Legislators get tough on abuse of foreign doctor program

By Marshall Allen (contact)

Thursday, May 28, 2009 | 2 a.m.

Legislators have given final approval to a bill authorizing the Health Department to stop the exploitation of foreign doctors who have come to practice in the state’s blighted urban areas and rural towns.

Senate Bill 229 won Assembly approval last week and awaits Gov. Jim Gibbons’ signature.

The legislation is the latest of reforms sparked by a 2007 Las Vegas Sun investigation into the J-1 visa waiver program.

Many J-1 doctors were being overworked and underpaid by their bosses, or reassigned from their clinics in underserved neighborhoods, where they are supposed to serve the poor, to insurance-rich hospitals where they made more money for their employers.

Sen. Maggie Carlton, a Las Vegas Democrat and a member of an advisory committee formed to oversee the program, sponsored the bill.

The legislation would:

• Make a violation a more clearly punishable offense under state law, prosecutable by the attorney general’s office.

• Charge the participating employers a fee that would cover the cost of enforcement.

• Protect whistleblowers who report violations from civil and criminal liability.

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A growing percentage of Nevadans under 65 are paying a greater proportion of their family’s pretax income on health care costs, a new report shows.

People with health insurance are among those facing increased health care costs.

The report “Too Great a Burden” by the advocacy group Families USA attributes the increasing costs to rising health insurance premiums, which force employers to make difficult choices. They may drop coverage altogether, pass more premium costs to employees, provide coverage that includes fewer services and/or choose policies that require higher out-of-pocket costs. This has shifted the costs to Americans at a dramatic rate from 2000 to 2009, the report shows. According to the report:

• Almost 30 percent of Nevadans under 65 — 700,000 people — will spend more than 10 percent of their pretax family income on health care in 2009, an increase from 15 percent of Nevadans under 65 in 2000.

• About 31 percent of insured Nevadans under 65 — 576,000 people — will spend more than 10 percent of their pretax family income on health care in 2009, an increase from 15 percent in 2000.

• Almost 9 percent of Nevadans under 65 — about 200,000 people — will spend more than 25 percent of their pretax family income on health care in 2009, an increase from 4 percent in 2000.

• More than 8 percent of insured Nevadans under 65 — 153,000 people — will spend more than 25 percent of their pretax family income on health care in 2009, an increase from 3 percent in 2000.

Nationally, about one in four Americans will spend more than 10 percent of their pretax family income on health care in 2009.

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Nevada legislators have been desperately searching for revenue sources to address the state’s budget crisis, but they spent little time discussing an increase of the tobacco tax.

A Centers for Disease Control and Prevention report released last week shows that the tobacco tax excised in Nevada is less than a third of the national average, and is in line with taxes collected in states that grow tobacco. Taxes can be used to offset health care costs affiliated with smoking, for anti-smoking programs or other health care costs.

Nevada levies a tax of 40 cents per pack of cigarettes.

The average tobacco tax in the major tobacco-growing states — Georgia, Kentucky, North Carolina, South Carolina, Tennessee and Virginia — was 38.5 cents per pack of cigarettes on April 1, the CDC reported. Among all other states the average tax excised was $1.31 per pack.

The CDC reports that cigarette smoking and exposure to secondhand smoke result in about 443,000 premature deaths and $97 billion in lost productivity in the United States every year.

The federal government’s tobacco tax increased to $1.01 per pack in April.