Now that the current deadly meningitis outbreak — which has infected an estimated 337 Americans across 18 different states, and caused 25 deaths so far — has put a spotlight on compounding pharmacies that currently fall outside the jurisdiction of the Food and Drug Administration’s safety regulations, state officials are beginning to crack down on the pharmacies that produce compounded drugs.

In Massachusetts, where tainted steroid shots produced at the New England Compounding Center (NECC) first exposed thousands of Americans to a rare strain of fungal meningitis, local officials are taking a more serious look at compounding pharmacies that remix and repackage drugs for widespread sale. As the New York Times reports, Massachusetts Gov. Deval Patrick (D) is working to address the public health risks posed by compounding pharmacies in the absence of FDA regulatory oversight, and recently shut down the third compounding pharmacy in his state that did not meet inspection standards:

Gov. Deval Patrick last week directed the state’s Board of Registration in Pharmacy to immediately start unannounced inspections of compounding pharmacies that prepare sterile, injectable medications. There are 25 such pharmacies in Massachusetts, and Mr. Patrick has acknowledged that the state rules governing them were insufficient. Although the Food and Drug Administration can inspect compounding pharmacies and issue warnings, the agency says states have ultimate jurisdiction.

At the news conference on Sunday, Dr. Lauren Smith, the interim commissioner of the Massachusetts Department of Public Health, said the state was bringing on five additional inspectors to help with unannounced visits to compounding pharmacies. The goal is to inspect all of them by Jan. 1, she added.

Smith told Reuters that the statewide inspections are part of “a series of aggressive and necessary actions to protect public safety and enhance oversight of this industry” after the contaminated steroid shots from the NECC brought on the national meningitis epidemic.

Although public health advocates have called for strengthened FDA regulatory power over compounded drugs for decades — warning that since compounding pharmacies are not currently subject to the FDA’s health and safety guidelines, they are able to distribute products like the tainted steroids that pose serious public health risks — the pharmaceutical industry has lobbied to prevent the agency from having any additional oversight in that area. Some members of Congress have already called for a criminal investigation into the meningitis outbreak.

The Obama Administration is preparing for the federal government’s impending role as the primary sponsor of two new multistate health insurance plans that will be available for individuals and small businesses to purchase under Obamacare’s statewide insurance exchanges in 2014.

Although they are not exactly the same, the nationwide plans do somewhat resemble the government-run “public option” that some congressional Democrats advocated during the Obamacare debate. As the New York Times reports, the plans represent an opportunity for the federal government to contract with large-scale providers and inject marketplace competition into Obamacare’s insurance exchanges:

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees. [...]

The federal standards will pre-empt state rules in at least one respect: the national health plans will automatically be eligible to compete against other private insurers in the new exchanges, regardless of whether they have been certified as meeting the standards of those exchanges.

The administration has promised to “work cooperatively with states.” But it is unclear whether the government-sponsored plans will have to comply with all state laws and consumer protection standards; whether they will have to comply with state benefit mandates; and whether they will have to pay state fees and taxes levied on other insurers to finance exchange operations. [...]

“Multistate plans have real potential benefits for consumers,” said Ronald F. Pollack, the executive director of Families USA, a liberal-leaning consumer group. “But there is also potential trouble if the multistate plans are exempted from some consumer protection standards.”

State health commissions, private insurers, and consumer protection advocates alike want to see the nationwide plans compete on a level playing field so that benefits standards and competitive pressures are both fair and consistent throughout state exchanges. If implemented properly, however, the new multistate health plans could drive down health costs while offering consumers coverage approved directly by the federal government.

Health insurance CEOs haven’t always been the biggest proponent of President Obama’s health care reform law, but that doesn’t mean they’re excited about the possibility of Mitt Romney repealing Obamacare in its entirety if he wins next week’s election. In fact, as the Associated Press reports, insurers are increasingly wary of the prospect of a Romney victory.

Despite the false conservative talking point that Obamacare puts a strain on the economy, industry analysts predict that the health reform law will be good for insurers’ bottom lines once it is fully in effect. Obamacare’s expansion of the Medicaid program, for example, could be a huge boon for the private insurance industry as new Medicaid beneficiaries enroll in plans with commercial insurance companies. And now that major insurers like UnitedHealth Group and BlueCross Blue Shield have already invested millions of dollars in implementing Obamacare — and expect to profit off that investment when they gain additional customers under the health reform law — they aren’t eager to see the law repealed.

Most troubling for the insurance industry is the uncertain prospect of a partial repeal. If a Romney administration repeals just some of Obamacare’s key provisions while leaving others in place, insurers worry that the health reform law will be entirely unsustainable, causing premium costs to skyrocket:

Things could get grim for the industry if Republicans succeed in repealing the Affordable Care Act’s subsidies and mandates, but leave standing its requirement that insurers cover people with health problems. If that’s the outcome, the industry fears people literally could get health insurance on the way to the emergency room, and that would drive up premiums.

“There are a lot of dollars and a lot of staff time that’s been put into place to make this thing operational,” G. William Hoagland, until recently a Cigna vice president, said of the health care law.

Insurers “are not going to be out there saying, ‘Repeal, repeal, repeal,’” said Hoagland, who oversaw public policy at the health insurance company. “They will probably try to find the particular provisions that cause them heartburn, but not throw the baby out with the bath water.” [...]

“I spend a lot of time in executive offices and board rooms, and they are good Republicans who would like to see Romney win,” said [Robert Laszewski, an industry consultant and blogger]. “But they are scared to death about what he’s going to do.”

Industry officials’ primary concern about a potential Romney administration is that the presidential candidate has offered few details about what his alternative to Obamacare would look like, despite the fact that he has pledged to repeal the law on his first day in office. There is no consensus on the issue among Republicans in Congress, either.