Archive for the “Failed Policy” Category

ObamacareWaiverThe number of temporary healthcare reform waivers granted by the Obama administration to organizations climbed to more than 1,000, according to new numbers disclosed by the Department of Health and Human Services.

HHS posted 126 new waivers on Friday, bringing the total to 1,040 organizations that have been granted a one-year exemption from a new coverage requirement included in the healthcare reform law enacted almost a year ago. Waivers have become a hot-button issue for Republicans, eager to expose any vulnerabilities in the reform law.

In order to avoid disruption in the insurance market, the healthcare overhaul gives HHS the power to grant waivers to firms that cannot meet new annual coverage limits in 2011. The waivers have typically been granted to so-called “mini-med” plans that offer limited annual coverage — as low as $2,000 — that would fall short of meeting the new annual coverage floor of $750,000 in 2011.

“We don’t want to take away people’s health insurance before they have some realistic other choices,” HHS Secretary Kathleen Sebelius said in an interview with The Hill earlier this year.

Republican lawmakers have seized on the waivers as proof that the law they want to see repealed is flawed, and they have accused the administration of giving them waivers as gifts to union allies. The administration has rejected both claims as Republicans on the House Energy and Commerce Committee have asked HHS for in-depth details about every waiver decision and request.

Read the rest of the story at The Hill.

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Here’s the link to the list.

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sosFrom the Wall Street Journal

Democrats think they know how to run the insurance industry better than the insurance industry, and they’re getting the chance to prove it under ObamaCare. Consider the early returns on its plan to insure Americans denied coverage for pre-existing conditions.

To judge by President Obama’s rhetoric, the insurance industry’s victims have been wandering the country like Okies in “The Grapes of Wrath.” Thus ObamaCare gave the Health and Human Services Department the power to design and sell its own insurance policies. The $5 billion program started in July and runs through 2014, when ObamaCare’s broader regulations kick in.

Mr. Obama declared at the time that “uninsured Americans who’ve been locked out of the insurance market because of a pre-existing condition will now be able to enroll in a new national insurance pool where they’ll finally be able to purchase quality, affordable health care—some for the very first time in their lives.”

So far that statement accurately describes a single person in North Dakota. Literally, one person has signed up out of 647,000 state residents. Four people have enrolled in West Virginia. Things are better in Minnesota, where Mr. Obama has rescued 15 out of 5.2 million, and also in Indiana—63 people there. HHS did best among the 24.7 million Texans. Thanks to ObamaCare, 393 of them are now insured.

States had the option of designing their own pre-existing condition insurance with federal dollars in lieu of the HHS plan, and 27 chose to do so. But they haven’t had much more success. Combined federal-state enrollment is merely 8,011 nationwide as of November 1, according to HHS.

Read the rest of the column here.

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From NCPA

John GoodmanBy John Goodman – I’ve been through this three times. You’d think that someone would notice a pattern. Learn lessons. Avoid repeating dumb mistakes. Alas, it was not to be.

First there was the Medicare Catastrophic Care Act of 1988. A drug benefit added to Medicare was passed one year and repealed the next. It was the first repeal of a major federal welfare program in 100 years. Grass-roots negative reaction was so intense that House Ways and Means Chairman, Dan Rostenkowski, was chased down the streets of Chicago by angry senior citizens. Then there was HillaryCare. After working for a year, the designers of this plan met ignoble defeat. There was never a hearing. Not even a vote. And now there is ObamaCare.

In all these cases, politicians and special interests met behind closed doors to carve up huge chunks of the medical marketplace. They then emerged and announced their plan to push everyone around and tell them what to do in the most intimate and personal aspects of their lives. In all three cases, the voters replied “no.” 

The reaction of nonseniors to the latest reform is easy to understand. How many times did Barack Obama say, “If you like the health plan you are in, you can keep it”? Inside the Beltway, I’m sure no one bothered to count. They weren’t listening anyway. That’s because no one in Washington — whether Republican or Democrat, man or woman, old or young, tall or short, fat or thin — no one took this promise seriously from the get-go.

But out in the Hinterland, people did take it seriously. And when it was obvious that the promise was not going to be kept and that no one who voted for ObamaCare could explain why the promise was not being kept, the negative reaction was palpable. Adding to the understandable fear and anxiety was a threat by McDonald’s to abolish health insurance for 30,000 employees and 3M’s announcement that it would end coverage for its retirees.

Folks, this is only the beginning. Over the next two years, many more people will get hit with similar unpleasant surprises. In an earlier Health Alert, I predicted that this election would not go well for people who devised the Affordable Care Act (ACA). If this Rube Goldberg contraption is not opened up and seriously repaired, we will have another election in 2012 just like this one.

As for seniors, this is all a no-brainer. For every $1 of benefits under the new bill, they will bear $10 of cost. As Joe Newhouse explained in Health Affairs, by the end of the decade their access to care will be worse than low-income families on Medicaid. (See the very excellent chart prepared by the Office of the Medicare Actuary.) Not only will seniors have to turn to community health centers and safety net hospitals for their care, they will be the least preferred patients in the waiting lines.

Read the rest of the column

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From the Washington Times

Health_Care_Poll_Star_s640x437After taking a beating at the hands of Missouri voters in August, “Obamacare” could be roughed up once again at the ballot box in November.

Following the lead of the successful Missouri initiative, which passed with 71 percent of the vote, Arizonans, Coloradans and Oklahomans will decide this fall whether to approve proposed constitutional amendments that would allow them to opt out of key provisions of President Obama‘s signature national health care law.

The three initiatives prohibit the government from forcing individuals to buy health care insurance – a “mandate” that critics say violates the U.S. Constitution – and would allow patients and employers to pay providers directly without penalty. The idea is to protect state residents from “the ongoing takeover of health care by government,” backers of the Colorado campaign say.

There’s just one problem, say opponents of the state ballot initiatives: The entire strategy is “an exercise in futility,” in the words of Oklahoma Gov. Brad Henry, a Democrat. Federal law trumps state law, meaning that the measures are certain to be overturned even if they win 100 percent of the vote.

“No state has the authority to selectively ignore federal laws of its choosing, no matter how much some people may dislike them, and any attempt to do so will be ruled unconstitutional by the courts,” said Mr. Henry, who opposes State Question 756. The only practical outcome of the vote, he added, would be a “costly legal battle.”

“I don’t think it makes sense to waste taxpayers’ money on a legal action we know we will lose, particularly during a historic revenue crisis,” he said.

Jon Caldara, who is spearheading the Amendment 63 campaign in Colorado, said opponents are forgetting about “a pesky little thing called the 10th Amendment,” which reserves to the states “the powers not delegated to the United States by the Constitution.”

“There have been numerous examples to suggest that there are times when state law supplants federal law,” said Mr. Caldara, president of the free-market Independence Institute in Golden. “If federal law always supplanted state law, then we wouldn’t have 20 state attorneys general suing to overturn the federal law.”

That joint lawsuit, challenging the constitutionality of the health care law primarily over the insurance-buying mandate, is proceeding in the courts even as the political fight continues.

Mr. Caldera added that, if opponents truly thought the states and the voters were powerless, then “they wouldn’t have spent so much trying to keep us off the ballot.”

Read the rest of the story.

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From Reuters

aamcThe U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, the Association of American Medical Colleges said on Thursday.

The group’s Center for Workforce Studies released new estimates that showed shortages would be 50 percent worse in 2015 than forecast.

“While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025,” the group said in a statement.

“The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare.”

Medicare is the federal health insurance plan for people over the age of 65, and census projections show that group growing as the giant baby boomer generation born from 1946 to 1964 hits retirement age.

The U.S. healthcare reform plan signed into law by President Barack Obama in March is designed to provide insurance to 32 million Americans who now lack it.

The AAMC projected a shortage of 33,100 physicians in specialties such as cardiology, oncology and emergency medicine in 2015.

It calls for Congress to increase funding to train new doctors. “The number of medical school students continues to increase, adding 7,000 graduates every year over the next decade,” the AAMC said.

It said at least 15 percent more were needed.

Other groups, such as the nonprofit Rand Corporation and the Institute of Medicine, have also projected various physician shortages.

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From the Washington Examiner

obama-address-congressSix months ago, President Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi rammed Obamacare down the throats of an unwilling American public. Half a year removed from the unprecedented legislative chicanery and backroom dealing that characterized the bill’s passage, we know much more about the bill than we did then. A few of the revelations:

» Obamacare won’t decrease health care costs for the government. According to Medicare’s actuary, it will increase costs. The same is likely to happen for privately funded health care.

» As written, Obamacare covers elective abortions, contrary to Obama’s promise that it wouldn’t. This means that tax dollars will be used to pay for a procedure millions of Americans across the political spectrum view as immoral. Supposedly, the Department of Health and Human Services will bar abortion coverage with new regulations but these will likely be tied up for years in litigation, and in the end may not survive the court challenge.

» Obamacare won’t allow employees or most small businesses to keep the coverage they have and like. By Obama’s estimates, as many as 69 percent of employees, 80 percent of small businesses, and 64 percent of large businesses will be forced to change coverage, probably to more expensive plans.

» Obamacare will increase insurance premiums — in some places, it already has. Insurers, suddenly forced to cover clients’ children until age 26, have little choice but to raise premiums, and they attribute to Obamacare’s mandates a 1 to 9 percent increase. Obama’s only method of preventing massive rate increases so far has been to threaten insurers.

» Obamacare will force seasonal employers — especially the ski and amusement park industries — to pay huge fines, cut hours, or lay off employees.

» Obamacare forces states to guarantee not only payment but also treatment for indigent Medicaid patients. With many doctors now refusing to take Medicaid (because they lose money doing so), cash-strapped states could be sued and ordered to increase reimbursement rates beyond their means.

» Obamacare imposes a huge nonmedical tax compliance burden on small business. It will require them to mail IRS 1099 tax forms to every vendor from whom they make purchases of more than $600 in a year, with duplicate forms going to the Internal Revenue Service. Like so much else in the 2,500-page bill, our senators and representatives were apparently unaware of this when they passed the measure.

» Obamacare allows the IRS to confiscate part or all of your tax refund if you do not purchase a qualified insurance plan. The bill funds 16,000 new IRS agents to make sure Americans stay in line.

If you wonder why so many American voters are angry, and no longer give Obama the benefit of the doubt on a variety of issues, you need look no further than Obamacare, whose birthday gift to America might just be a GOP congressional majority.

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From the Washington Examiner

All you need to know about Dr. Donald Berwick, President Obama’s choice to head the Centers for Medicare and Medicaid Services, is summed up in the nominee’s own words. At the 60thanniversary celebration of Britain’s socialized National Health System, Berwick praised NHS, which he clearly views as superior to America’s private medical system: “You could have had the American plan … Britain, you chose well.”

The families of 1,200 patients who died prematurely in recent years while in the care of NHS doctors and nurses might beg to differ.A shocking 2010 report by Queen’s Counsel Robert Francis found that NHS patients were left unattended “for unacceptable amounts of time” in urine- and feces-soaked beds. At one NHS hospital, four members of the same family — including a newborn girl — died within 18 months of each other because of medical blunders. “There can no longer be any excuse for denying the enormity of what occurred,” Francis noted, harshly criticizing “a lack of care and mistreatment which have no place in any civilized and well-run health service.”

Yet Berwick has called NHS a “global treasure,” saying he is “a romantic about NHS. I love it.” It’s no coincidence that this centrally planned, government-run health care system appeals to a Harvard-educated pediatrician who views patients not as individuals, but as members of collective “units of concern” defined by age, disease or socioeconomic status. Berwick has criticized the use of new life-saving technologies and wants non-physician “primary care providers” to ration care by controlling access to specialists and diagnostic tests to reduce each “unit’s” per-capita costs. He has also characterized aggressive interventions in terminally ill patients as “assaults,” not heroic attempts to extend their lives.

This is a radical departure from the focus on individual patients and their private relationship with doctors of their choice that have made American medicine the best in the world. And while Berwick was among the first to introduce industrial-style quality controls in 3,000 American hospitals, which by all accounts has been a huge success in improving patient care, his rigidly ideological view that America’s health system should mimic Britain’s NHS is inimical to the preservation of individual freedom and high-quality care. His nomination should be decisively rejected by the Senate. Americans live longer, healthier lives than Brits precisely because government bureaucrats have not been in charge of their health care for the past 60 years. If confirmed by the Senate, Berwick will define that quality down to British standards. That would not be choosing well.

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From Washington Examiner

the_pillAs further evidence of how politicized health care would become under Obamacare, Politico reports that Planned Parenthood is pushing for a national mandate that insurers must provide free birth control.  Over the objections of those who think that Americans should be free to seek out health plans consistent with their own moral or religious beliefs, or the dictates of their own conscience, Planned Parenthood (a backer of Obamacare) is launching lobbying efforts aimed at “getting no-cost birth control in the bill,” as it seeks to persuade Obama administration officials to rule that Obamacare requires private insurers to provide birth control — and to do so free of any co-pays or out-of-pocket costs.  (Costs would instead be passed along through slightly higher premiums.)

Meanwhile, a coalition including the Center for Reproductive Rights is seeking to find justification to extend this mandate to include free emergency “contraception” as well.

Somewhat amusingly, Politico writes, “Planned Parenthood has other plans in the works, too. It might soon tap young adults, particularly those who have had their dependent coverage extended up to age 26 [by Obamacare], who are curious about what benefits they will receive. ’Certainly, we have a very large, grass-roots organization interested in making an impact,’ [Laurie] Rubiner [Planned Parenthood’s vice president of public policy] said.”  Politico adds, “College campuses, too, could be fruitful territory…”

If nothing else, you’ve got to give them credit for seeking out new and creative reasons for people to back Obamacare:  Sure, it would raise health costs and deficits, expand the powers of the federal government to heretofore unthinkable levels, and reduce the quality of American medicine.  But, on the other hand, insurers would be required to give those up to the age of 26 free birth control as part of their parents’ insurance policy.

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From the Washinton Examiner

hospitalPhysicians 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.

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From John Goodman’s blog

richardfosterRick 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.

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obamacareRep. 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)

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From the American Spectator

PiggyBankCutoutBy William Tucer.  Two weeks ago we smashed the side view mirror on our car and had to take it to the shop. We paid $250 for a replacement.

This week I went to my dermatologist to see if I had developed any more skin cancers (red hair and all that). The doctor took a biopsy on one spot and sent if off to the lab. If it’s malignant, I’ll have to go back and have a bigger chunk of my cheek removed. The cost of all this? Zero.

This simple comparison illustrates why healthcare “reform,” as Congress has just adopted it, will probably bankrupt the country.

As far as auto insurance is concerned, we have it like almost everyone else. It covers major damage. A year ago I was in a fender-bender. The insurance paid a small portion of the repairs. Several years ago, we bought my son a car and — typically — he nearly totaled it within a week. The insurance company paid an astounding $8,000 in repairs but our premiums tripled and we spent several years paying the penalty. That’s what “underwriting” is about. After one accident you get moved into a higher risk category. It’s what you might call a “pre-existing condition.”

At the auto shop, the mechanics have high school backgrounds with two or three years of on-the-job training and use basic hydraulic lifts and wrenches. I pay them $250 for parts and an hour of labor. At the doctor’s office, the person who serves me has done four years of medical school plus another three or four years of hospital residency and uses sophisticated equipment. The lab that does the biopsy will have the latest technology. Yet because I have a part-time job with a major employer, I receive union “health benefits” that pay for everything. I would be happy to pay $80-100 for my visits to the dermatologist. After all, I pay a plumber $50 just to come to my house and look at my leaking sink. But because politicians like Nancy Pelosi have convinced people that even a $20 co-payment is an “insurance company rip-off,” I get my medical services for free.

Not that I am unaware of the dangers of falling out of this system and going uninsured. A few years ago I didn’t have coverage and was paying $500 apiece for these minor office procedures.       

As John Goodman and Robert Musgrave wrote in their brilliant analysis, Patient Power (written in 1994 and still the best critique around), what we are calling “health insurance” is not insurance at all. It is prepaid medical benefits. Insurance is a way of pooling the risk for major expenses — the kind you incur when you have an auto accident or suffer a serious illness. Prepaid benefit plans try to cover all medical expenses, no matter how small.

No insurance company could possibly provide auto insurance that paid the bills every time you changed a tire. The premiums would be impossibly expensive and people would abuse the system, running to the auto shop every time they felt they needed new windshield wipers or suffered a dent in their bumper. Likewise, no insurance company offers policies with 100 percent coverage of all medical bills. The premiums would be impossibly expensive and people would run to the doctor every time they had a sniffle or suffered a cut finger.

Instead, prepaid benefits plans were pioneered by the major corporations and their labor unions, plus federal, state and local governments and their labor unions, which are now the majority of union members and one of the principle players in this melodrama. Taking advantage of an IRS ruling that health and retirement benefits could not be taxed as income, major corporations and governments began funneling tax-free dollars to their employees as “greater take-home pay.” Instead of income, employees got first-dollar coverage of all medical bills with no co-payments and no deductibles. In other words, medical care was “free.” And of course people began to treat it that way. Writing in 1994, Goodman and Musgrave argued that it was all these people flooding into the system with cost-free health benefits that was driving up medical prices.

What corporations, governments and their unions had created was a mini-welfare state. We all know what happens to welfare states. When General Motors went under this year, it was lamenting that every car that came off the line had $1,500 in employee and retiree health benefits on board. When President Clinton tried to “reform” healthcare in the 1990s, one of the central initiatives was that the bloated healthcare commitments made by major corporations would be off-loaded onto the government.

Practically every state and local government in the country has the same unfunded employee pension and health benefits threatening them with bankruptcy. Medicaid is working the same way and now consumes 25 percent of state budgets. And of course the granddaddy of all is Medicare, which now has unfunded liabilities of $90 trillion over the next seventy years and will only be payable if the dollar loses about 80 percent of its value.

So what has Congress decided to do in order to “reform” this system? Instead of getting a grip benefits and substituting a policy of health insurance, the Democrats have decided to extend the same unrealistic benefits to everybody.

Read the rest of the column.

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us_rep_michele_bachmannU.S. Representative Michele Bachmann (MN-06) issued the following statement today after introducing legislation to repeal the Democrats’ government takeover of health care:

 

“It’s no secret, President Obama and Democrat leaders have ignored the will of the people and have chosen to ram through their trillion-dollar health care bill despite the American people’s overwhelming objection to it.

“It’s future generations, our children and grandchildren who will pay the price for our government’s arrogance and recklessness, and the American people won’t ever forget the irresponsible actions of this Administration and Democratic Majority. After all, government answers to the people, not the other way around. I’m asking my colleagues to join me in repealing this monstrosity of a bill.”

Click here to view the legislation .

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From Washington Examiner

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