From the Washington Examiner

From Investors Business Daily

Broken Pledge: An early draft of regulations written for the health care overhaul estimates that more than half of U.S. workers will see their medical insurance change. Funny, that’s not the promise we remember.

Late last week, reports surfaced that an 83-page White House document had been leaked from the White House. If the rules included in this draft are promulgated, the health plans of 51% of workers will be subject to change within three years.

In the new system, companies that modify employee coverage after Jan. 1, 2014, will lose their “grandfather” status and be forced to comply with ObamaCare rules. This means they will have no choice but to buy plans that will cost more because the law says they must include expanded coverage.

Changes in plans that would cause a company to lose its grandfather status can be as modest as a small shift in the co-payment amount or in the employees’ contribution to the coverage. By merely asking workers to share a bit more of the burden, companies will have to buy new plans.

Many Americans are likely to find the added coverage of the new plans unnecessary for their needs and the extra costs taxing to household budgets. How many who liked their plans will have new ones forced on them by a bureaucracy that’s not equipped to make decisions for people it doesn’t know?

According to the midrange estimate cited in the White House document, small businesses will be hit hardest. Two-thirds of them “will relinquish their grandfathered status by the end of 2013″ while 45% of large employer plans will be affected.

“In the worst-case scenario,” reported IBD’s Sean Higgins and David Hogberg on Monday, “69% of employers — 80% of smaller firms — would lose that status, exposing them to far more provisions under the new health law.”

Are the bureaucrats writing these regulations unfamiliar with the promise President Obama made repeatedly last year: “If you like your health care plan, you can keep your health care plan”?

Did they know that Linda Douglass, the White House fixer who said it was her job to “keep track of all the disinformation out there about health insurance reform,” assured the public that Obama was sincere when he said that? The answer to both is an emphatic yes.

So why write regulations that break a presidential promise? Because that promise was never meant to be kept. Like all the misrepresentations about cost, it was meant to mislead the public and generate support for, or at least blunt opposition to, a government takeover of the health care sector.

From Investors Business Daily

Internal administration documents reveal that up to 51% of employers may have to relinquish their current health care coverage because of ObamaCare.

From the Washington Examiner

By Senator Tom Coburn — President Obama and his allies kicked off an unusual, and perhaps unprecedented, taxpayer-subsidized political campaign this week to sell to the public a legislative program that has already been signed into law.

The obvious coordination between the White House and its allies outside government who are running a $125 million campaign raises troubling questions. But, first, I’ll address the substance of what the president talked about, and ignored.

On Tuesday, the president trumpeted a provision in his plan that will give seniors a $250 rebate check if they reach the Medicare prescription drug benefit “doughnut hole” coverage gap in 2010. The president also spent a great deal of time repeating his talking points from last year’s health care debate. He claimed his plan would reduce the deficit and claimed the arguments of his critics were not “anchored in reality.”

As a practicing physician with more than 25 years of experience, and as a former business owner in the health care sector, I’d suggest this new PR campaign is grounded in politics rather than reality. The so-called experts behind this effort appear to be political hacks and career politicians who have zero real-world experience in the health care sector.

First, the president’s claims about the supposed benefits of a $250 rebate check for seniors are wildly out of proportion to both the reality of Medicare and his own program. Less than 10 percent of seniors enrolled in Medicare will receive a rebate check.

On the other hand, a greater percentage of seniors enrolled in Medicare – the 25 percent participating in Medicare Advantage – will see their benefits cut because the White House ultimately wants to kill the program for ideological reasons. Seniors are about to learn that if they like their plan, they can’t keep it. Medicare Advantage providers are already planning on cutting benefits and raising fees because of the law.

The president’s interest in the doughnut hole also suggests the PR campaign is willfully overlooking and exacerbating a much greater threat – Medicare’s $38 trillion unfunded liabilities. Our real national challenge is not the doughnut hole but our financial black hole of debt that is threatening to swallow not only Medicare but our entire economy.

During the most recent meeting of the president’s debt commission two esteemed economists, Kenneth Rogoff of Harvard and Carmen Reinhart of the University of Maryland, declared that our debt is already at 90 percent of our GDP, which they view as a tipping point at which economic growth slows considerably.

Borrowing from future generations and foreign governments to pay for rebate checks represents the kind of perverse short-term decision making that has brought our nation to the edge of a fiscal black hole. At best, throwing rebate checks at Medicare is an exercise in futility that will postpone real reform.

The president made a number of other claims that weren’t anchored in reality, such as his claim that his plan will reduce the deficit. When real-world accounting is applied to health care spending and necessary expenses like the doctor fix are included, all of the so-called savings evaporate.

Even the Congressional Budget Office, which the White House sites as its authoritative source, has contradicted the White House. CBO Director Douglas Elmendorf recently said, “The rising costs of health care will put tremendous pressure on the federal budget during the next few decades and beyond … In CBO’s judgment, the health legislation enacted earlier this year does not substantially diminish that pressure.”

Yet, perhaps the most important reality check in this debate is to acknowledge the obvious. This new PR campaign has nothing to do with improving the health of Americans and everything to do with improving the job security of politicians who voted for this bill against the wishes of their constituents. Turning federal agencies into de facto direct mail and political advertising branches of the Democratic political establishment will refill the swamp and remind voters why they loath Washington.

The American people have not only made up their minds about this bill, they are fatigued with this debate and the condescension of the Washington establishment who considers their objections to be based on fear, scare tactics and hysteria.

The American people have studied this law more intently the politicians and unelected staff who wrote it. They have made decisions based on information, not misinformation. The campaign’s rhetoric of victimization is not a comeback at Republicans but an insult to the millions of Americans who did their homework and made good faith, informed judgments about a bill that fixed the wrong problem.

The reality is Congress and the White House had a chance to do something bold and bipartisan to fix the real problem, and they blew it. This law represents a failure of content, not communication. Sooner or later, a nation that aspires to a future beyond a rendezvous with debt will insist that this misguided law be repealed and replaced.

From Health Care News

The National Federation of Independent Business (NFIB)—the nation’s largest small-business advocacy organization—has joined the ranks of twenty state attorneys general in a lawsuit attacking the constitutionality of President Obama’s new healthcare law.

The May 14 announcement came on the heels of repeated calls from NFIB members nationwide to challenge Obamacare in court, according to Elizabeth Milito, senior executive counsel for the NFIB Small Business Legal Center in Washington, DC. Milito said the lawsuit charges the new healthcare law directly undermines the organization’s mission, which is to promote and protect the rights of small business owners to “own, operate, and grow their business.”

“NFIB worked diligently throughout the legislative process to try to shape and improve the healthcare bill as it was being debated,” Milito said. “When we felt the legislation had reached a point that was unacceptable to our members and us, we were vehemently opposed to the bill and worked to defeat it.”

 

‘This Unconstitutional Law’

There are many provisions in what she called “this unconstitutional law” that will devastate small business, Milito said, noting the lawsuit’s two main legal claims relate to the “unconstitutionality” of the individual mandate.

“We do not believe the commerce clause of the U.S. Constitution gives Congress the authority to regulate inactivity,” Milito said. “Requiring every individual to purchase health insurance or face a fine is an unprecedented and unconstitutional act of Congress. Requiring NFIB members to obtain and maintain health coverage deprives our members of their liberty and property interests without the due process of law.”

John Graham, director of health care studies at the California-based Pacific Research Institute, agrees.

“By allowing the federal government to define ‘coverage’, Obamacare reduces individuals’ and businesses’ freedom to decide what they want in a health-insurance policy and how much of their health dollars they’d prefer to spend on medical care, which is under their own control,” Graham said.

Read the rest of the article

From Washington Examiner

From The Hill

The new healthcare law will pack 32 million newly insured people into emergency rooms already crammed beyond capacity, according to experts on healthcare facilities.

A chief aim of the new healthcare law was to take the pressure off emergency rooms by mandating that people have insurance coverage. The idea was that if people have insurance, they will go to a doctor rather than putting off care until they faced an emergency.

People who build hospitals, however, say newly insured people will still go to emergency rooms for primary care because they don’t have a doctor.

 

“Everybody expected that one of the initial impacts of reform would be less pressure on emergency departments; it’s going to be exactly the opposite over the next four to eight years,” said Rich Dallam, a healthcare partner at the architectural firm NBBJ, which designs healthcare facilities.  

“We don’t have the primary care infrastructure in place in America to cover the need. Our clients are looking at and preparing for more emergency department volume, not less,” he said.

Some Democrats agree with this assessment.

Rep. Jim McDermott (D-Wash.) suspects the fallout that occurred in Massachusetts’ emergency rooms could happen nationwide after health reform kicks in.

Massachusetts in 2006 created near-universal coverage for residents, which was supposed to ease the traffic in hospital emergency rooms.

But a recent poll by the American College of Emergency Physicians found that nearly two-thirds of the state’s residents say emergency department wait times have either increased or remained the same.

A February 2010 report by The Council of State Governments found that wait times had not abated since the law took effect.

Read the rest of the story.

From Human Events

From the Washinton Examiner

Physicians at McBride Orthopedic Hospital had ambitious plans for their Oklahoma City hospital before Obamacare. Two new operating rooms and a four-bed intensive-care unit were part of a multimillion-dollar expansion project that promised to bring competition and more health care choices to the community.

But once President Obama’s signature was dry on the 2,409-page Patient Protection and Affordable Care Act, so, too, was the McBride project. The recently enacted law imposed a series of new federal regulations on physician-owned hospitals, including an immediate ban on expansion.

“We pulled the plug when the law was signed,” McBride Chief Executive Mark Galliart said. “We were ready to break ground. We had everything approved by the state. We had the construction agreement in place. We were going to meet our timeline until the legislation passed.”

Within days of enactment of the new law, developers across the country nixed plans for 24 new physician-owned hospitals under construction. It will be a struggle for an additional 47 new such hospitals under construction to meet an Obamacare-imposed deadline of Dec. 31 to be finished and have their Medicare certification.

Galliart is now preparing McBride for other onerous requirements imposed by Obamacare on the nation’s 260 physician-owned hospitals. In addition to limits on expansion and new construction, the law restricts new investments, requires new annual reports to the government and sets fines for hospitals that fail to abide by transparency rules.

Imagine if the government owned General Motors and the Congress passed a bill that barred Ford from producing “any new cars and couldn’t expand on its existing cars,” Galliart said. “What other industry would put up with this? If we were spending money recklessly and harming people, that’s one thing. But physician-owned hospitals are doing it better and more efficiently.”

Read the rest of the story.

From John Goodman’s blog

Rick Foster is the Chief Actuary of Medicare, and his office has just released a devastating critique of the Administration’s health reform law.

Before getting to details, let me say there is nothing in the report that is surprising to independent health economists. The conclusions are consistent with everything The Lewin Group and other private estimates have been saying for months. What is surprising is that one of the most respected agencies of the U.S. government is completely undermining the Alice-in-Wonderland fables being spun by the White House, on Capitol Hill and in the mainstream media. To wit:

• You cannot take close to one trillion dollars away from one group of people and spend it on another group of people and somehow leave those footing the bill better off.
• You cannot give millions of people large increases in medical care without creating any new doctors, new nurses or other paramedical personnel.
• You cannot arbitrarily reduce what you are paying providers by billions of dollars and still expect to get the same quantity and quality of care.
• You cannot give millions of patients and thousands of doctors new incentives to waste medical resources and then expect health care spending to go down.

In other words, the Chief Actuary is simply saying reality is reality. Economics is economics. A is A.

 

Convenient summaries of the Actuary’s report have been produced by the Republican staff of the House Ways and Means Committee and by the Senate Republican Policy Committee. Although these are partisan groups, the summaries appear to be quite faithful to the source. Here are the salient findings (with page numbers in the Actuary’s report):

• Health care costs will go up, not down. National health expenditures will increase from 17 percent of GDP now to 21 percent under the new law and will be higher than without the legislation. [Page 4] Net federal spending on health care will also increase.
• Health care shortages are “plausible and even probable.” Because of the increased demand for health care, “supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons.” [Page 20]
• 14 million employees will lose their employer coverage. Employees of small firms are especially at risk (despite small employer tax credit subsidies). [Page 7]
• 2 million employees who lose coverage will have to enroll in Medicaid. [Page 3]
• A Medicaid insurance card is not a guarantee of care. An estimated 18 million people will be added to Medicaid. [Page 3] However, because there is no corresponding increase in the supply of caregivers, “it is reasonable to expect that a significant portion of the increased demand for Medicaid would be difficult to meet, particularly over the first few years.” [Page 20]
• One in ten insured workers will see their health benefits taxed. By 2019, more than 10% of insured workers will “be in employer plans with benefit values in excess of the thresholds (before changes to reduce benefits) and this percentage would increase rapidly thereafter.” [Page 13]
• Higher taxes will lead to higher premiums. The new taxes on medical devices, prescription drugs, and insurance plans “would generally be passed on through to health consumers in the form of higher drug and device prices and higher insurance premiums.” [Page 17]
• There are more than one-half trillion in Medicare cuts. The new health law cuts “$575 billion” from Medicare. [Page 4]
• Medicare cuts would threaten almost one in every seven hospitals. About “15 percent of Part A providers would become unprofitable within the 10-year projection period.” [Page 10]
• Overall access to care for seniors would go down. Because of the law’s payment reductions, “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program. [Page 10]
• 7.4 million people will lose access to Medicare Advantage plans. Enrollment in MA plans will be cut in half (from its projected level of 14.8 million under the current law to 7.4 million under the new law). [Page 11]
• False advertising: The new “Medicare Tax” doesn’t go to Medicare. “Despite the title of this tax, this provision is unrelated to Medicare; in particular, the revenues generated by the tax on unearned income are not allocated to the Medicare trust funds.” [Page 9]
• False advertising: Budgetary double-counting does not improve Medicare’s solvency. Medicare cuts “cannot be simultaneously used to finance other federal outlays (such as the coverage expansions) and to extend the [life of the Medicare] trust fund, despite the appearance of this result from the respective accounting conventions.” [Page 9]
• The new long-term care insurance plan (CLASS Act) is unsound. The program faces “a significant risk of failure” because the high costs will attract sicker people and lead to low participation. [Page 15]
• The promise to those with pre-existing conditions is unfunded. “By 2011 and 2012 the initial $5 billion in Federal funding for [high risk pools] would be exhausted, resulting in substantial premium increases to sustain the program.” [Page 16]
• The law does almost nothing to limit actual fraud and abuse. The fraud provisions in the law will save only about two percent of $47 billion in suspect claims.

From the Orlando Sentinal

MOUNT DORA — A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care “elsewhere.”

“I’m not turning anybody away — that would be unethical,” Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. “But if they read the sign and turn the other way, so be it.”

The sign reads: “If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Estella Chatman, 67, of Eustis, whose daughter snapped a photo of the typewritten sign, sent the picture to U.S. Rep. Alan Grayson, the Orlando Democrat who riled Republicans last year when he characterized the GOP’s idea of health care as, “If you get sick, America … Die quickly.”

Chatman said she heard about the sign from a friend referred to Cassell after his physician recently died. She said her friend did not want to speak to a reporter but was dismayed by Cassell’s sign.

“He’s going to find another doctor,” she said.

Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida‘s College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is “trying to hold onto the nub of his ethical obligation,” Allen said.

“But this is pushing the limit,” he said.

Read the rest of the story.

Rep. Dave Camp, ranking Republican of the House Ways and Means Committee, has compiled this list of when different aspects of the recently passed healthcare legislation will go into effect.  Click here for a PDF version of the document.

2009

• 2-year tax credit (total cap of $1 billion) for new chronic disease therapy investments
• Medicare cuts to hospitals begin (long-term care (7/1/09) and inpatient and rehabilitation facilities (fiscal 2010)) 2009

2010

• States and federal officials review premium increases
• FDA authorized to approve “follow-on” biologics
• Increase brand name pharmaceutical Medicaid rebate (from 15.1% to 23.1%)
• Medicare payments to physicians in primarily rural areas increase (2 years)
• Deny “black liquor” eligibility for cellulosic biofuel producers credit
• Tax credits provided to certain small employers for health care-related expenses
• Increase adoption tax incentives for 2 years
• Codify economic substance doctrine and impose penalties for underpayments (transactions on/after 3/23/10)
• Provide income exclusion for specified Indian tribe health benefits provided after 3/23/10
• Temporary high-risk pool and high-cost union retiree reinsurance ($5 billion each for 3.5 years) (6/23/10)
• Impose 10% tax on indoor UV tanning (7/1/10)
• Medicare cuts to inpatient psych hospitals (7/1/10)
• Prohibits lifetime and annual benefit spending limits (plan years beginning 9/23/10)
• Prohibits non-group plans from canceling coverage (rescissions) (plan years beginning 9/23/10)
• Requires plans to cover, at no charge, most preventive care (plan years beginning 9/23/10)
• Allows dependents to stay on parents’ policies through age 26 (plan years beginning 9/23/10)
• Provides limited protections to children with pre-existing conditions (plan years beginning 9/23/10)
• Hospitals in “Frontier States” (N.D., Mont., Wyo., S.D., Utah) receive higher Medicare payments (fiscal 2011)
• Hospitals in “low-cost” areas receive higher Medicare payments for 2 years ($400 million, fiscal 2011)

2011

• Medicare Advantage cuts begin
• No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over-the counter medicines
• Medicare cuts to home health begin
• Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed for inflation in Parts B/D)
• Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc.
• Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable medical equipment
• Impose new annual tax on brand name pharmaceutical companies
• Americans begin paying premiums for federal long-term care insurance (CLASS Act)
• Health plans required to spend a minimum of 80% of premiums on medical claims
• Physicians in “Frontier States” (N.D., Mont., Wyo., S.D., Utah) receive higher Medicare payments
• Prohibition on Medicare payments to new physician-owned hospitals
• Penalties for non-qualified HSA and Archer MSA distributions double (to 20%)
• Seniors prohibited from purchasing power wheelchairs unless they first rent for 13 months
• Brand name drug companies begin providing 50% discount in the Part D “donut hole”
• 10% Medicare bonus payment for primary care and general surgery (5 years)
• Employers required to report value of health benefits on W-2
• Steps towards health insurance administrative simplification (reduced paperwork, etc) begins (five year process)
• Additional funding for community health centers (five years)
• Seniors who hit Part D “donut hole “in 2010 receive $250 check (3/15/11)
• New Medicare cuts to long-term care hospitals begin (7/1/11)
• Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient rehab facilities begin (fiscal 2012)
• New tax on all private health insurance policies to pay for comp. eff. research (plan years beginning fiscal 2012)

2012

• Medicare cuts to dialysis treatment begins
• Require information reporting on payments to corporations
• Medicare to reduce spending by using an HMO-like coordinated care model (Accountable Care Organizations)
• Medicare Advantage plans with a 4 or 5 star rating receive a quality bonus payment
• New Medicare cuts to inpatient psych hospitals (7/1/12)
• Hospital pay-for-quality program begins (fiscal 2013)
• Medicare cuts to hospitals with high readmission rates begin (fiscal 2013)
• Medicare cuts to hospice begin (fiscal 2013)

2013

• Impose $2,500 annual cap on FSA contributions (indexed to CPI)
• Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned, nonactive business income for those earning over $200,000 or $250,000 for families (not indexed to inflation)
• Generally increases (7.5% to 10%) threshold at which medical expenses, as a percentage of income, can be deductible
• Eliminate deduction for Part D retiree drug subsidy employers receive
• Impose 2.3% excise tax on medical devices
• Medicare cuts to hospitals which treat low-income seniors begin
• Post-acute pay for quality reporting begins
• CO-OP Program: Secretary of Health and Human Services awards loans and grants for establishing nonprofit health insurers
• $500,000 deduction cap on compensation paid to insurance company employees and officers
• Part D “donut hole” reduction begins, reaching a 25% reduction by 2020

2014

• Individuals without government-approved coverage are subject to a tax of the greater of $695 or 2.5% of income
• Employers who fail to offer “affordable” coverage would pay a $3,000 penalty for every employee that receives a subsidy through the Exchange
• Employers who do not offer insurance must pay a tax penalty of $2,000 for every full-time employee
• More Medicare cuts to home health begin
• States must have established Exchanges
• Employers with more than 200 employees can auto-enroll employees in health coverage, with opt-out
• All non-grandfathered and Exchange health plans required to meet federally mandated levels of coverage
• States must cover parents /childless adults up to 138% of poverty on Medicaid, receive increased FMAP
• Tax credits available for Exchange-based coverage, amount varies by income up to 400% of poverty
• Insurers cannot impose any coverage restrictions on pre-existing conditions (guaranteed issue/renewability)
• Modified community rating: individual or family coverage; geography; 3:1 ratio for age; 1.5:1 for smoking
• Insurers must offer coverage to anyone wanting a policy and every policy has to be renewed
• Limits out-of-pocket cost-sharing (tied to limits in HSAs, currently $5,950/$11,900 indexed to COLA)
• Insurance plans must include government-defined “essential benefits ” and coverage levels
• OPM must offer at least two multi-state plans in every state
• Employers can offer some employees free choice vouchers for health insurance in the Exchange
• Government board (IPAB) begins submitting proposals to cut Medicare
• Impose tax on nearly all private health insurance plans
• Medicare payment cuts for hospital-acquired infections begin (fiscal 2015)

2015

• More Medicare cuts to home health begin

2016

• States can form interstate insurance compacts if the coverage with HHS approval (2016)

2017

• Physician pay-for-quality program begins for all physicians
• States may allow large employers and multi-employer health plans to purchase coverage in the Exchange.
• States may apply to the HHS secretary for a limited waiver from certain federal requirements

2018

• Impose “Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain threshold: ($10,200 individual coverage, $27,500 family or self-only union multi-employer coverage)

From the Washington Examiner