Contract Killer
By Michael W. Lynch
Even the most skilled managed-care bashers in the Clinton administration must have felt a little queasy last October. That's when 96 HMOs announced that they would no longer do business with the federal government.
For months, HMO representatives had been telling the Health Care Financing Administration, which administers Medicare, that without reimbursement increases and relief from new regulations, they would be forced to pull out of some markets. While the HCFA sets non-negotiable pay rates for participating plans, it can't force insurers to renew Medicare contracts.
"We told them, `No deal,'" bragged President Clinton at an October 8 press conference. "We're not going to allow Medicare to be held hostage to unreasonable demands." The upshot for the 50,000 seniors now living in areas bereft of a single managed-care provider? They can enroll in Medicare's traditional plan, for which seniors will pay the same premium as before in return for fewer services. How's that for reasonable?
Too Kool?
By Ryan H. Sager
Smoking has gone from a personal vice to a public health problem to a civil rights violation. In a lawsuit filed in U.S. District Court in Philadelphia, the National Association of African Americans for Positive Imagery, the Uptown Coalition (originally formed in 1990 to protest a cigarette brand aimed at urban blacks), and a group of current and former smokers claim that the marketing of menthol cigarettes to blacks violates their civil rights.
Based on the Civil Rights Acts of 1866 and 1870, which were enacted to protect former slaves during Reconstruction, this lawsuit marks the first attempt to sue tobacco companies under federal civil rights law rather than personal injury or product liability statutes. The suit alleges that blacks account for 60 percent to 70 percent of menthol puffers and argues that since the soothing effect of menthol enables deeper inhaling, menthol cigarettes have a disparate impact on black smokers' health.
The plaintiffs want tobacco companies and industry groups to make public all research about the impact of smoking on blacks. It also seeks a ban on menthol cigarettes.
In explaining the use of civil rights legislation, plaintiffs' attorney Stephen Sheller told CNN that the acts were "intended to prevent targeting black people in ways that take advantage of them."
Courtroom Shootout
By Brian Doherty
With the smoke of the tobacco industry's settlement with the states still hanging in the air, city governments are turning their attention toward the handgun industry. Chicago and New Orleans have filed civil suits against groups of gun makers, distributors, and sellers; other cities, including New York, Philadelphia, Los Angeles, Tampa, and Boston, are contemplating joining the posse. The cities argue that gun makers and sellers must pay at least some of the costs that municipalities bear while treating victims of gun violence. (See "Smoking Guns," July.)
Chicago has strict gun control, and the city argues that gun makers and dealers are creating a public nuisance by supplying the areas outside the city with more handguns than they need, thus guaranteeing that the excess will end up in Chicago. Charging that legal gun manufacturing and sales constitute a public nuisance is a novel legal strategy--and one whose chances of success seem low. Generally, attempts to characterize legal, regulated businesses as nuisances have failed in court.
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