Obama Care: 04/01/2013

Tuesday, April 30, 2013

CORRECTED-UPDATE 3-FDA approves Roche drug for late-stage breast cancer

(Corrects paragraph 5 to show control arm included Xeloda, not Herceptin)

* Drug is first of its kind for solid tumors

* To carry warnings on liver, heart damage

* ImmunoGen shares up 1.9 pct; Roche up 1.5 pct

WASHINGTON, Feb 22 (Reuters) - U.S. health regulators approved a new drug made by Swiss drugmaker Roche Holding AG for some patients with late-stage metastatic breast cancer who fail to respond to other therapies.

The U.S. Food and Drug Administration said on Friday it had approved Kadcyla, also known as ado-trastuzumab emtansine, for patients whose cancer cells contain increased amounts of a protein known as HER2.

The drug's label will carry a boxed warning, the most serious possible, of the Kadcyla's potential to cause liver and heart damage or even death. The drug can also cause life-threatening birth defects.

Still, fewer patients in a clinical trial experienced severe side effects than those who received standard therapy.

The approval was based on a study of about 1,000 women who had already been treated with Roche's drug Herceptin and a taxane chemotherapy. Patients who were given Kadcyla survived an average of 30.9 months, compared with 25.1 months for those in the control arm who took Xeloda and GlaxoSmithKline Plc's Tykerb.

The drug will be priced at $9,800 a month, higher than Wall Street analysts had expected but likely acceptable to insurers.

"We don't expect to see significant payer pushback on pricing at launch, given the drug's efficacy and safety," said Simos Simeonidis, an analyst at Cowen and Company, in a research note on Friday.

Kadcyla works by attaching Herceptin, also known as trastuzumab, to a drug called DM1, developed by ImmunoGen Inc , which interferes with cancer cell growth.

"Kadcyla delivers the drug to the cancer site to shrink the tumor, slow disease progression and prolong survival," said Dr. Richard Pazdur, director of the FDA's office of hematology and oncology products.

Other drugs approved for HER2-positive breast cancer include Herceptin, Tykerb, and Perjeta, or pertuzumab, which is also made by Roche and was approved in 2012.

Kadcyla is a member of a class of drugs known as antibody-drug conjugates, or "armed antibodies." They combine an antibody, Herceptin in the case of Kadcyla, with a killer toxin, in this case DM1, and a link that binds them together to deliver a highly potent bomb within the diseased cells.

The drugs seek out specific cells that express proteins associated with the cancer, while leaving other cells alone.

The first conjugate to be approved was Mylotarg which was pulled from the market in 2010 by Pfizer Inc's after a study showed it did not extend survival for patients with myeloid leukemia, a bone marrow cancer.

In 2011, Seattle Genetics won U.S. approval for Adcentris, a conjugate targeting Hodgkin's lymphoma, several types of T-cell lymphoma and other hematologic malignancies.

Kadcyla is the first armed antibody to be approved to treat a solid tumor.

The approval triggers a $10.5 million payment to ImmunoGen and sets the stage for the company to receive royalties of between 3 and 5 percent, depending on sales. The 5 percent level is triggered when sales top $700 million in the United States. The company also receives 5 percent when sales top $700 million elsewhere in the world.

Analysts estimate the drug could generate annual peak sales of $2 billion to $5 billion, assuming it is used earlier in the disease's progression and for longer periods of time.

John Sonnier, an analyst at William Blair & Co, said he believes the Kadcyla approval validates ImmunoGen's technology and will translate into other partnerships and the development of new wholly-owned compounds.

ImmunoGen's chief executive officer, Daniel Junius, said ImmunoGen has nine other compounds using some version of its TAP technology, which stands for targeted antibody payload. Some are being developed with partners and some are wholly owned by ImmunoGen.

The most advanced is a drug for non-Hodgkin's lymphoma being developed with Sanofi. The company also is conducting mid-stage trials of a proprietary drug for small-cell lung cancer.

"We believe this can be a very important tool for oncologists across a wide variety of indications," Junius said.

An analyst at J.P. Morgan, Cory Kasimov, said the approval of Kadcyla by itself is not enough to warrant owning ImmunoGen's shares.

"To justify a premium valuation, ImmunoGen needs to generate meaningful data with one of its other antibody assets, preferably one that is fully owned," he said in a research note.

Breast cancer is the second-leading cause of cancer-related death among women. An estimated 232,340 women will be diagnosed with the disease in 2013, and 39,620 will die from it, according to the National Cancer Institute. About 20 percent of breast cancer patients have increased amounts of the HER2 protein.

The most common side effects in patients treated with Kadcyla were nausea, fatigue, muscle and joint pain, increased liver enzymes, headache and constipation.

Shares of ImmunoGen closed up 1.9 percent at $14.57 on Nasdaq. Roche's shares closed up 1.5 percent.

(Reporting by Toni Clarke in Washington; editing by Gerald E. McCormick, John Wallace, Matthew Lewis and Carol Bishopric)

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The Recipe For Prosperity

Highlight transcript below to create clipTranscript: Print | Email Go Click text to jump within videoFri 22 Feb 13 | 07:00 PM ET How the sequester might impact the economy, with Rep. Gregory Meeks (D-NY); Mark Simone, WOR Radio Talk Show Host; Robert Costa, National Review; and Gen. Barry McCaffrey, NBC News' military analyst.

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In Shift, NY Times Embraces 'Moral Dimension' Provided by Bishops -- at Least for Expanding Obama-Care

Friday's lead New York Times story celebrated "G.O.P. Governors Providing a Lift For Health Law." The most notable convert: Florida Gov. Rick Scott, who reversed his position this week and announced his support for expanding Medicaid.

The Times' Abby Goodnough and Robert Pear credited Scott for the embrace of Obama-care (via "proponents" who "say that doing so will not only save lives, but also create jobs and stimulate the economy") and also found a convenient "moral dimension" in the call by Catholic bishops to expand the Medicaid program, a dimension the paper never found when the Church was opposing the Obama-care requirement that religion institutions provide contraception coverage.

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

A left-wing supporter of Obama-care was merely titled a "consumer group."

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

And the Times conveniently discovered how the Roman Catholic bishops "have added a moral dimension to the campaign" in support of Medicaid expansion.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

Oddly, the paper only finds that "moral dimension" when the bishops come out in favor of liberal causes, not when the "moral dimension" involves rejecting the administration's requirement that religion institutions provide contraception coverage.

The last use of the term in a story on Catholic bishops used it in the context of the bishops pushing left-wing issues like "economic inequality" -- "Bishops Open 'Religious Liberty' Drive" on November 15, 2011 (Note the suspicion-arousing quote marks.) Religion reporter Laurie Goodstein even took care to differentiate the "moral dimension" of left-wing causes from the Church's apparently less-admirable traditional opposition to abortion and homosexuality.

The bishops are struggling to reclaim the role they played in the 1980s and into the ’90s as a nationally recognized voice on the moral dimension of public policy issues like economic inequality, workers’ rights, immigration and nuclear weapons proliferation. Since then, however, they have reordered their priorities, with abortion and homosexuality eclipsing poverty and economic injustice.

Clay Waters is the director of Times Watch, an MRC project tracking the New York Times. Click here to follow Clay Waters on Twitter.

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Sequestration Cuts To Education Programs Threaten To Widen Education Gap Between Rich And Poor

The achievement gap between school districts in high-income neighborhoods and those in low-income ones is already more canyon than crack, and if $1.7 trillion in automatic sequestration cuts are allowed to go into effect on March 1, that gap could grow even wider.

Dozens of education programs would face reduced funding, but three crucial programs — No Child Left Behind, Head Start initiatives, and the Individuals with Disabilities Act — provide the most assistance to low-income students and also face the sharpest cuts if the sequester is allowed to go into effect, as the Center for American Progress’ Juliana Herman and Kaitlin Pennington detailed in a new report:

Altogether, the sequester would cut approximately $725 million from Title I funding, potentially affecting 2,700 schools, impacting 1.2 million students, and placing 9,880 education staff at risk of losing their jobs. [...]
Head Start and Early Head Start—a similar program for infants—both work to ensure that parental income does not determine whether a child will be able to learn during these influential years. But should sequestration happen next week, approximately 70,000 children will be kicked out of Head Start due to inadequate funding. [...]
If sequestration goes through, funding under the Individuals with Disabilities Act could be reduced by as much as $579 million.

In all, the report estimates, the cuts would impact as many as 1.2 million children, 30,000 teachers and 2,700 schools, the overwhelming majority of which will be from low-income communities.

Recent studies have shown the devastating correlation between income and student achievement. Since the late 1980s, the gap in metrics like college completion between students from high-income and low-income households grew by more than 50 percent.

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Global Fight Against Tuberculosis

Highlight transcript below to create clipTranscript: Print | Email Go Click text to jump within videoFri 22 Feb 13 | 01:22 PM ET Turberculosis is making a global comeback, including in the United States. Dr. William Schaffner of Vanderbilt University School of Medicine, discusses the concern surrounding the disease.

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Cruz: Harvard Law did have Marxists

Sen. Ted Cruz’s office has chided the New Yorker for calling a three-year-old speech news, but has confirmed that the Texas Republican believed that the Harvard Law faculty had numerous self-described Communists.

Cruz, according to the New Yorker, said that there were a dozen Marxists on the law school faculty committed to overthrowing the U.S. government when he attended Harvard during the 1990s. But according to Cruz, there was but a single Republican on the same faculty.

Catherine Frazier, a spokeswoman for the senator, told a conservative website that the Texas Republican's 2010 speech was substantively correct.

“It’s curious that the New Yorker would dredge up a three-year-old speech and call it ‘news,’” Frazier told The Blaze.

“Regardless, Senator Cruz’s substantive point was absolutely correct: in the mid-1990s, the Harvard Law School faculty included numerous self-described proponents of ‘critical legal studies’ — a school of thought explicitly derived from Marxism – and they far outnumbered Republicans.”

The New Yorker article came as media reports have discussed what The New York Times called Cruz’s “brash” entrance to the Senate.

Cruz has played a significant role in the GOP opposition to Chuck Hagel, a former Republican senator from Nebraska and President Obama’s nominee for Defense secretary.

Some Democrats have suggested that Cruz’s campaign against Hagel reminded them of former Sen. Joe McCarthy (R-Wis.) and his crusade against Communism in the 1950s. Cruz has said that he had promised Texas voters he would shake up Washington.

The New Yorker article had suggested that Cruz might have been discussing critical legal studies, followers of which have said they were influenced by Karl Marx, in his speech.

Charles Fried, a solicitor general under President Reagan and Harvard Law professor, also chided Cruz, saying the Texas senator had undercounted the Republicans on the law school’s faculty.

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No, Batwoman’s Engagement Doesn’t Solve DC Comics’ Orson Scott Card Problem

Over at io9, Rob Bricken asks whether Batwoman’s in-costume proposal to her girlfriend Maggie Sawyer will earn DC Comics good-will that it lost by hiring National Organization for Marriage board member and virulent homophobe Orson Scott Card, or “is this too little, too late for the company”?

I’m 99% sure the only reason DC hasn’t mentioned Batwoman’s marriage to the press is because it would call attention to the furor caused by the company’s recent decision to hire Orson Scott Card, scifi author and ardent detractor of gay rights, to write Adventures of Superman. Angry fans and retailers alike are planning to boycott the Superman comic in general, and some DC in particular unless Card is removed.
It’s too early to tell if Batwoman’s proposal will at all mitigate DC’s public relations problems with Card, or even if Card might have a problem collecting a check from a company whose works seemingly condone gay marraige. But at the moment, at least Kate Kane and Maggie Sawyer are happy, even if nobody else is.

I’m always delighted to see more, and richer depictions of gay characters, especially in a medium where they were marginalized by the Comics Code and the disapprobation of Congress, a panic fed by cooked research. But this plot development won’t save DC Comics, and not just because a proposal on the page doesn’t really outweigh the harm Card’s speech and actions cause in the real world. Who gets hired to create content and what content ends up on the page are issues that are often related, but that function separately. People who care about where their money goes and the values of the content that they consume are going to care about both of those elements.

Something I wish I’d said more clearly the first itme I wrote about DC’s decision to hire Card to write Superman is that calls to fire him don’t appeal to me that strongly because it separates out his hiring from DC’s other hiring practices, which among other things, have produced a staff with very few women and no lead African-American writers on any comics titles. A decision by comics stores not to stock the title, demonstrating that Card’s values turn them off from a product that otherwise might have been profitable for them, makes more sense. And what would be most interesting to me is an explanation from DC about what process lead to Card’s selection. What made his pitches’ stronger than other writers? How did they weigh the likely publicity challenges from his employment against what appears to be a larger institutional imperative to modernize the brand by telling stories about committed gay couples? If DC Comics wants its image to be gay-friendly, then it should have been expected to be evaluated for consistency. More same-sex engagements doesn’t eliminate the appearance of a glaring contradiction in DC’s image.

If all DC wants is our money, rather than our social approval, that’s fine. But it needs to recognize that fishing for money on the grounds that it’s producing progressive and game-changing content is going to be a more difficult task if there’s a disconnect between what the content is, and who the money spent on it ends up going to.

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Ranbaxy to resume generic Lipitor production for U.S.

Feb 22 (Reuters) - Indian generic drugmaker Ranbaxy Laboratories Ltd said on Friday it will resume production of its version of Pfizer's cholesterol fighter Lipitor for sale in the United States after resolving the issues that led to a November recall. Ranbaxy in November recalled its atorvastatin from the U.S. market and stopped manufacturing the widely used cholesterol lowering medicine after the company discovered contamination with tiny glass particles in certain lots of 10 milligram, 20 mg and 40 mg doses of the drug. Atorvastatin is the generic name for Lipitor. "We are working with the U.S. FDA, and have identified and implemented multiple corrective and preventative actions," Ranbaxy spokesman Chuck Capriello said in an e-mailed statement. "As part of the first step in initiating the manufacturing process to resume supplies to the U.S. market, we have commenced the production of the drug substance for our atorvastatin product," he added. The recall and production halt did not affect Ranbaxy's atorvastatin supply for markets outside the United States, the company said. During its first six months on the market, atorvastatin generated sales of nearly $600 million for Ranbaxy, according to industry analyst estimates. Prior to expiration of Pfizer's patent, Lipitor was the world's top selling prescription medicine with annual peak sales of about $13 billion for the largest U.S. drugmaker. Ranbaxy has been operating under heightened scrutiny to ensure it meets good manufacturing practices following a series of manufacturing problems that nearly derailed it ability to sell atorvastatin in the United States. In 2008, the FDA banned the company from importing about 30 drugs after it found manufacturing deficiencies at two of the company's facilities in India, and Ranbaxy was later accused of falsifying data used in its drug applications. Ranbaxy said on Friday that it was confident in the continuing safety and quality of its products.

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South African Student Who Accidentally Shot Himself Allegedly Used School Guard’s Gun

A 13-year-old student in Durban, South Africa accidentally shot himself in the leg at school this week – reportedly using a school security guard’s gun. Guards are not armed at the school, but this guard had allegedly brought his personal gun from home. IOL reports:

A security guard was on duty at an oThongathi (Tongaat) primary school when the teen allegedly removed the guard’s private gun from his unsecured bag.
The Grade 7 pupil at Hambanathi Primary, sustained a single gunshot wound to his thigh and is reported to be in a stable condition at Osindisweni Hospital, in Verulam.
According to the school principal, he had allegedly removed the gun from the guard’s bag and was attempting to shove it into the waist of his pants, when a shot accidentally went off, said the school principal, Mrs S Mahlinza.
The guard, who was meant to be unarmed, is contracted by the KwaZulu-Natal Department of Education.
He has been arrested and charged for failing to secure his firearm.

The incident has prompted calls for “urgent” action to ban guns in schools, with officials citing the recent Newton, Ct. tragedy. In the United States, meanwhile, the National Rifle Association has urged more armed school guards as a solution to preventing future school shootings, and several states are now considering legislative proposals, in spite of scientific and historical evidence that armed school guards don’t prevent these sorts of incidents. Many states are even implementing programs to arm teachers and add gun courses for students.

The physical danger of armed guards highlighted by this incident is not the only threat posed by the NRA’s plan. Placing more officers in schools has also been correlated with drastic and racially disproportionate upticks in student arrests – often as an alternative means of school discipline. The criminalizing of minor student infractions known as the “school-to-prison pipeline” is already an epidemic in some states, and has the potential to dramatically alter a child’s future by funneling them out of school and into the criminal justice system.

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Ranbaxy to resume generic Lipitor production for U.S.

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Monday, April 29, 2013

Dust Bowl Days: Historic U.S. Drought Projected To Persist For Months, Worsened By Thin Western Snowpack

NOAA's latest seasonal drought outlook projects historic drought will persist.

By Lauren Morello and Andrew Freedman via Climate Central. See also the NY Times piece, “Thin Snowpack in West Signals Summer of Drought”

Time is running out to avert a third summer of drought in much of the High Plains, West and Southwest, federal officials warned Thursday.

Without repeated, significant bouts of heavy snow and rain in the remaining days of winter, a large part of the country will face serious water supply shortages this spring and summer, when temperatures are hotter and average precipitation is normally low.

The drought already ranks as the worst, in terms of severity and geographic extent, since the 1950s. Though it’s not over yet, its economic impact appears to be severe, said Brad Rippey, a meteorologist at the Agriculture Department’s Office of the Chief Economist.

It “will probably end up being a top-five disaster event” on the government’s ranking of the costliest weather events of the past three decades, he said at a Capitol Hill briefing Thursday.

There is little relief predicted in the National Oceanic and Atmospheric Administration’s (NOAA) latest three-month drought outlook, which the agency released Thursday. Federal forecasters predict that drought will persist in the Rocky Mountain and Plains states, expand throughout northern and southern California and return to most of Texas, a state that has been mired in drought since 2011.

NOAA does forecast improvements in drought conditions in the Upper Midwest and Southeast, areas that have received beneficial precipitation in recent weeks.

“The next couple of months will kind of determine how the spring and summer plays out in that part of the country,” said Jake Crouch, a climate scientist at NOAA’s National Climatic Data Center in Asheville, N.C. Crouch said that continued drought conditions could threaten water supplies in many areas, particularly in the Southwest.

Dwindling Water Supplies

With drought extending into its second or even third year in some areas, the main concerns are shifting from agriculture and recreation to water supplies as rivers run dry and reservoirs shrink.

Speaking at the annual meeting of the American Association for the Advancement of Science in Boston on Feb. 15, Texas state climatologist John Nielsen-Gammon said water managers are especially concerned about the situation in West Texas, where emergency conservation plans have gone into effect as water supplies dwindle.

In the western U.S., low mountain snowpack is once again a concern, especially in portions of Colorado, New Mexico and Wyoming that feed the Platte and Arkansas rivers, said Mike Strobel of USDA’s National Resources Conservation Service.

Western mountain snowpack compared to average. (Credit: USDA)

“We’ve got the same trend we had last year,” Strobel said. “But prior to last year, we had very good snowpack, so there was a lot of moisture in reservoirs and soil” when drought conditions hit. This year, reservoirs are running low and soils are dry, which could magnify the impact of a winter without much snow buildup.

In Colorado, where 100 percent of the state is experiencing some level of drought, snowpack is at 70 percent of the long-term average and just 91 percent of last year’s total, Strobel said. Streamflow forecasts are poor and reservoir levels are low.

“We just don’t have the water in storage right now as we’re heading into the spring and summer, periods that are essential for agriculture and water management,” he said.

Those dry conditions and poor snowpack have also raised the risk that water levels could drop on the Mississippi River later this year, in a repeat of factors that reduced barge traffic last fall.

“We need rain in spring and fall so that we don’t have a crisis like we had this year on the Mississippi,” said Steve Buan from NOAA’s North Central River Forecast Center.

The portions of Minnesota, Wisconsin and Iowa that funnel water into the Mississippi are “bone dry,” Buan said. NOAA estimates there is a 40 percent chance that come fall of 2013, the Mississippi River will dip as low, or lower, than during the record-breaking autumn last year.

The drought was most likely initially set into motion by the cooler-than-average water temperatures in the tropical Pacific Ocean, combined with the effects of warmer-than-average waters in the Atlantic Ocean. Studies have shown that this combination tends to favor major drought events in the U.S.

But some scientists, such as Nielsen-Gammon, suggest that the overall warmer climate created by manmade global warming may have amplified this already devastating drought, particularly by triggering more intense heat during the spring and summer of 2012.

A recently released draft of a new federal climate change assessment shows that as the climate continues to warm in the next few decades, drought events are likely to become more frequent and severe, leading to more significant water supply and agricultural impacts in much of the U.S

Escalating Costs

The continuing drought has already taken a toll on the nation’s farmers, said the USDA’s Rippey.

Drought during last year’s growing season took “major hits on row crops,” especially corn and sorghum, he said. Parched conditions reduced the nation’s production potential for those two crops by about one-quarter. Drought cut corn yields by 4 billion bushels and sorghum yields by 100 million bushels.

According to Climate Central research released on Feb. 18, the states of Missouri, Illinois and Indiana were among the hardest hit “Corn Belt” states, with yields at nearly 30-year lows.

The U.S. soybean crop rebounded slightly during a cooler, wetter August last year, though the overall yield still dropped by 200 million bushels, USDA found.

But heading into spring, it’s winter wheat that is the most immediate concern, Rippey said. In Oklahoma and South Dakota, roughly two-thirds of the current winter wheat crop is rated “poor” or “very poor,” while more than half of Texas’ crop falls into the same categories despite some rainfall this winter.

“We are at high risk for abandonment this year,” Rippey said, predicting that farmers could walk away from 25 percent or more of the nation’s winter wheat this year, the worst since 2002, unless their crops begin receiving steady, regular rains.

USDA won’t release its official estimates of crop production for 2013 until mid-May. But the agency is optimistic that U.S. corn will do well this year, yielding 163.5 bushels per acre. July weather will tell the tale, Rippey said, but encouraging signs include ebbing drought in the eastern half of the Corn Belt.

Another Destructive Wildfire Season Ahead?

It’s still too early to tell whether poor snowpack and persistent drought will yield another severe fire season in the western U.S., experts said.

Last year’s fires consumed many of the dead and damaged trees and underbrush that fuel wildfires, said Jim Douglas, a senior advisor at the Interior Department.

“If that fuel doesn’t regrow, it’s not there,” he said. “So we could have drought conditions with nothing to burn yet. And we could have a spring with early moisture, with a lot of grass growing good and tall. If it dries out in late summer, we could have very bad fire conditions.”

The National Interagency Fire Center projects an immediate above-average fire risk in regions hardest hit by drought in its Feb. 1 outlook, including portions of the Oklahoma Panhandle and eastern Colorado. But in the drought-stricken Rocky Mountains and Southwest, fire season normally doesn’t begin until April, the center said, and what it will look like isn’t yet clear.

– By Lauren Morello and Andrew Freedman

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Why Your Boss Is Dumping Your Wife

By Jen Wieczner

Companies have a new solution to rising health-insurance costs: Break up their employees’ marriages.

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By denying coverage to spouses, employers not only save the annual premiums, but also the new fees that went into effect as part of the Affordable Care Act. This year, companies have to pay $1 or $2 “per life” covered on their plans, a sum that jumps to $65 in 2014. And health law guidelines proposed recently mandate coverage of employees’ dependent children (up to age 26), but husbands and wives are optional. “The question about whether it’s obligatory to cover the family of the employee is being thought through more than ever before,” says Helen Darling, president of the National Business Group on Health. See: When your boss doesn’t trust your doctor

While surcharges for spousal coverage are more common, last year, 6% of large employers excluded spouses, up from 5% in 2010, as did 4% of huge companies with at least 20,000 employees, twice as many as in 2010, according to human resources firm Mercer. These “spousal carve-outs,” or “working spouse provisions,” generally prohibit only people who could get coverage through their own job from enrolling in their spouse’s plan.

Such exclusions barely existed three years ago, but experts expect an increasing number of employers to adopt them: “That’s the next step,” Darling says. HMS, a company that audits plans for employers, estimates that nearly a third of companies might have such policies now. Holdouts say they feel under pressure to follow suit. “We’re the last domino,” says Duke Bennett, mayor of Terre Haute, Ind., which is instituting a spousal carve-out for the city’s health plan, effective July 2013, after nearly all major employers in the area dropped spouses.

But when employers drop spouses, they often lose more than just the one individual, when couples choose instead to seek coverage together under the other partner’s employer. Terre Haute, which pays $6 million annually to insure nearly 1,200 people including employees and their family members, received more than 20 new plan members when a local university, bank and county government stopped insuring spouses, according to Bennett. “We have a great plan, so they want to be on ours. All we’re trying to do is level the playing field here,” he says.

While couples generally prefer to be on the same health plan, companies often find that spouses are more expensive to insure than their own employees. That’s because, say benefits experts, covered spouses tend to be women, who as a group not only spend more on health care, but also have more free time to go to the doctor if they don’t work. Indeed, JetBlue’s covered spouses cost 50% more than crewmembers themselves, according to the airline’s online Q&A about its health plan, which this year extended wellness incentives to spouses for the first time. See: Selling health insurance by the pound

Any change would be aimed at alleviating concerns of the Catholic church. WSJ's Louise Radnofsky reports. Photo: AP

About a fifth of companies had policies to discourage spouses from joining their health plan in 2012, according to Mercer, though most just charged extra—$100 a month, on average—to cover spouses who could get insurance elsewhere, rather than deny coverage entirely. Indeed, large firms including generics maker Teva and supply chain manager Intermec have spousal surcharges costing $100 a month, or $1,200 annually, while Xerox charges $1,000 for the year. See: 10 things your office won’t say

But experts say more firms are likely to drop spouses altogether, whether they work or not—especially when the new federal health-care exchanges open in 2014, providing an alternative for spouses left out in the cold. “When there’s a place for people to go, employers won’t feel as beholden or compelled to cover the spouse,” says Joan Smyth, an employee benefits consultant with Mercer.

Firms that recently decided to drop spouses from their plans range from private insurance agencies to school systems and universities like Ball State, as well as large companies like pump and valve manufacturer Flowserve. Wisconsin-based furniture company KI carved out spouses this year when couples flocked to its plan for the first time during open enrollment. “Now, each employer is responsible for its own employee,” says Timothy Van Severen, corporate risk manager for KI, which insures about 1,700 employees in its health plan. “We were going to see a higher claim cost if we didn’t do that, because of the migration coming back to us.”

Some companies drive spouses away using other tactics, such as making spousal coverage prohibitively expensive through higher surcharges or by making reimbursement rates so low that spouses can’t afford the plans. The share of employers who allow spouses in their plan but don’t pay for any part of it rose from zero to 3% this year, according to human resources consulting firm Towers Watson. Northrop Grumman, the large security firm, will cover spouses who can get insurance through their own employers, but only if they first enroll in their own plan, and use Northrop’s as secondary coverage. (Some companies actually pay spouses an incentive if they enroll in their own plan, though insurance experts say the incentive is a waste of money—and that employers would do better by just cutting spouses off.) “You’re making it kind of a no-brainer for the other adult dependent to get on his or her own plan,” says Helen Darling, president of the National Business Group on Health. “No one wants to be just a dependent magnet.”

But like any breakup, the separation of spouses into different health plans can be traumatic for families. Greg Fischer, a vice president in the employer solutions division at HMS, says demand has increased for the company’s dependent audits, which have revealed that 3% of spouses are ineligible for the health plans, either because of plan rules or divorce and legal marriage issues. The news can be upsetting to couples when one partner is forced to pay more for coverage or accept lesser benefits: One spouse may even have to stop seeing the family doctor if his or her new plan stipulates a different set of providers. “I think that’s where the pain point comes in for the employee—that their spouse may have to be covered under a different plan, or their benefits might be reduced,” Fischer says.

Couples then have to decide whether to stick together, even if it means losing benefits, or to split up so at least one spouse maintains coverage. If they separate, they may also have to choose which plan to insure the kids under, or whether to use different plans for each. “It certainly makes the family unit have to do some real soul-searching and figure out what works best for them,” says Karen McLeese, vice president of employee regulatory affairs for CBIZ Benefits & Insurance Services. The decision, she adds, will likely come down to dollars and cents.

For their part, employers say they try to educate employees on their options well in advance of the change, and health plans or insurance brokers sometimes step in to guide people through the transition and help them find doctors in their new network. In announcing its spousal carve-out, Ball State University, for one, warned employees to prepare “since this is a potentially life-changing event.” The university employee benefits staff worked with spouses and their employers to guide them through the transition onto their own plan, and have even allowed some spouses with “uncooperative” companies to stay on “until the conflict is resolved,” says Joan Todd, a spokeswoman for the university. “We wanted to be very careful that no spouse would lose coverage before they could be placed on their own employer’s plan.”

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Leslie and Ben and Liz and Criss: NBC Comedies On Modern Marriage

This post discusses plot points from the February 21 episodes of Parks and Recreation.

Their shows are entirely different animals, but in recent weeks, I’ve been thinking a lot about the differences between Liz Lemon and Leslie Knope. Both are the main characters of tonally innovative and critically loved but ratings-challenged sitcoms, both have as their best friends older, Alpha-male archetypes, and both lead teams of people who are not always eager to make their lives easy. And both of them recently married their soulmates, laid-back food truck operator Criss Cross and anxious geek and good-government nerd Ben Wyatt, in impromptu ceremonies where they wore dresses that summed up significant themes of the run of their shows. As I watched Leslie and Ben tie the knot on last night’s Parks and Recreation and thought about the episode today, something came clear for me. Liz Lemon is a much pricklier, more challenging character than the relatively normal if professionally ambitious Leslie Knope. But Leslie’s relationship with Ben is more radical than Liz’s marriage to genial weirdo Criss.

Much of Liz Lemon’s dating history was about her coming to terms with what she really wants. In Floyd, she learned that she wanted her career and relationship with New York more than she wanted him in the suburbs. With Drew, she found out that handsome is only as handsome does. Carol turned out to be as rigid as Liz herself was. But in Criss, Liz found someone who was complimentary to her, whose great strength and expression of love for Liz was to help her handle her worst tendencies. He was a guy who’d never mistake an argument at Ikea for a breakup, who wasn’t intimidatingly perfect—his idea of romanticism was making Liz a table out of found objects that almost immediately collapsed—and, as we found out in the finale, really just wanted to stay home and raise their adopted children, letting Liz be the primary breadwinner. It makes sense that Liz married Criss in her Princess Leia outfit: their relationship was about Liz finally embracing herself precisely as she was, even if sometimes it’s the worst, because of society.

But while I appreciate 30 Rock‘s embrace of ladyweirdness, from female science fiction fandom, to using your treadmill as a hanger for a ham-stained wedding dress, to ambivalence about sex, Liz and Criss’s relationship came down to a fairly common argument about being loved for who you really are, even if who you are is kind of neurotic and strange. Parks and Recreation, by contrast, took two relatively conventional humans, albeit ones with intense fondness for calzones, waffles, Game of Thrones, and in Leslie’s case, a hoarding problem, and used a conventionally shot sitcom wedding where a makeshift family comes together at the last minute, to make permanent a relationship based on ideas that are deeply challenging by the standards of popular culture.

When Leslie met Ben, he was working as an Indiana State auditor, a job he’d chosen in part to redeem his disastrous tenure as the teenaged mayor of his small town, where he’d bankrupted the city government by building an elaborate ice skating complex and been impeached. The auditor’s job was a way for Ben to demonstrate that he’d definitively left the misconceptions of his first foray into government behind, so someone might give him the chance to run an agency or a city again. But over the course of Ben’s relationship with Leslie, he’s made a significant shift from planning for his own long-term ambitions to working to make Leslie’s dreams happen.

Now, it’s not that men in popular culture never help the women that they love achieve their professional goals. But that sort of encouragement usually doesn’t require sacrifice or compromise on the man’s part. Instead, he’s generally presented as someone who provides the wisdom, insight, or experience that a woman needs to self-actualize, whether it’s successful producer Adam Bennett (Patrick Wilson) teaching Becky Fuller (Rachel McAdams) how to handle her feuding news anchors in Morning Glory, or shock jock Mike Chadwick (Gerard Butler) teaching his uptight producer Abby (Katherine Heigl) to relax. Criss isn’t teaching Liz how to do her job better, but he also essentially gets exactly what he wants by being with her, even if what he wants is to achieve in the domestic realm rather than a professional one. It’s a variation on the ideal of Having It All: having it all and having it together, without the need for conflict and compromise. This sort of ideal even shows up in breakup stories. In The Devil Wears Prada, Andie (Anne Hathaway) and Nate’s (Adrian Grenier) relationship falls apart when it doesn’t live up to their expectations that they will both be pursuing their careers and deeply present in their lives—exit, for both of them, turns out to be preferable to compromise and accommodation.

But for Ben, dating Leslie and supporting her run for office have entailed real sacrifices. He gave up his job in city government so she could keep hers and survive an ethics trial prompted by the revelation that they hadn’t disclosed their romantic relationship, a move that let Leslie preserve the prospects of a potential run for office, while putting another strike on his own record, precisely the kind of thing he came to Pawnee to avoid. Losing his job has real emotional consequences for Ben, who at one point ends up weeping in a Batman suit. He puts his energy into getting Leslie elected, and after that victory, takes a job working as a higher-profile campaign consultant in Washington. But once again, Ben chooses Leslie over his own career trajectory, coming home from Washington to propose to her instead of going to run a Florida campaign. And now that they’re married, Ben has settled into Pawnee and is running the Sweetums Foundation, a job that allows him to do good and to make smart decisions about budget and impact, but that also is a respectable local job that bolsters Leslie’s relationship with the town’s dominant industry.

Is it any wonder, then, that for her vows, Leslie told Ben “The things that you have done for me to help me, support me, surprise me, to make me happy, go above and beyond what any person deserves. You’re all I need. I love you and I like you.” There’s very little in popular culture that would have told Leslie, or that tells any woman, that she’ll find a partner who isn’t just happy to be supportive when it’s a fit, but who, when his interests and hers are in conflict, will prioritize hers, and choose and work to support them again and again. And there’s something remarkable about Ben’s declaration that “In my time working for the state government, my job sent me to 46 cities in 11 years. I lived in villages with eight people, rural communities, farming towns, I was sent to every corner of Indiana. And then I came here, and I realized this whole time I was wandering around everywhere looking for you.” Ben didn’t just find Leslie. In looking for the recovery of his own reputation, Ben found Leslie’s career instead, and made it his cause—the man’s come so far that he’s even capable of being touched by what appears to be the mysterious resurrection of Lil’ Sebastian.

For another couple, it might have been bizarre for the bride to wear a dress that’s made of headlines and documents about her career, but for Ben and Leslie, it’s perfect. Working together on projects like the Harvest Festival and her election didn’t just bring Ben and Leslie together and then closer as a couple—it was a core substance of their relationship and a reflection of their mutual values. And showing us a relationship like that is one of the reasons I don’t just love Parks and Recreation: I like it, too.

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UPDATE 3-FDA approves Roche drug for late-stage breast cancer

* Drug is first of its kind for solid tumors

* To carry warnings on liver, heart damage

* ImmunoGen shares up 1.9 pct; Roche up 1.5 pct

(Adds additional analyst comment, background)

By Toni Clarke

WASHINGTON, Feb 22 (Reuters) - U.S. health regulators approved a new drug made by Swiss drugmaker Roche Holding AG

for some patients with late-stage metastatic breast cancer who fail to respond to other therapies.