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ByRicardoAlonso- Zaldivar The Associated Press WASHINGTON The na- tion's respite from trouble- some health care inflation is ending, the government said Wednesday in a report that renews a crucial bud- get challenge for lawmak- ers, taxpayers, businesses and patients. Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend. Projections by nonparti- san experts with the Health and Human Services de- partment indicate the pace of health care spending will pick up starting this year and beyond. The introduc- tion of expensive new drugs for the liver-wasting disease hepatitis C also contributes to the speed-up in the short run. The report from the Of- fice of the Actuary projects that spending will grow by an average of 6 percent a year from 2015-2023. That's a notable acceleration af- ter five consecutive years, through 2013, of annual growth below 4 percent. Although the coming bout of health-cost inflation is not expected to be as ag- gressive as in the 1980s and 1990s, it will still pose a di- lemma for President Barack Obama's successor. Long term, much of the growth comes from Medicare and Medicaid, two giant govern- ment programs now cover- ing more than 100 million people. The United States is ex- pected to spend more than $3 trillion on health care this year, far above any other economically ad- vanced country. Yet Amer- icans are not appreciably healthier, and much what they spend appears to go for tests and treatments of questionable value. Fraud also siphons off tens of bil- lions of dollars a year. Because health care spending is so high, shifts of a couple of percentage points have significant economic consequences. Health care inflation has recently been in line with overall economic growth, keeping things manageable. As spending rebounds, health care again will start consuming a growing share of the economic pie, crowd- ing out other worthy prior- ities. From 17.2 percent of the economy in 2012, health care is expected to grow to a 19.3 percent share by 2023, the report said. "The period in which health care has accounted for a stable share of eco- nomic output is expected to end in 2014, primarily because of the (health care law's) coverage expansions," it concluded. Yet if Obama's Affordable Care Act is an immediate trigger for rising costs, the analysts who produced the report said it is not the only factor. It's probably not the most important one when placed next to a recovering economy and an aging pop- ulation. Traditionally, the state of the economy has been the strongest driver of health care spending. The report estimated that 9 million uninsured people gained coverage this year as the health care law's big coverage expansion got underway, and another 8 million will be added next year. More people insured translates into higher de- mand for medical ser- vices and more spending, so White House claims of dramatic savings from the health law were always sus- pect. But the fiscal dooms- day warnings from "Obam- acare" detractors have not materialized, either. Part of the reason seems to be a push-and-pull effect within the health overhaul. Obama's insurance expan- sion increases spending, but Medicare cuts under the same law help keep other costs down. And Congress reinforced Obama's Medi- care cuts with a round of its own during recent bud- get battles. The analysts said they did not see much evidence that payment reforms en- couraged by the health law are having an impact on costs yet. Medicare is ex- perimenting with how it pays hospitals and doctors to reward efficiency while maintaining or improving quality. The White House may take comfort that the report does not foresee a return to inflation rates of 7 percent a year or more. "We are not projecting that growth will get back to its rapid pace of the '80s and '90s," said Sean Keehan, a senior economist who worked on the report. Again, factors other than the health care law seem to be involved. For exam- ple, employers have signif- icantly increased deduct- ibles and copayments, so working families must pay more out of their own pock- ets when they use medical care. The report was pub- lished online by the jour- nal Health Affairs. Among other findings: — Medicare and Med- icaid will drive costs from 2016-2023, with average annual increases of 7.3 per- cent and 6.8 percent re- spectively. For Medicare, it's partly due to the retire- ment of the baby-boom gen- eration, while Medicaid will see higher use of services by elderly and disabled benefi- ciaries. — The federal, state and local government share of health care spending will keep steadily rising, from 44 percent in 2012 to 48 percent in 2023. The share of costs covered by busi- nesses will decline from 21 percent to 19 percent. LONG-TERM TREND Reportsayshealthcareinflationtorise MICHAELBIESECKER‑THEASSOCIATEDPRESS Henry McCollum speaks to the media a er being released from Central Prison in Raleigh, N.C., on Wednesday. McCollum spent more than 30years on death row; By Michael Biedsecker The Associated Press RALEIGH, N.C. North Caro- lina's longest-serving death row inmate and his younger half brother walked out as free men Wednesday, three decades after they were convicted of raping and murdering an 11-year- old girl who DNA evidence shows may have been killed by another man. Henry McCollum, 50, hugged his weeping parents at the gates of Central Prison in Raleigh, a day after a judge ordered his release, cit- ing the new evidence in the 1983 slaying of Sabrina Buie. His half brother, 46-year-old Leon Brown, was later freed from Maury Correctional Institution near Greenville, where he had been serving a life sentence. "I knew one day I was go- ing to be blessed to get out of prison, I just didn't know when that time was going to be," McCollum said. "I just thank God that I am out of this place. There's not anger in my heart. I forgive those people and stuff. But I don't like what they done to me and my brother be- cause they took 30 years away from me for no rea- son. But I don't hate them. I don't hate them one bit." Brown declined to be in- terviewed following his re- lease, saying through his attorney he was too over- whelmed. He hugged his sis- ter outside the prison before asking to go for a cheese- burger and milkshake. "We were just looking at each other and just smil- ing," said Ann Kirby, one of Brown's lawyers. "We may have been smiling too hard to say anything." During his long years on death row, McCollum watched 42 men he de- scribes as brothers make their last walk to the nearby death chamber to receive le- thal injections. If not for a series of lawsuits that has blocked any executions in North Carolina since 2006, McCollum would have likely been put to death years ago. He often lay awake at night in his solitary cell, thinking of the needle. "I'd toss and turn at night, trying to sleep," he said. "Cause I thought ... these people was going to kill me." Superior Court Judge Douglas Sasser overturned the convictions Tuesday. He said another man's DNA being found on a cigarette butt left near the body of the slain girl contradicted the case put forth by pros- ecutors. The ruling was the lat- est twist in a notorious case that began with what defense attorneys said were coerced confessions from two scared teenagers with low IQs. McCollum was 19 at the time, and Brown was 15. There was no physical evidence connecting them to the crime including DNA from the cigarettes. Defense lawyers peti- tioned for their release after a recent analysis from the discarded cigarette pointed to another man who lived near the Robeson County soybean field where Buie's body was found. That man is already serving a life sen- tence for a similar rape and murder that happened less than a month later. The men's freedom hinged largely on the new local prosecutor's acknowl- edgement of the strong ev- idence of their innocence. Half brothers freed a er three decades in prison DEATH ROW By Kevin Mcgill The Associated Press NEW ORLEANS A federal judge upheld Louisiana's ban on same-sex marriages on Wednesday, a rare loss for gay marriage support- ers who had won more than 20 consecutive rulings over- turning bans in other states. U.S. District Judge Mar- tin Feldman also upheld the state's refusal to rec- ognize same-sex marriages performed legally in other states. His ruling was the first to uphold a state ban since the U.S. Supreme Court struck down part of the federal Defense of Mar- riage Act last year. Feldman himself ac- knowledged that his won't be the final word. "Clearly, many other courts will have an opportunity to take up the issue of same- sex marriage; courts of ap- peals and, at some point, the U.S. Supreme Court," he wrote. "The decision of this Court is but one stud- ied decision among many." Gay rights advocates said they would carry the case to the 5th U.S. Circuit Court of Appeals, which al- ready has before it an ap- peal by the state of Texas of another federal judge's rul- ing that struck down that state's gay marriage ban. In 2004, 78 percent of Louisiana voters approved an amendment to the state constitution banning gay marriage. Gay marriage is legal in 19 states and the District of Columbia. Isabel Medina, a pro- fessor at the Loyola Uni- versity New Orleans law school, said she didn't see the ruling as a significant road block for gay mar- riage advocates. Even a 5th Circuit decision upholding Feldman's ruling would affect only three states: Texas, Louisiana and Mis- sissippi, she noted. It's likely the Texas case will be the first to go to the 5th Circuit, and cases else- where likely will reach the Supreme Court before Lou- isiana's, said Professor Carl Tobias of the University of Richmond School of Law in Virginia. Nevertheless, he said, Feldman's ruling is significant. "It is important, because Feldman is a very expe- rienced federal district judge, and no other federal judge has ruled that way at the trial level," Tobias said in a telephone interview. Feldman was appointed to the bench by President Ronald Reagan in 1983. Feldman said gay mar- riage supporters failed to prove that the ban violates equal protection or due process provisions of the U.S. Constitution. He also rejected an argument that the ban violated the First Amendment by effectively forcing legally married gay couples to state that they are single on Louisiana in- come tax returns. Feldman sided with the state, which had ar- gued that the nation's high court, in the Defense of Marriage Act decision, rec- ognized the rights of state voters and legislatures to define marriage. "Although opinions about same-sex marriage will understandably vary among the states, and other states in free and open de- bate will and have chosen differently, that does not mandate that Louisiana has overstepped its sover- eign authority," he wrote. FEDERAL JUDGE Louisiana ruling breaks pro-gay marriage streak By Matthew Perrone The Associated Press WASHINGTON The Food and Drug Administration says there is little evidence that testosterone-boosting drugs taken by millions of American men are benefi- cial, though the agency is also unconvinced by stud- ies suggesting the hormone carries serious risks. The agency posted its review online Wednesday ahead of a public meeting to discuss the benefits and risks of treatments that raise levels of the male hor- mone. Regulators agreed to convene the September 17 meeting after two federally funded studies found links between testosterone ther- apy and heart problems in men. The scrutiny comes amid an industry marketing blitz for new pills, patches and formulations that has trans- formed testosterone a mul- tibillion-dollar market. Ad- vertisements for prescription gels like Fortesta and Andro- gel promise aging men re- lief from "Low-T," a condi- tion they link to low libido, fatigue and weight gain. But FDA reviewers state that "the need to replace testosterone in these older men remains debatable." While testosterone levels naturally decline after age 40, it's unclear whether those lower levels actually lead to the signs commonly associated with aging, in- cluding decreased energy and loss of muscle. The FDA first approved testosterone injections in the 1950s for men who had been diagnosed with hy- pogonadism, a form of ab- normally low testosterone caused by injury or medi- cal illness. But the recent advertis- ing push is focused on oth- erwise healthy men who simply have lower-than-nor- mal levels of testosterone. The FDA memo calls tes- tosterone use in these pa- tients "controversial" and notes that "there are no re- liable data on the benefit in such a population." The agency will ask its panel of outside experts this month whether the pre- scribing information on tes- tosterone drugs should be revised to focus on a nar- rower group of patients. The panelists will also be asked to weigh in on two recent studies that showed higher rates of cardiovas- cular problems in men us- ing testosterone. A U.S. Veterans Affairs study pub- lished in November 2013 showed a 30 percent in- crease in stroke, heart at- tack and death among older men taking testosterone. In January, another feder- ally funded study of 45,000 men with an existing heart condition suggested testos- terone therapy could double the risk of heart attacks in men 65 and older. But in its review, the FDA notes that two other stud- ies have associated testos- terone with longevity. Ac- cording to the agency re- view, the available studies "do not provide convincing evidence that testosterone replacement therapy is as- sociated with adverse car- diovascular events." According to the review documents, FDA will ask its experts whether drug- makers should be required to conduct long-term fol- low-up studies to assess heart risks with testoster- one drugs. HEALTH FDA finds little evidence to support testosterone drugs By Larry Neumeister The Associated Press NEW YORK Andrew Madoff, Bernard Madoff's last surviving son, died of cancer on Wednesday, years after turning his fa- ther in and insisting he had been duped like the rest of the world into be- lieving history's most no- torious Ponzi king was an honest financier. Andrew Madoff, 48, was "surrounded by his lov- ing family" when he died at a New York City hospi- tal from mantle cell lym- phoma, his attorney, Mar- tin Flumenbaum, said in a statement. Andrew Madoff and his brother, Mark, both worked on the legitimate trading side of their fa- ther's Manhattan firm, two floors removed from the private investment business where Bernard Madoff carried out his $65 billion Ponzi scheme over several decades. Bernard Madoff, 76, was arrested in December 2008. He pleaded guilty to fraud charges months later and is serving a 150- year sentence at a federal prison in North Carolina. Exactly two years after the father's arrest, Mark Madoff hanged himself in his Manhattan loft apart- ment as his 2-year-old son slept in another room. "One way to think of this is the scandal and ev- erything that happened killed my brother very quickly," Andrew Madoff told People magazine last year. "And it's killing me slowly." Andrew Madoff was first diagnosed with the rare form of cancer in 2003 but went into remission. He blamed the relapse on the stress of living with his father's scam. The disease returned in October 2012, and he told People mag- azine that he felt "blind- sided." Andrew Madoff had served as the chairman of the Lympho6ma Research Foundation's board of di- rectors until his father's scheme was revealed. In his statement, Flumen- baum said Andrew Madoff had "lost his courageous battle" with the disease. PONZI KING'S SON Andrew Madoff dies of cancer | NEWS | REDBLUFFDAILYNEWS.COM THURSDAY, SEPTEMBER 4, 2014 4 B