 100 million yuan. The hospital is set to open late next month.

New Frontier has entered a partnership with a few Hong Kong institutions to train health care workers on the mainland.

For example, experts from the Vocational Training Council will provide training courses for carers in all health care institutions under New Frontier, while the Society for Rehabilitation will provide training for mainland physiotherapists and occupational therapists working in the firms Chengdu rehabilitation hospital.

Two young Hongkongers have joined the growing trend of taking part in exchanges between Hong Kong and mainland health care personnel by working as interns at a separate hospital under the Care Alliance.

Opting for elderly care might be a rather unusual career choice for Yeung Kwok-ho, 22, and Dickman Wai, 21, who have started a two-month internship after completing a higher diploma course in elderly care services at the citys Institute of Vocational Education.

I want to understand how elderly care homes operate on the mainland and whether there are any practices we can adopt, said Wai, who was motivated to study elderly care after seeing his grandmother suffering in a Hong Kong care home.

Would the elderly in China respond differently to the same techniques I use in Hong Kong?

The pair, who were the first two students in their programme to take up internships on the mainland, will help organise physical exercises for the elderly and cognitive training for those with dementia.

Continue reading here:

Hong Kong experts to train mainland Chinese health care workers under new scheme - South China Morning Post