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All items for May, 2013


The Obamacare Disinformation Campaign Begins.

 Stanley Feld M.D.,FACP,MACE

to the April Kaiser Health Tracking Poll forty two (42) percent are unaware
that Obamacare is still the law of the land.
 Twelve (12) percent of the surveyed population
believes Obamacare has been repealed by Congress. Obamacare has been repealed
by the House of Representatives many times. It has not gotten through committee
or on to the floor of the Senate. Harry Reed has blocked consideration.

Seven (7) percent of the surveyed
population believes Obamacare had been overturned by the Supreme Court. It is
true that parts of Obamacare have been overturned by the Supreme Court.  An additional twenty three (23) percent do not
know whether or not Obamacare remains law.

Half the public surveyed says it
does not have enough information about the healthcare reform law to understand
how it will impact their own family. The majority of this half are the
uninsured and low-income households.

Obamacare as a law is in financial trouble. The
generous amount of money put in the budget for Obamacare has been spent already. The tax
increases put in place to fund Obamacare have not been sufficient.

Congress has refused to pour good money after bad.

President Obama seems unconcerned about the money he
spends to fund Obamacare as the deficit continues to soar.

He continues to blame congress for Obamacare’s

He also blames the decrease in important services
such as White House visits and air traffic controller furloughs on the
sequestration. He ignores the fact that the sequestration was his idea. He has
blamed his opponents for the sequestration.

Last week President Obama attacked his opponents
during the kick off of his public relations campaign to support Obamacare by
accusing them of generating disinformation about Obamacare.

Obama kicked off another campaign-style effort to get people to sign up for the
so-called Affordable Care Act.

In a statement dripping with condescension Obama tried to
blame misinformation for his health care troubles.”

He said, “Precisely because there’re
been so much misinformation, sometimes people may not have a sense of what the
law actually does.

He continued,   “We’re going
to need everybody out there to make sure they get the right information.”

“Don’t just read a blog or some
commentary from some pundit that has a political agenda.  Make sure you
know what the actual facts.”

Don’t let people confuse you.  Don’t
let them run the okeydokey on you.  Don’t be bamboozled.”

The next step in President Obama’s playbook is to
frighten the people.

“The refusal by about half the states to expand Medicaid will leave millions
of poor people ineligible for government-subsidized health insurance under
President Obama’s health care law even
as many others with higher incomes receive federal subsidies to buy insurance.”

 My impression was that states that refused to form
their own health insurance exchanges were going to have health insurance
exchanges ceated by the Obama administration. The federal government run exchanges were
supposed to provide the same coverage the states are supposed to provide under
directives controlled by the Obama administration.

HHS said “But
those options will be unavailable to some of the neediest people in states like
Texas, Florida, Kansas, Alabama, Louisiana, Mississippi and Georgia, which are
refusing to expand Medicaid.”

The Obama administration
keeps moving terms around. It also usually gives the story to a favored media
outlet, in this case the New York Times.

The administration’s creditably
is fading fast.

The tactics used to hide the
real Bengashi story, the challenge to freedom of the press and IRS tactics and
the realization by unions that the bill is not in favor of their motives has
served to question President Obama’s creditability.

He claims to have not known anything
about each scandal. His unawareness of these scandals has been hard to believe
by most people.

The stories about each
scandal, told by the administration, are unbelievable. These stories become
more unbelievable as they are changed daily in an attempt to soften the blow.

This makes me think
President Obama’s campaign tactics to promote Obamacare is not going to fly
with the public.

People in those states who
have incomes from the poverty level up to four times that amount ($11,490 to
$45,960 a year for an individual) can get federal tax credits to subsidize the
purchase of private health insurance. But many people below the poverty line
will be unable to get tax credits, Medicaid or other help with health

People below the poverty
level should pay a small percentage of their income for  healthcare coverage. They are already immune
from paying income tax if they make less than $38,000 a year.

Citizens at other levels of
income should pay a greater percentage of their income just as they do in
Indiana. Everyone should have some skin in the game so they are responsible and
feel independent of government decision making.

The administration is
blaming those non-participating states for Obamacare’s mistakes. It is worse
that they are penalizing the indigent.

Administration officials
said they worried that frustrated consumers might blame President Obama rather
than Republicans like Gov. Rick Perry of Texas and Gov. Bobby Jindal of
Louisiana, who have resisted the expansion of Medicaid.”

This is not President
Obama’s unusual campaign tactic. I cannot believe the American people have let
him get away with these tactics for so long.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Another Obama Political Campaign Has Started

Stanley Feld

I have predicted Obamacare will fail ever
since its passage. Proponents of Obamacare believe Obamacare is America’s last
hope for meaningful healthcare reform with affordable care for all.

They now admit there are some problems
with Obamacare but little tweaks will fix it.

Obamacare is not America’s last chance for
healthcare reform. Obamacare is a series of regulations pasted on to an already
dysfunctional healthcare system. It is destined to collapse on it own weight
and regulations. There are over 20,000 new regulations to date with thousands
coming each week as we get closer to January 1,2014.

I believe the business model I outlined
using 2013 technology is the system that will align all the stakeholders’
incentives and provide universal care at an affordable cost for all.

It will provide freedom of choice and
enhance the patient physician relationship. It will be a system that is patient
centered as opposed to Obamacare being government and outcome centered.

An outcome centered healthcare system puts
the government and the healthcare insurance industry in control of medical care
decisions. It will control access to care and result in rationing medical care.

The passage of Obamacare was a political

The bill was slipped through the Senate just
before dawn three Christmas eves ago with only one Republican vote in both
houses of congress. Obamacare is not a bipartisan act.

Nancy Pelosi told the American public and congress
that we would not know what is in it until we pass it.

We have been told that most of congress has not
read the act completely.

The new entitlement’s start-up date is October
2013. The implementation date is January 1,2014. No one is ready for either

 “The size and
complexity of the Affordable Care Act meant that its implementation was never
going to easy
. But behind the scenes, even states that support or might support
the Affordable Care Act are frustrated about the Health and Human Services
Department's special combination of rigidity and ineptitude.”

state governments have tried to get a clear idea of how Obamacare would work in
practice with the health insurance exchange.

 The states are terrified of the economic burden the health
exchanges could impose on their deficit-ridden states.

The Supreme Court has given the states a choice of signing on
whereas there was not a choice in the original bill.  

Some states felt they could not turn down the health insurance
exchange because the Obama administration was offering them too much money,

The Obama administration is starting to make preliminary deals
with states that have rejected the health insurance exchanges at this point.

The administration is giving Ohio and Arkansas more money to pay
for health insurance for people earning up to 133% above the poverty level. (Income
of $14,400 a year). This deal nowhere as creative as the Indiana Health Plan
and will cover many fewer people.

This offer will not cover people who really need insurance.

The preliminary deals with Arkansas and Ohio will be more costly
that deals with other states
. It is questionable whether the Obama
administration has the authority to spend the additional money.

As new regulations keep being produced none of the real hard
operational questions are being answered.

A regulation usually requires 60 days of public comment. The Obama
administration has unilaterally shortened public comment to 30 days. The shortened
public comment period for new regulations can be challenged by the states and

There are other problems that states are having with Medicaid and
Obamacare. Many feel that HHS is treating states not as partners but as serfs
to the federal government.

The central government is building a data hub to determine who is
eligible for Medicaid and Obamacare health insurance exchanges. This new
federal bureaucracy will dispense insurance subsidies and police the market.

Many states want to cut their administrative costs to balance
their budget. They are combining the application process for Medicaid, food
stamps, cash assistance and other antipoverty programs into one agency.

HHS's privacy rules say the hub can only be used for Obamacare.
HHS will force states to become less efficient by having a free standing
bureaucracy for Obamacare and has flatly refused to consider participating
states’ requests for combining all the agencies under one roof.

Twenty-four (24) states have still refused to participate as of
May 15th. The Obama administration will have to run a federal
exchange in those states.

HHS has not revealed how it will handle these exchanges. The
agency running the federal exchange won't reveal how it will operate.

The irony is that many of the states would participate if HHS gave
them more flexibility to manage their own programs and control costs.

“At a House Energy and Commerce hearing on Thursday, Obamacare
point man Gary Cohen all but took the Fifth on how he'll deal with this and
other challenges.”

It seem as if it is going to be a vast
undertaking that can not possible be in place in October or operational on
January 1st, 2014.

Chris Christie (N.J.) and Bill Halsam
(Tenn) wanted to participate but now feel the health insurance exchange in not
a sane or rational marketplace. The costs
and risks were too high.

This is all-or-nothing
political gambit is meant to put the governors of states not participating in a
bad political spot at home if they don’t participate.”

“At this point, the total administrative burden on the federal
government has massively increased. Yet neither the federal government nor the
states have the human or financial resources to discharge these tasks in a
timely fashion, making it highly unlikely that these exchanges will be up and
running by January 1, 2014.”



 Making things worse for
Obamacare is no fewer than 18 Democratic Senators came out against Obamacare's
$28 billion tax on medical device sales.

The list of Democratic Senators
includes Chuck Schumer, Dick Durbin and Patty Murray. Either they believe it or
the lobbyists got to them.

The medical device industry has received little
guidance about how to comply with the tax. This has caused significant
uncertainty and confusion for medical device businesses.

These are some of the problems Obamacare is

President Obama is unfazed. In the face of criticism from
about his incompetent implementation of Obamacare, he is going on the road to spin some misinformation and make it
look like Obamacare is great and his critics are political.

President Obama co-opted
Mother’s Day in his latest campaign to sell Obamacare that begins now and will
last until the 2014.

President Obama kicked off
another campaign-style effort to get people to sign up for the so-called
Affordable Care Act.

In a
statement dripping with condescension Obama tried to blame misinformation for
his health care troubles.”

He said, “Precisely because there’re been so much
misinformation, sometimes people may not have a sense of what the law actually

He continued,   “We’re going to need everybody out there to make sure
they get the right information.”

just read a blog or some commentary from some pundit that has a political
agenda.  Make sure you know what the actual facts.”

let people confuse you.  Don’t let them run the okeydokey on you. 
Don’t be bamboozled.”

Doesn’t this sound like his
political campaign of 2012?

President Obama seems to
have forgotten that a lot of misinformation about Obamacare results from his

Wasn’t he was the guy that
said, “If you like you doctor you will be able to
keep your doctor and if you like your healthcare plan you can keep your
healthcare plan.”

None of this is true
including free choice, affordable healthcare insurance, and free access to

I wonder when Americans are
going to get tired of President Obama’s misinformation and false promises.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Chargemaster Data And Transparent Pricing

Stanley Feld M.D., FACP, MACE

chargemaster, or charge description master (CDM
), is a
comprehensive listing of items billable to a hospital patient or a
patient's health insurance provider. It is published every
year from billing data and payments.

 Chargemasters include
thousands of hospital services, medical
, drugs, supplies, and diagnostic evaluations such as imaging and

item in the chargemaster is assigned a unique identifier code and a set price
that are used to generate patient bills.

impact of the chargemaster is such that those with good insurance pay the least for that care,
whereas the uninsured, and others who pay out-of-pocket for healthcare
pay the full chargemaster listed price for the same services.

There are multiple
list prices for hospital services and one price the government pays. Some of
the list prices are unconscionable. They are not tied to the cost of the
service. A drug most often quoted is the price of an aspirin. An aspirin cost a
penny a pill. Hospitals charge $45.

With the ubiquitous
Internet, we as patients and we as physicians can easily look up what the
hospital systems are overcharging for each service and procedure.

Both the list price and the price
paid by the government’s for each hospital system is in the report
. The
government pays different hospital systems in the same area different prices.  The reason for this is not transparent.

When I send a patient for a test in
the hospital, I have no idea of what the test costs the patient. If I knew the
prices and felt the patient was overcharged, I would sent the patient another
hospital for that test. 

There are two important issues
to notice here.

 1. Hospital
systems are trying to buy physicians practices so physicians have no choice
for his patients.

systems are trying to consolidate with other hospitals so physicians cannot
send their patients to another hospital system.

3. The Obama government thinks this is a good thing. I think decreasing local competition
is a bad thing for patients.

"The important issue will be for
those folks that end up having to deal with chargemaster charges, which is the
uninsured consumers,"

Chargemaster is "For them and their advocates, something to use in
negotiation around how the cost of their care should be discounted."

It will not affect the insured who already
have had prices negotiated by their healthcare insurance company. However, many consumers are going
to be uninsured as companies drop it healthcare insurance coverage. Consumers might choose to go bare.
All of a sudden prices will be forced to be transparent.

Something unfair is still going on. The average Medicare payment
for people treated for respiratory infection and inflammation with major
complex comorbidities ranges from $24,084 at the University of California San
Diego Medical Center, to $18,862 at Sharp Memorial Hospital to $11,989 at
Pomerado Hospital.

Treatment given in each hospital system is probably not different. The political connections are different.

These price differences go on all over the country.

The distraction from the politics in the chargemaster
list price for the respiratory infection described above was as high as
$133,347 at Sharp Chula Vista Medical Center. This difference between list
price and paid price is absurd.  Hospital systems search for the highest price they can get.

Medicare Advantage plan beneficiaries might find chargemaster
very useful.

If they go to a hospital out of network they might find
themselves liable for the entire retail price of the hospital charges.

The rules are unfavorable to Medical Advantage

The Obama administration wants to eliminate the popular
Medicare Advantage program.

The trick for Medicare Advantage patients is to go only
to hospitals within the network for their plan.

“Joseph Fifer, President
and CEO of the Healthcare Financial Management Association, says he thinks
“hospitals should publish all of their charges for all of their DRGs on their
webpages. And that will happen, he thinks, but it will take some time.”

Until now, he says,
"hospitals didn't know what other hospitals were charging. The restraint
of trade lawyers would put the fear of God into their chief financial officers
saying, we can't find out what the pricing is at other hospitals for fear of
(being accused of) anti-trust behavior."

This is a hollow
excuse not to create transparent fees and to continue to confuse the public.

 I believe the government should require
hospital systems to post prices that the government pays for services,
procedures and hospitalization

If a hospital
system refuses to post its prices, the state government should withhold that hospital
systems license until it does.

The alignment of
incentives should alway be in favor of consumers.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Obama Administration Continuously Declines To Renew Indiana’s Medicaid Waiver

 Stanley Feld M.D.,FACP,MACE

In light of the recent alleged IRS
scandel targeting certain groups, I am reminded of the Medicaid incident in
Indiana. I believe the incident is resolved now with the Obama administration
granting a waiver to Indiana after two years of bureaucratic haggling.

In 2007 Governor Mitch Daniels (R.) was
successful in getting the Indiana state legislature to pass a Medicaid reform
plan called the Healthy Indiana Plan. It is an expansion of Medicaid. It uses a consumer-driven
health plan to encourage low-income beneficiaries to take control of their
health and healthcare dollars.

This healthcare plan is a variant of my
ideal medical saving account.

 The Healthy Indiana Plan has been very successful.

Healthy Indiana Plan has been the most
innovative and successful reform of Medicaid in the history of the Medicaid

The federal government’s waiver for the
plan was given in 2007 and set to expire on December 31, 2012. Indiana applied
for an extension of the Medicaid wavier in early 2011. In November 2011 the
Obama Administration rejected the state’s request to extend its federal waiver.

Over 45,000 poor Hoosiers on Medicaid
were scheduled to lose this innovative Medicaid coverage in 2013.

Medicaid is theoretically run by the
states in cooperation with the federal government.  In reality, any time a state wants to make
the tiniest changes in its
Medicaid program, it has to go hat-in-hand to the U.S. Department of Health and
Human Services with a formal request for a waiver and these waivers are usually

 This federal control has been part of the
disagreement states have with the federal government over health insurance
exchanges. The central government wants to shift the financial burden on the
states while controlling the states’ decisions.

Indiana succeeded in gaining a waiver in 2007
because it was seeking to expand Medicaid to
a group of people who weren’t then eligible for the program and because the
state’s effort required no additional outlays from the federal government.  Governor
Mitch Daniels paid for the
Medicaid expansion by increasing the state’s cigarette tax by 44 cents. It made
sense to everyone except the people that smoked. 

Patients had skin in the game because
they had to pay 2 -5% of their income for their insurance coverage. The plan
provided financial as well as wellness incentives.

We did a lot of reading on
criticism of health savings accounts,” says Seema Verma, who was the
architect of the Indiana
program. “One of the criticisms was that people didn’t have enough money to pay
for preventive care. So we took preventive care out, made that first-dollar

“ Also, people said that people didn’t have enough for the
deductible, so we fully funded it. Then, you have to make your contribution
every month, with a 60-day grace period. If you don’t make the contribution,
you’re out of the program for 12 months. It’s a strong personal responsibility

 I described the Healthy Indiana plan in
detail in January 2008 pre President Obama

Medicaid patients get a specified amount
of preventive care for free.  Included
are free annual physical exams, pap smears and mammograms for women,
cholesterol tests, flu shots, blood glucose screenings, and tetanus-diphtheria

Medicaid beneficiaries have no
cost-sharing requirements (co-pays, deductibles, etc.) except for non-urgent
use of emergency rooms.

The money remaining in the Medicaid
patients’ POWER accounts at the end of the year can be applied to the following
year’s contribution only if they obtain the required free preventive disease

“The program has been, by many measures, a smashing success. “What
we’re finding out is that, first of all, low-income people are just as capable
as anybody else of making wise decisions when it’s their own money that they’re
spending,” Mitch Daniels explains in a Heritage Foundation video.”

“And they’re also acting more like good consumers. They’re
visiting emergency rooms less, they’re using more generic drugs, they’re asking
for second opinions. And some real money is starting to accumulate in their
[health savings] accounts.”

The program has been
very popular. Ninety (90) percent of enrollees are
making their required monthly contributions. Employers didn’t dump their
workers onto the program, crowding others out, because you needed to be
uninsured for six months in order to be eligible for it.

 “The program’s level of
satisfaction is at an unheard-of 98 percent approval rating,” Verma told 
Kenneth Artz.

Lower income families are not too stupid
to be wise healthcare consumers despite popular belief.

2010 study by
Mathematica Policy Research found that in the program

71 percent met the preventive care
requirement and were able to roll the balances over to the following year.  Only 39% obtained preventive care in the
first six months. It proves financial incentives work.

The lack of physician access is the
biggest reason why health outcomes for Medicaid patients lag far behind those
of individuals with private insurance.

Healthy Indiana pays better than
traditional Medicaid. The physician access trend has been reversed. Preventive
care participation rates are higher than the
privately-insured population.

Why would the Obama administration, which
controls the states’ Medicaid programs, refuse to grant a waiver for Indiana’s successful

The first excuse HHS used was “ HSS  hadn’t written the regulations for Obamacare

According to Seema Verma  “the state will now have to file a much more
complex “State Plan Amendment” that may not get approved before the Healthy
Indiana program is set to expire.”

Before his term expired Gov. Daniels
had written to HHS Secretary
Kathleen Sebelius asking her for permission to use the Healthy Indiana Plan to
handle Obamacare’s mandatory expansion of Medicaid. He had not heard back.

The Obama Administration claims to be on
the side of the poor.  Why would it not
approve a waiver of a popular program for the poor that provides the poor with
superior health care?

Whatever the reason, tens of thousands of people will be
needlessly harmed.

burdens and “poison pills” have been thrown at the Indiana health plan. One
such poison pill is not allowing the state to include the $1100 Power account given to Medicaid patients to make
wise medical care choices.

the government pays the healthcare insurance industry for help desks and rent
for buildings where there are help desks as direct patient care instead of

It is
not only bewildering, it is obscene.

controversy continued throughout 2012 past the expiration date of the 2007
waiver into 2013.

Pence, the new governor, kept fighting off bureaucratic rules but got nowhere
through March of 2013.

The subtext of all of this is the
Obama administration wants a top down centrally controlled Medicaid system with
the financial burden on the states and Indiana wants to control its own destiny
with its successful plan.

like the following has been going on. Diane Gerrits, CMS' director of state
demonstrations and waivers, wrote in a Feb. 25 letter that the state will have
to resubmit its application because it had not yet held two public hearings
required by law.

CMS said as a result of the failure to comply with the transparency portion of
the proposal, the state must begin a 30-day state public comment and notice
period. The state must follow with an additional 30-day federal public comment.

has been going on since 2011

Mike Pence fired back,

 "The Feb. 25, 2013, letter from HHS does not
indicate in any way that the waiver application process has been
jeopardized," he wrote Thursday. "It does, however, speak to the
flawed bureaucratic process that has impeded progress on our successful Healthy
Indiana Plan."

Obama administration is trying to destroy all health savings accounts both
public and private. This is probably the reason for these artificial delays.

in mid April, under public pressure and possibly the impending IRS scandal Indiana’s
waiver request was approved.

is a happy ending to the Indiana saga and perhaps a model to get all the
Medicaid programs out of the deep ditch they are in.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Don’t Confuse Me With Facts


The Obama administration refuses to believe that
physicians are not interested in seeing Medicaid patients. The Obama
administration must think that by increasing Medicaid enrollment the number of
physicians willing to see these patients will increase. I believe the Obama
administration is wrong.

survey called the Health Tracking Study Physician Survey,
sponsored by the Center for Studying Health System Change, polled more than
4,700 physicians around the country in 2008.

The survey covered many private practice
issues. One question surveyed was about new patients these physicians would
likely accept.

The survey showed that Internists are 8.5 times
more likely to reject all Medicaid patients as opposed to patients with private

There is an additional cohort of doctors who
only accept “some” (i.e. reject most) new Medicaid patients.

These numbers might surprise some but they
reflect reality.

 The physicians who accept “all” or “most”
Medicaid patients are a concentrated minority.

This means that if you have Medicaid
insurance coverage it will be very hard to find a physician who will see you.

Medicaid and MD


The administration refuses to believe
that the 32 million new Medicaid patients will have a difficult time finding a

Most other observers accept the fact that
Medicaid beneficiaries have a tough time finding physicians. The main reason is
due to the fact that Medicaid deeply underpays physicians and hospitals for
their services.

There is also resistance by progressive
thinkers to believe that Medicaid coverage has poor performance outcomes.

In reality Medicaid coverage is bad
insurance coverage.

Scott Gottlieb M.D.’s article in the WSJ in 2011

Medicaid Is Worse Than No Coverage at All!

research shows that patients on this government plan fare poorly. The question is
why does the President Obama want to shove one in four Americans into it?"

Dr. Gottlieb’s question is a very good

The Oregon Experiment just published in
the New England Journal of Medicine reached the same conclusion.

We found no significant effect of Medicaid coverage on the prevalence
r diagnosis of hypertension or high cholesterol levels or on the use of
medication for these conditions. Medicaid coverage significantly increased the
probability of a diagnosis of diabetes and the use of diabetes medication, but
we observed no significant effect on average glycated hemoglobin levels or on
the percentage of participants with levels of 6.5% or higher.”

The was no difference
in “clinical outcomes.”  However, as I
explained on many occasions, in the past there are large defects in measuring
clinical outcomes.

In additional, the
findings in clinical outcome studies are often misinterpreted.

Medicaid coverage decreased the probability of a positive
screening for depression (−9.15 percentage points; 95% confidence interval,
−16.70 to −1.60; P=0.02)
, increased the use of many preventive services, and
nearly eliminated catastrophic out-of-pocket medical expenditures.”

The results of
screening for depression in the Oregon Experiment are not statistically
significant. In order to be statistically significant a p value has to be less
that .05.

Ezra Klein of the Washington Post found the
words to publish the results as very positive for Medicaid
coverage using the
Oregon Experiment as proof. The article was entitled Here’s what the Oregon Medicaid
study really said”

Since the media
is the message Ezra Klein used the media to get his biased message out even if
the message is wrong.

He might be
right that Medicaid coverage is important but the Oregon Experiment did not
prove it.

The real
problem with the Oregon Experiment is that the design of the study is
defective. If a study’s design is wrong the conclusions are wrong on both sides
of the argument.

There are
real structural problems with Medicaid coverage in its present form. Its
reimbursement method is also wrong. The only way to provide quality affordable
care to lower income families is to fix Medicaid’s structural defects.

To force 32
million people into a defective system is going to lead to disastrous fiscal
and medical care consequences.

I have to think
the Obama administration does not care about the results or the administration is
blinded by its own ideology.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Listen To This !

Stanley Feld M.D.,FACP,MACE

Obama administration seems to exhibit a definite pattern for releasing
unfavorable information. It always seems to occur on a Friday afternoon when
everyone is thinking about the weekend.

Last Friday it was reported that,Health
and Human Services Secretary Kathleen Sebelius has gone, hat in hand, to health
industry officials, asking them to make large financial donations to help with
the effort to implement President Obama’s landmark health-care law,”
two people familiar
with the outreach said.

has repeatedly rejected requests by the Obama administration for more money for

Orrin G. Hatch (R-Utah) said To solicit
funds from health-care executives to help pay for the implementation of the
President’s $2.6 trillion health spending law is absurd.”

Affordable Care Act (Obamacare) included 1 billion dollars to be used in
overall implementation of the law. The 1 billion dollars is almost gone. The
CBO projects that Obamacare now needs 5-10 billion dollars to get the law “up and running over the next 10 years.”

come?  There is no explanation available.
My guess is that it is the result of waste, inefficiency and excessive bureaucracy.

All of
a sudden the government needs money to train and outsource to community
organizers the job of getting the underprivileged to sign up for healthcare
insurance through the health insurance exchanges. 

addition many states have not signed up to run their health insurance

needs the money to fund and manage the health insurance exchanges in those 33

Obama administration also promised those states that did sign up that it would
pay all the expenses for three years.

assume the administration did not need congressional approval for this

could also assume that the Obama administration’s plan was to stick the startup
expenses to the states rather than the federal government. 

has refused to provide the requested additional funding for Obamacare.

Obamacare was supposed to be budget neutral. It
clearly will not be budget neutral according to present CBO estimates. It will
more likely be in the negative by over 1 trillion dollars despite the tax

need only be reminded of the 10 hidden taxes they are already paying to fund
Obamacare in order to understand congress’s attitude.

“After Congress rejected a request in March
for nearly $1 billion in additional spending for fiscal 2013, the White House
asked for $1.5 billion for fiscal 2015 to set up and run dozens of exchanges
that will provide Americans options for health insurance. The new marketplace
is scheduled to launch in October 2013 for open enrollment.”

It is
already anticipated that the promised “affordable healthcare insurance” will be
unaffordable to indigent or low-income earners.

documents show that the Obama administration has already pulled hundreds of
millions of dollars from projects not specifically earmarked for Obamacare to
implement Obamacare.

HHS announced that it would use $150 million in Affordable Care Act funds meant
to build additional community health centers to train thousands of health-care
outreach workers at facilities that already exist.

“Investing in health centers for outreach
and enrollment assistance provides one more way the Obama administration is
helping consumers understand their options and enroll in affordable coverage,”
Secretary Sebelius said in a statement.

 It is
strange and unexpected by the Obama administration that few are signing up for

Sebelius seems to be trying to make congress feel guilty for Obamacare’s costs
overruns. I have a feeling there are going to be a lot of cost overruns in the
next future along with an attempt to raise taxes.

We requested additional money from congress
but we didn’t receive any additional funding for the exchanges,” Ellen Murray,
HHS’s assistant secretary for financial resources, said last month at a budget

“So we’ve had to come up with a Plan B.
We’ve been working very hard to develop that.”

“Part of our mission is to help uninsured
Americans take advantage of new, quality affordable insurance options that are
coming thanks to the health law.”

Sebelius might have stepped over the federal regulations line once more.   She got into a bit of a jam before last years
the election when she violated federal law by
‘accidentally’ endorsing President Obama’s reelection at an appearance in her
official HHS capacity. The press and congress gave her a pass and so the miscue
failed to gain public notice.

time it might not be so easy.   Federal regulations prohibited department
officials from asking for funds from industry officials, business or
subordinates in an official capacity, which has in the past sought to do
business with that Department.

Sebelius has done just that making multiple phone calls to health industry executives,
community organizations and church groups.

has asked them to contribute whatever they can to nonprofit community
organizers that are working to enroll uninsured Americans and to increase
awareness of the law.

was revealed to the press last Friday by an HHS official and an industry person
familiar with the secretary’s activities.

Sebelius’ only way out of this jam is that the law permits her to solicit as a
private citizen. The administration began to spin it as an act of a private citizen
soliciting aid from parties interested in helping the healthcare law’s

might be dirty pool to some but those stakeholders affected are intimidated
from speak out because of their potential loss of business from the government.

a while Americans get use to and are bored by these tactics.

press blows them off as insignificant and the public forgets about them.

I do
not believe these maneuvers can stop Obamacare from failing under its own
weight. It is a law with too many defects.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Surprises For Physicians Coming With In Health Insurance Exchanges

Stanley Feld M.D.,FACP, MACE

important components of Obamacare are Accountable Care Organizations (ACOs) and
Health Insurance Exchanges (HIEs).

adoption of both by medical communities and the states has been slow for good

I have
discussed the difficulties of setting up and the executing effective Accountable
Care Organizations

Some hospital systems are trying to set up ACO’s. These hospital systems
are buying up physicians’ practices and trying to develop integrated care

The hospital systems are buying the physicians’ intellectual property and
surgical skills sets. It will not work once physicians realize what happened.

The relationship between community hospital systems and practicing
physicians had always been tense. Physicians do not trust hospitals and hospitals
do not trust physicians.

Some physician groups are trying to develop their own ACOs. They are trying
to convert hospital systems from being providers of patient care to vendors for
their physician ACO.

If there are two hospitals in a community or town the hospital systems
might become competitive.

The huge problem for physicians is the assuming of risk. If healthcare
insurance companies cannot manage risk, why would physicians think they can
manage risk?

 A variable that cannot be controlled
in managing risk are patients. With all the obesity and the increase in
diabetes mellitus it seems patients do not have the incentives to manage their
own risks.

 Patients and physicians must be provided with appropriate financial
incentives if there is the slightest chance of managing risk and decreasing the
cost of healthcare.

 The adoption of ACOs has been slower than the Obama administration has anticipated.

of the Health Insurance Exchanges has been slow by states. Some states
recognize the financial risk the Obama administration is trying to force on

risk is ever present even if the federal government is going to pay the entire
bill for the first three years.

As soon as physicians realize
the risk the Health Insurance Exchanges are going to impose on them, they will
not be willing participate.

These risks become more
apparent will each succeeding release of regulation.

Kathleen Sebelius said it two
weeks ago when she said there would be plenty of surprises ahead for physicians.

and Human Services Secretary Kathleen Sebelius, who told a gathering a few
weeks ago at the Harvard School of Public Health that she has been
"surprised" by the political wrangling caused so far by Obamacare,
there are likely to be plenty of surprises ahead.”

Physicians could face dramatic
financial challenges for treating patients who receive health coverage through
the Affordable Care Act's (ACA) Health Insurance Exchanges starting next year.

Insurance companies will not
process claims on patients who haven't paid their premiums in 3 months
, leaving
doctors on the hook to recoup payment directly from the patients.”

Obamacare provides a 3-month grace
period to individuals who haven't paid their premiums for insurance purchased
through the Health Insurance Exchanges.

This provision will prove to be a
problem for physicians.

In Obamacare patients who fail to
pay their premium are free to sign up for another plan provided by the Health Insurance

They can also start seeing another
physician without the insurance company or new physicians being aware of the
patient’s delinquent premium record.

"Why would a doctor sign up to treat these patients] if
they're going to be completely at risk and have to collect from the patient
directly for their care?"  "This
is a really bad provision in the bill, and we've got to get it fixed."

Under traditional insurance provided
by employers, the plan is still liable for paying doctors even if the patient
or employer hasn't paid their premiums,

Under the health insurance exchange
the individual is responsible for their monthly premium. If the patients
discontinue payment of their premium the healthcare insurer is not obligated to
pay the physician for the care provided.

Most of the time patients have stopped
paying premiums because they cannot afford them. Patients buying healthcare
insurance from the Health Insurance Exchanges are lower income producing

expected annual, out-of-pocket cost for an individual is estimated to be around
$6,400 and $12,800 for a family. This is not an insignificant expense for low
wage earners.

Recent premium estimates indicate
that the premium will be higher. This could be one of the surprises Kathleen
Sibelius is referring to.

Another potential shortcoming of the
Health Insurance Exchange is the reimbursement rates provided to physicians.
The Obama administration believes Medicaid rates are sufficient.

I wonder if any of President Obama’s
healthcare policy wonks ever questioned why so many physicians do not accept

The answer is simple. The
reimbursement rate is less than the physicians fixed overhead to see the patient.

Medicaid physicians are driven to
see many patients a day to try to make a living.

It would be difficult maintaining a
physician patient relationship and a high quality of care seeing over 100
patients a day.

When their overproduction is
discovered these physicians are investigated for fraudulent practices.

 The rates the healthcare insurance industry
will pay physicians will not be set until late summer.

The big provider groups are negotiating with plans on their
payments. Small groups will only get a "take it or leave it" contract
from the health plans.

It seems obvious that fewer
physicians will sign up to accept patients receiving coverage through the
Health Insurance Exchanges once physicians understand what Obamacare is doing.

 This will result in a further physician

 The simple question is what is Obamacare
trying to do to the healthcare system?

 Is Obamacare trying to destroy the
healthcare system?

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Consumers Are Becoming Terrified Of Obamacare

Stanley Feld M.D.,FACP,MACE

Congress has finally figured out Obamacare’s financial burden to them
personally and their staff. They want out and are trying to sneak in a waiver for

Millions of Americans are going to pay more for their healthcare
insurance and get less coverage and a higher deductible cost.

Can ordinary American get the same waiver as government workers?

Actuary consultants
from Oliver Wyman in an article published in the journal of the American
Academy of Actuaries, found that "around six million of the 19
million people with individual health policies are going to have to pay
more—and this even after accounting for the government subsidies offered under
the law."

 "For example, single adults age 21-29 earning
300% to 400% of the federal poverty level will be hit with an increase of 46%
even after premium assistance from tax credits."

The number of people seeking individual healthcare insurance
will be even higher when it becomes clear that employers presently providing
healthcare insurance to employees will drop the coverage and elect to pay the

The present estimate is that 65% of employers are either
definitely going to drop healthcare coverage or are seriously considering
dropping coverage.

healthcare insurance industry claims the reason for the increases in premiums
is the Obama administration’s regulatory policies for participating in health
insurance exchanges.

 Obamacare's community-rating regulations, which
require insurers to accept everyone but limit or ban them from varying premiums
based on age or health.

  1.  The law
    also mandates "essential" benefits that are far more generous than
    those currently offered and thus raise the premiums.
  2. The healthcare insurance industry will be
    required to pay a tax on every healthcare insurance policy sold through the
    health insurance exchange. The industry is anticipating the tax and passing it
    on the anticipated cost to the consumer.
  3. Employers with over 50 employees are decreasing the
    number of employees to less than 50 employees so as not to pay a penalty for
    not providing insurance.
  4. Employers are not required to
    provide insurance for employees working less that 30 hours a week and so
    employers are decreasing employee work hours.

 The Bureau of Labor
Statistics reported on a category of workers who will almost surely be
involuntarily under-employed as a result of health reform.

“The present
estimate is that 10 million part-timers now working 30-34 hours per week will
have their work week decreased to under 30 hours a week.”

to Congressional Budget Office projections in July and September 2012, three
million people will lose their insurance altogether in 2014 due to Obamacare.

million will have to pay the individual-mandate tax penalty in 2016 because
they don't want or won't be able to afford coverage, even with the government subsidies.

It is anybody’s guess how many people will be uninsured. The more
uninsured people that are eliminated from the insurance pool the higher the
insurance premium for those insured.

Rather than providing universal affordable care the Obama
administration has created a system that will result in more uninsured consumers and faced with unaffordable costs.

Are all these people going to qualify for Medicaid? I do not believe so.
They will earn too much to qualify for Medicaid and too little money to afford
the upcoming premiums.

It is estimated that 30 to 40 million American families’ will
experience an adverse affect in healthcare coverage as a result of Obamacare.

Americans are becoming concerned as the reality of the negative effects
of Obamacare become clear.

Even the traditional mainstream media is starting to report those
concerns as Obamacare’s negative effects are being felt.

Theoretically Obamacare sounds good. Practically it will collapse
the healthcare system.

Health and Human Services Secretary Kathleen Sebelius, who told a
gathering a few weeks ago at the Harvard School of Public Health that she has
been "surprised" by the political wrangling caused so far by Obamacare,
there are likely to be plenty of surprises ahead.”

What are the other surprises? What is going to happen to all the
uninsured and underinsured?

It looks like the outcomes are going to be the opposite of the goal of

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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