Tag Archives: health care

Politics are Ruining Our Future and Will Keep Us in Purgatory!! Obamacare Is A Political Nightmare That’s Not Going Anywhere. Is there A Solution?

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Some conservatives are unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back the Obamacare regime.

I was disgusted last week speaking with a friend who is a very powerful strategist in the Democratic Party. She agreed with me when I suggested to her that the Democrats would Never sign off on either an immigration or health care plan until after the midterm election. I sensed this after the President signed an Executive Order reversing the separation of illegal immigrant children from their illegal parents as the Democrats, especially Ms. Pelosi and Mr. Schummer asked him to “pen”.

How can we make any progress at all when there is no cooperation between the parties and the administration? I am truly frustrated and wonder when we all are going to wake up and make these Senators and Representatives to “do their job”! They all only care about their own reelection models…. and impeaching the President. How have we sunk so low, so far??

Congress is still wading through the swampy waters of Obamacare. Congressional Republicans, who ran against Obamacare through four election cycles, have spent most of the past year running away from it. But they are finding the law hard to escape.

Democrats who once shied away from Obamacare now can’t stop talking about it. They are blaming Republicans for the next round of premium increases that will become finalized in the weeks leading up to the November elections.

Republicans will justifiably respond that Obamacare is a mess they didn’t make. Voters may nevertheless hold them accountable for not cleaning up that mess, despite years of campaign promises.

Congress should keep those promises, according to a group of conservative policy analysts, state-based think tanks, grassroots organizations, and GOP governors and state legislators. Tuesday, a group of them announced support for the Health Care Choices Act, a proposal that would repeal Obamacare entitlements and replace them with grants to states to finance consumer-centered reform.

The plan is innovative and bold. The ill-fated bills Congress considered last year kept the federal structure of Obamacare with relatively minor modifications. For example, those proposals modified the federal tax credits that are at Obamacare’s core; the Health Care Choices Act would repeal them. And while last year’s bills would have reduced federal spending on Medicaid coverage of able-bodied adults, the Health Care Choices Act would scuttle the Medicaid expansion policy entirely.

The proposal resembles the successful welfare reform of the 1990s, which repealed the individual entitlement to cash benefits and replaced it with grants to states to assist the needy. The Health Care Choices Act does the same thing with health care, but on a much grander scale. It would repeal an open-ended federal entitlement program expected to cost $1.6 trillion over the next decade and replace it with a block grant. It is welfare reform on steroids.

Block grants are not blank checks. Like welfare reform, which required states to implement policies to encourage work and reduce dependency, the Health Care Choices Act would require states to pursue two important goals: reducing costs and increasing health care choices.

States would be required to spend a portion of their federal allotments on meeting the medical needs of the sick without saddling the healthy with exorbitant premiums. Other stipulations would prevent states from using the money to expand Medicaid or to warehouse the poor in state-contracted managed care plans. States would have to provide low-income people assisted through the through the block grant, as well as Medicaid and State Child Health Insurance (CHIP) recipients, the option of applying the value of their assistance to the plan of their choice. Think of it as school choice for health care.

The new money would be provided through the CHIP statute, which, unlike Obamacare, includes permanent restrictions on the use of funds for abortion. Within those broad guidelines, states would design their own programs, determining who is eligible for assistance and what they’re eligible for. They would be released from Obamacare regulations on essential health benefits, age-related premium variation, and the requirement that insurers enroll the sick and healthy in the same insurance pools. Repealing these regulations would allow states to repair or ameliorate much of the market dislocation Obamacare produced.

In short, the Health Care Choices Act would dismantle two of Obamacare’s pillars and weaken the third: Obamacare’s individual entitlement would be abolished, the employer mandate (like the individual mandate) would be repealed, and federal insurance rules would be diluted.

Some conservatives look at the proposal’s health care reform donut and complain about the hole. They have particularly faulted the plan for not repealing Obamacare’s pre-existing condition rules.

A Republican reaction to last week’s Justice Department motion in a lawsuit that seeks to invalidate these rules is instructive. Democrats attacked the Trump administration – and Congressional Republicans – for opposing pre-existing condition protections.

To stanch the political bleeding, Senate Majority Leader Mitch McConnell declared, “Everybody I know in the Senate – everybody – is in favor of maintaining coverage for pre-existing conditions.”

McConnell’s colleagues pointedly did not race to the microphones to distance themselves from their leader. Nor are scores of House and Senate conservative incumbents campaigning on a promise to repeal the popular pre-existing condition requirements.

The message is clear: repealing that requirement does not enjoy anything like majority support even in a GOP Congress. For some conservatives, that is reason enough to leave Obamacare in place. If Congress can’t pass a perfect bill, they argue, then it shouldn’t pass anything at all.

A growing cadre of conservatives is unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back an Obamacare regime that continues to raise costs and constrict health care choices.

They view the Health Care Choices Act’s repeal of Obamacare’s entitlements and devolution of power from Washington to the states not as the final word on health care reform, but as an essential component of a broader effort. Expanding health savings accounts is part of that effort. Promoting innovative approaches like health-sharing ministries and direct primary care is another. Trump administration regulatory proposals to allow small businesses and independent contractors form health insurance purchasing groups across state lines also are part of it, as is its plan to expand the sale and renewal of short-term, limited duration policies.

Conservatives who back the Health Care Choices Act prefer real progress to theoretical perfection and the inaction it induces.  They also argue that it is politically better for Republicans to confront Obamacare than to be blamed for its failures.

Republicans are stuck in a Nash equilibrium on Obamacare repeal. Conservative firebrands, Republican moderates, and congressional leadership – each for very different reasons – are content to make Obamacare repeal the new balanced budget, something they talk about to mine money and votes from their base, but never seriously pursue.

The millions of families and thousands of small businesses suffering under Obamacare deserve better.

Obamacare Faces New Life-threatening Conditions

Opponents of the Affordable Care Act have been busy. In the midst of several headline-making events on other issues, the Trump administration has instigated two major efforts to effectively do what Congress could not do earlier this year — repeal Obamacare.

The result is a laundry list of warnings for all health care consumers, not just those who buy insurance on the ACA exchanges. Here’s a closer look at the latest changes to the health insurance marketplace:

Expanding association health plans

The administration issued new rules on Tuesday that expand the use of what’s known as association health plans. They allow small businesses and self-employed individuals to buy health insurance collectively through what’s loosely defined as an industry association. By pooling together, members can buy insurance for less expensive group rates, the way employees of large corporations do.

Association plans have been around for a long time, but under the ACA they were restricted. The new rules loosen some of these restrictions and expand the reach of these plans. At the same time, these plans are exempt from many of the protections under the ACA, including coverage of the 10 essential health benefits such as maternity and mental health services, hospitalization and prescription drugs.

In addition, the new rules allow association plans to sell insurance across state lines. States regulate health insurers, and for the most part, insurers must adhere to each state’s regulations for the consumers they serve in those states. But under the new rules, association plans can choose which state they want as their regulatory jurisdiction. That means they could conceivably choose a loosely regulated state as their home base.

Association plans have seen their share of scandals in the past, largely due to this state regulatory confusion.

The new rules aren’t a surprise. The Trump administration has been calling for the expansion of association health plans as a way of offering more options outside of Obamacare and a way for small businesses and individuals to have access to more affordable group insurance.

But advocates worry that the move is a return to the bad old days before insurers had to adhere to standard regulations that protected consumers from paying insurance premiums, only to find coverage wasn’t there when they needed it.

“The new rule will allow groups of businesses to band together to buy insurance across state lines, which will be bad for small firms and their employees because it will lead to higher premiums, unbalanced risk pools and lower-quality insurance,” said John Arensmeyer, founder, and CEO of Small Business Majority.

In addition, the provision may encourage a new batch of healthier people who can get by with skimpier coverage to sign up for association plans instead of the ACA exchange plans. That could leave more sick people in the exchanges without the benefit of younger, healthier people balancing the risk pool. According to the Congressional Budget Office, 6 million people are expected to enroll in expanded association health plans.

If you’re considering one of these plans, many of which are expected to be available in September just before the 2019 ACA open-enrollment period, be sure to read everything you can get your hands about the plan as carefully as you can. You’ll want to be sure you understand any limitations in coverage so you can determine if the plan is right for you.

A threat to preexisting condition coverage — and more

Tuesday’s announcement comes on the heels of another potentially devastating blow to the ACA. Earlier this month the Justice Department announced it would not defend the law against a lawsuit brought by the attorneys general of Texas and 19 other states.

The suit claims that because the newly enacted tax law eliminates penalties associated with the individual mandate, the ACA requirement that most Americans carry health insurance is no longer constitutional. In addition, the suit contends that consumer insurance protections under the law also aren’t valid.

Since then an outcry has been heard from health care advocates, insurers, congressional Republicans and most recently a group of bipartisan governors from nine states. The protest is focused on the provision in the ACA that requires insurers to provide equal coverage and the same premium rates to people with pre-existing conditions as they provide to people without previous health problems.

The requirement applies to all insurers, not just those in the exchanges, and polls show most Americans — including many who don’t support Obamacare overall — want to preserve it. Even Senate Majority leader Mitch McConnell famously said, “Everybody I know in the Senate, everybody, is in favor of maintaining coverage for preexisting conditions.”

Still, the Texas court case would potentially eliminate many more ACA provisions, including the premium subsidies so many exchange customers rely on, essential health benefits and Medicaid expansion, said Eliot Fishman, senior director of health policy at Families USA. That said, Fishman believes the court case will take time, so consumers who are planning on signing up for exchange coverage for 2019 at the end of this year should not be dissuaded from doing so.

Health warning-Obamacare is in legal peril once again! Many legal scholars are dismissing a new case. Don’t listen to them.

Noah Feldman wrote that one shouldn’t turn your back.  Could key portions of the Affordable Care Act be declared unconstitutional – years after the Supreme Court upheld them? The Trump administration’s Department of Justice has just filed a brief saying so in a suit by several states that aims to take down the whole program.

Most mainstream legal commentators think the government’s arguments are unconvincing. But it’s crucial to remember that this was exactly the reaction of the same set of people in 2010 when the original argument was made against the individual mandate by libertarian law professor Randy Barnett. Just two years later, five justices of the Supreme Court embraced Barnett’s argument.

Given the excitement for judicial activism building among conservatives, the Trump administration may have more than a 50 percent chance of success.

Just in case you haven’t thought much about the individual mandate and the Constitution in the last six years, let me provide an update and a brief refresher. The update is that, in 2017, Congress passed the Tax Cuts and Jobs Act. In the law, Congress repealed the tax penalty associated with the individual mandate that everyone has health insurance.

In other words, the ACA still says you have to have insurance. But if you don’t, nothing happens to you. You may remember that the Obama team was worried about the interaction between the individual mandate and the popular ACA provisions that say insurance companies can’t refuse to cover anybody because of pre-existing conditions and can’t charge you more if you are already sick.

The theory went something like this: If you aren’t compelled to buy insurance when you’re healthy, but you’re allowed to buy it when you find out you are sick, then only sick people would buy health insurance. That, in turn, would create a “death spiral” for insurance under the ACA, as insurance costs went up.

Crucially, President Barack Obama’s Department of Justice relied on this argument in trying to convince the Supreme Court to uphold the individual mandate. This death spiral doesn’t seem to have happened yet, however.

Now comes the new constitutional challenge to the ACA, filed by a group of states led by Texas. Their argument begins with the fact that, when the Supreme Court upheld the individual mandate, it did so in a very strange way. The five conservative justices all agreed that, under the commerce clause of the Constitution, Congress did not have the authority to make people buy insurance.

Their reasoning was borrowed from Prof. Barnett, who had proposed in his article that while the Congress has the power to regulate existing commercial activities, it can’t force people to undertake a commercial activity they are not already engaged in. This was the famous broccoli hypothetical: the conservatives argued that the commerce clause wouldn’t allow Congress to pass a law requiring everyone to buy and eat broccoli, even though Congress could lawfully regulate broccoli prices.

Despite this conclusion about the commerce clause, however, Chief Justice John Roberts joined the four liberals to uphold the individual mandate on the ground that it was a tax and therefore fell within Congress’s separate taxing power. The other four conservatives were clearly frustrated with Roberts, but his vote carried the day.

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place. The Supreme Court already excludes the commerce clause, and now the tax rationale is gone. Trump’s Department of Justice has agreed with this claim.

The states say that without the individual mandate, the whole ACA should be struck down as unconstitutional. Trump’s Justice Department didn’t go quite that far. But it did say that the ACA provisions on pre-existing conditions are so linked to the individual mandate that it should now be struck down.

Legal observers are pretty upset about this — but not all for the reason you’d think. Some are focused on the strange circumstance that Justice is arguing that the law is unconstitutional. It’s not supposed to work that way. The executive branch is supposed to argue in favor of the constitutionality of laws currently on the books.

That’s bad, without a doubt. But it seems less worrisome than the possibility that courts, including the Supreme Court, might actually adopt the Trump administration’s view and strike down the ACA provisions on pre-existing conditions.

Legally, I don’t think that would be the right decision. I don’t think that the repeal of the penalty means that the no-penalty individual mandate is necessarily unconstitutional, since there is no sanction for violating it, so it isn’t really much of a law at all.

And even if the no-penalty mandate were unconstitutional, it doesn’t follow that the mandatory coverage provisions need to go. They are logically separate from the individual mandate. The mandate may have been thought been necessary to make those provisions work in practice, but it turns out that, so far at least, they are operating without it, and the death spiral hasn’t happened.

But it is entirely possible that five justices would follow the chain of formal logic laid out by the states and adopted by the Justice Department. The best argument in favor of that position is that the Obama Department of Justice told the Supreme Court years back that these provisions were interlinked – “inseverable” in legal jargon.

There is, therefore, a real and indeed significant chance that the most popular part of the ACA could be struck down. You may have thought that the whole ACA-and the-courts topic was over. But as it turns out, it keeps coming back, like a figure from a horror movie. Don’t turn your back.

And look at all of the campaign “idiots” who are experts on health care and declare that their State will have better healthcare by adopting Medicare for All. Don’t they know that Medicare is a Federal program that States can’t themselves change? And how are they going to pay for it if the prediction that Medicare and Social Security programs will be out of money by 2026-2034?

Let’s talk more about Medicare for All!

Looking at the Question-Why Are Physicians So Unhappy?

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With the Affordable Care Act(ACA) you would think that physicians would be ecstatic. They will have more covered patients; that is less, patients without insurance coverage. So, why are they “miserable”?

Daniela Drake in her article in The Week magazine stated that “Being a doctor has become a miserable and humiliating undertaking.” Caring for the sick used to be prestigious and everyone admired the profession. That is except for the doctors themselves, who started seeing the changes. Today the physicians, and especially the primary care doctors, have more work to do then ever before. They work extra hours in a hectic, thankless, unsatisfying profession, which is now dominated by insurers and with the ACA, more government control, government bureaucrats, and as usual the malpractice lawyers. She further states that “many doctors feel that America has declared war on physicians,” and her research shows that nine out of ten doctors say that they would discourage others from entering their profession. In fact of my five children and their friends, I have discouraged then from considering the practice of medicine.

I know that many people have very little empathy for the doctors, since most of the non-physicians believe that all physicians enjoy the sky-high incomes of the Hollywood plastic surgeons and Medicare-mill ophthalmologists. But research shows that the life of the primary-care physician is neither “privileged” nor especially lucrative. In fact, it is not only the primary-care physicians who are “suffering” from the discounted pay scale and denial of payment, with an increase in their workload. We see the general surgeons, cardiologists, ENT, pediatricians, etc. all suffering in the new health care model.

Physicians must now cram in 24-30 or more patients a day to pay the overhead due to regulated fees and cost of filling out insurance forms, which averages $58 per patient. The addition of the Electronic Medical Record software and hardware adds, on average, $30,000 per practitioner per practice. Also, don’t forget the high malpractice premiums that physicians must pay out just to see even one patient.

If you look at the average primary care physician patient visit, the visit lasts about 11-12 minutes per patient. The ACA is now adding even more bureaucracy and pressure to cut costs. With the new pay for performance, physicians will be penalized if they don’t improve the health of their patients or see their patients more than the allotted visits without showing improvement in the care of the patient.

How then do we attract the best minds to choose medicine as a profession and to convince the good physicians to stay in practice? As Ms. Drake summarizes, “the well-being of America’s caretakers is going to have to start mattering to someone.”

We will continue this discussion as we look at both sides of the picture-the perspective of the physician as well as the patient. The shorter visits create a toll on the doctor-patient relationship, which is considered a key ingredient of good care and may actually represent a missed opportunity for getting patients more actively involved in the own health, including preventative care. This goes back to our discussion regarding changing patient as well as doctor behavior.

The question is America, are you starting to see how complex the problem is and that with poor planning the system is already broken. We must all consider the future options and how we will all force our politicians to modify the health care system to benefit all.

Good Behavior and Bad Behavior-How do we reward or penalize behaviors?

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As I suggested weeks ago, that in order for the Accountable Care Act(ACA) to work or become sustainable as a health care system for the USA, we need to have behavioral changes take place.

These behavioral changes need to come from both the patient as well as from the physician and the health care delivery system. We can reward the physician as well as the health care delivery system by increasing reimbursements or payments for the patient interaction, i.e. patient visits, patient care, surgical procedures. We negatively affect the physician and health care system by assessing penalties or decreasing what the ACA pays out for patient interactions or surgical procedures. We can also penalize health care providers by denying them licensing to practice or increasing their malpractice premiums. This way we weed out the bad players in health care, as well as bad behavior.

But how do we encourage good behavior for patients involved in their care, improving their health? How do we penalize the patient who does not want to participate in their care, persisting in their bad behavior, with no improvement in their health? In fact these patients get sicker and the demands financially and the man/woman-power investment become unrealistic.

The patients that pay their insurance premiums, we can increase the premiums, increase their deductibles, penalize them on their taxes, whether federal of state taxes. But what will the results be? Increasing their deductibles discourages the patient from seeking medical care because the majority of cost is now out of pocket. So, how does this encourage good behavior?

Increasing the premiums for patient’s bad behavior and decreasing their premiums and deductibles for good involved compliant behavior makes a lot of sense. But increasing their premiums or assessing tax penalties will not work, especially in the fully subsidized person or persons who will not feel the true effect.

In fact, will any of these ACA health care strategies work if we can’t change the overall behavior of the patients who are going to still delay their care, resulting in the continued use of the most expensive form of health care….. the emergency room (ER) for their routine care. This is a problem because using the ER sets the system up for failure due to the increase expense and the level of care needed for the patients who wait until it is often too late to for preventive care and then often result in the need for interventional costly procedures.

In a survey that I completed I had a number of participants want to deny coverage altogether for these noncompliant patients. Really? How does this contribute to a system, which is designed to provide health care for all potential patients blinded to their financial status?

Unfortunately, we are truly stuck in that we can not really penalize bad behavior in the portion of the demographic segment of patients who are completely subsidized by the government health care system or those who pay no taxes.

But we can reward good behavior. Here is the answer, I believe, to this dilemma. If they already have subsides like SNAP cards, can we increase or bonus them for good behavior? I think this is a workable solution. We may have to put on our thinking caps and design creative rewards so that these “bad behavior” patients are converted to patients who participate in their care lowering their blood sugars, their weight and who will stop smoking.

I love the idea of the British system, utilizing consumer taxing to subsidize their system, i.e. the Value Added Tax (VAT), which is being increased from 17% to 27%. Heck, raise the tax on cigarettes to 50-75% as well as increasing the tax on alcohol as well as on “bad” non-nutritious foods.

We need to be very careful in that we don’t proceed down the murky path of true social engineering. Do we deny hip and knee replacements for the obese noncompliant diabetics? Why not? They are the patients who will have the highest complication rates, costing the system a true financial burden.

Do we extend this thinking to the noncompliant patients who don’t take their blood thinners, medications for high blood pressure and heart medicines? Why not? Here we will eventual see these patients dying out and therefore decreasing the “bad” patient population. Wow, should we really conceive these strategies? Think about it. In the European system where the necessary surgery waiting times are often weeks to months, aren’t they also culling out the “bad” behavior patients? Sure, the high-risk patients and noncompliant patients then die from their underlying premorbid diseases or go elsewhere for their care. I truly cringe when I just mention these potential strategies. But what options do we have?

So, what are your solutions to these difficult problems? We have to consider these problems and come up with solutions otherwise the system will eventually fail or result in a multi-tiered health care delivery system.

Medicare patients –Another set of losers in Obamacare

I decided to change my blog plan and discuss the changes in Medicare as the ACA goes into full action. Consider the following letter from a Medicare patient and if you are a senior citizen tremble with fear!

 

Letter from a senior gentleman in Mesa, Arizona:

 

  Dear Family, Friends, Neighbors and former Classmates,

 

I just found myself in the middle of a medical situation that made it very clear that  “the affordable care act” is neither affordable, nor do they care.

 

  I’ll go back about seven years ago to a fairly radical prostate surgery that I underwent. The Urologist (a personal friend) who performed the surgery was very concerned that it was cancer, though I wasn’t told this until the lab report revealed it was benign.  Since that procedure, I have experienced numerous urinary tract infections, UTI’s. Since I had never had a “UTI” prior to the prostate surgery, I assume that it is one of the side effects from surgery, an assumption since confirmed by my Family Doctor.

 

  The weekend of March 8-9, I was experiencing all the symptoms of another bout of UTI. By Monday afternoon the infection had hit with full force. Knowing that all I needed was an antibiotic, I went to an Urgent Care Center in Mesa, AZ., to provide a specimen, a requirement for getting the prescription. After waiting 45 min. to see the Doctor, I started getting very nauseous and lightheaded.

 

  I went to the Receptionist to ask where the bathroom was as I felt that I was going to throw up. I was told that I would have to wait for the Doctor because I would need to leave a specimen and they didn’t want me in the bathroom without first seeing him.

 

  That was when the lights went out, my next awareness was that of finding myself on the floor (in the waiting room) having violent dry heaves, and very confused. At this point, I tried to stand up but couldn’t make it, and they made it very clear they weren’t going to let me get up until the ambulance got there. By the way, when you’re waiting to see the Doctor and you pass out, you get very prompt attention.

 

Now, “the rest of the story”, and the reason for sending this to so many of  you.

 

  I was taken to the nearest hospital, to emergency. Once there, I was transported to an emergency examination room. Once I had removed my clothes and donned one of those lovely hospital gowns, I finally got to see a Doctor. I asked  “what is going on” I’m just having a UTI, just get me the proper medication and let me go home. He told me that my symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.

 

  For the next 3 hours I was subjected to several tests, blood draws, EKG’s, and demands for specimens. At about 7:30 the nurse came back to my room to inform me that one of the tests takes 1- 2 days to complete, I asked if they (the results) could be emailed, at which point she informed me that I wouldn’t need them emailed because I wasn’t going anywhere. I started arguing with her but was told, “if you don’t start behaving, I’ll start taking your temperature rectally, at which point I became a perfect gentleman. I did tell her I wanted to see the doctor because I had no intention of staying overnight.

 

  Now, this is what I want each of you to understand, please read these next sentences carefully. The doctor finally came in to inform me that he was going to admit me. I said,  “are you admitting me for treatment or for observation?” He told me that I would be admitted for observation. I said Doctor, correct me if I’m wrong, but if you admit me for observation my Medicare will not pay anything, this due to the affordable care act , he said that’s right, it won’t. I then grabbed for my bag of clothing and said, then I’m going home. He said you’re really too sick to be going home, but I understand your position, this health program is going to hit seniors especially hard.

 

  The doctor then left the room and I started getting dressed, I was just getting ready to put my shoes on when another doctor (the closer) came into the room, he saw me dressed and said, “where do you think you are going?” I simply said,  “I’m going home, to which he replied, quite vociferously, no you aren’t. I said, “Doc, you and I both know that under the “affordable care act” anyone on Medicare who is admitted to a hospital for observation will be responsible for the bill, Medicare won’t pay a cent”.  At which point he nodded in affirmation. I said, “You will either admit me for a specific treatment or you won’t admit me.” Realizing he wasn’t going to win this one, he said he would prepare my release papers.

 

  A few minutes later the discharge nurse came to my room to have me sign the necessary papers, relieving them from any responsibility. I told her I wasn’t trying to be obstinate, but I wasn’t going to be burdened with the full (financial) responsibility for my hospital stay.

 

  After making sure the door was closed, she said, “I don’t blame you at all, I would do the same thing.”  She went on to say, “You wouldn’t believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney.” She further said, “The ‘Affordable Care Act’ is going to be a disaster for seniors.  Yet, if you are in this country illegally, and have no coverage, you will be covered in full.”

 

  This is not internet hype folks, this is real, I just experienced it personally.  Moving right along, this gets worse.

 

  Today I went to a (required) follow up appointment with my Arizona Family Practitioner. Since my white count was pretty high, the follow up was important. During the visit I shared the experience at emergency, and that I had refused to be admitted. His response was “I don’t blame you at all, I would have done the same thing”.  He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.

 

  I told him that I had heard that the affordable care act would no longer pay for cancer treatment for those 76 and older, is that true? His understanding is that it is true.

 

  The more I hear, and experience the Affordable Care Act, the more I’m beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they’ll be.

 

  November is coming folks; we can have an impact on this debacle by letting everyone in Congress know that their responsibility is to the constituents, not the president and not the lobbyists. We need to let them ALL know that they are in office to serve and to look after the BEST INTERESTS of “we the people”, their employers, and not to become self-serving bureaucrats who serve only out of greed. And if they don’t seem to understand this simple logic, we’ll fire them.

 

  On the mend, (signed)

 

  REMEMBER:   Demand your hospital admission is for TREATMENT and NOT for OBSERVATION!

Letter from a senior gentleman in Mesa, Arizona:

So, is this a reality?

Consider the article written by Craig Joseph Dan, Medicare Patients are the First Casualty In Emerging Healthcare Revenue Battles. It turns out that how patients are technically admitted to a hospital, and how many “midnights” they stay, both play a critical role in what Medicare wi cover and what the out-of-pocket costs will be. Revenue battles are going to continue to heat up as the government decides how to pay for the care for the underinsured that will be covered by the ACA (Affordable Care Act).

The United States Department of Health and Human Services (DHHS) through the Medicare Modernization Act of 2003, created the Recovery Audit Contractor (RAC). The RAC identifies and recovers improper Medicare payments paid to healthcare providers under fee-for-service Medicare plans. The DHHS made the program permanent for all states by January 1, 2010 under section 302 of the Tax Relief and Health Care Act of 2006.

Dr. Bart Caponi wrote a summary of the RAC issue on te Hospital Leader blog site who offered his assessment. He stated that Medicare patients don’t really know that CMS uses private bounty hunters who are paid on contingency to audit and deny hospital claims. Therefore, hospitals provide the care and then either lose an audit or have to fight through a lengthy appeals process for reimbursement of services. This perceived risk or set of risks has changed the behavior of hospitals, which means, as we have seen in this letter, that patients can get blindsided with big out-of-pocket expenses.

Also, earlier this year, Maryland received a waiver from the Centers of Medicare and Medicaid Services (CMS) to institute a five-year demonstration program known as the all-payor model contract. This program attempts to reduce spending for hospital services by keeping the rate of revenue growth in hospitals from all sources- including private insurance, the government, and employers- to no more than growth in the overall state economy. The goal is to keep costs down by reducing the number of patients admitted the hospitals and encouraging hospitals to work with physicians to maintain their patient’s health. This program, implemented under H.B. 298 permits the Health Services Cost Review Commission to set rate levels and increases, which is the most comprehensive attempt by any state to control health care costs and includes all health care payors and most hospitals, as well as an enforcement mechanism. Interestingly, this commission is represented by a majority of the insurance industry. Lack of bias much???? Now who do you think is affected by these restrictions? Again consider the Medicare patients, especially in regions where the dominant people are the retired Medicare patients.

Beware senior citizens and those of you who will be covered by Medicare insurance in your future.

The ACA or Obamacare will force more consideration of costs and sustainability. Who will pay the cost of a flawed roll out and a flawed health care system?

Also, consider what the future of the ACA will be and what the future of health care will be?

Wake up America!