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Republican lawmakers have seized on the waivers as proof that the law they want to see repealed is flawed, and they have accused the administration of giving them waivers as gifts to union allies.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.

Here’s the link to the list.

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.

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.

By 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

After 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.

The 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.

From the Washington Examiner

Six 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.

From the Washington 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.