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America’s Rural Hospitals Are Being Destroyed

Stanley Feld M.D.,FACP,MACE

There is no question the federal government must decrease the amount of
money it is spending on healthcare. It simply cannot sustain the increasing
cost of health care.

Instead of figuring out how to make the system more efficient and cost
effective, the Obama administration is slowly destroying assets that have been
built at great costs to society in the past.

One example is the community hospital systems in large cities and the
voluntary hospital in smaller cities.
The government has subsidized their
development with tax incentives and reconciliation paybacks.

In recent years rural hospitals have been failing because of decreasing
government reimbursement. Many service the poor and elderly with emergency care
and outpatient clinics.

  • The role and structure of rural
    hospitals is changing,
    but they continue to be important local and
    regional centers of health care activity.
  • Rural hospitals tend to depend
    more on Medicare and Medicaid patients.
  • Most rural hospitals are organized
    on a not-for-profit basis
  • Rural hospitals make an important
    contribution to rural economies; expansion and diversification of the
    services that they offer will be important in their survival.
  • The quality of care provided in
    rural hospitals is generally equal to that provided by urban institutions,
    with some exceptions.

The Department of Health and Human Services' Office of the
Inspector General has recommended that Congress allow the Centers for Medicare
& Medicaid Services to strip critical access designation from any hospital
that was brought into the program under a state "necessary provider"
designation.

Brian Jordan, a program analyst for OIG's Office of
Evaluation and Inspections in Chicago, said that nearly 1,000 of the
approximately 1,300 critical-access hospitals
in 45 states gained the "permanent exemption"
under the necessary provider designation. Congress closed the loophole in 2006,
but grandfathered in the hospitals.

“Without
that designation, Jordan said about 800 hospitals would not have met location
requirements in 2011 because they were too close to another hospital.”

The "necessary provider"
designation is withdrawn if two hospitals are within 15 miles of one another.
It is estimated that Medicare could save 1.3 million per year for every
hospital eliminated from the necessary provider program.  

The total cost savings from eliminating
these rural hospitals would be less
than the
amount of money all salaries of the CEOs and other healthcare executives of healthcare
insurance companies take from Medicare a year.

If there is a problem with rural
hospitals it is their inefficiency and waste. The inefficiency should be fixed.
If the government wanted to do something constructive it should help rural
hospitals fix the inefficiencies.

The
“necessary provider hospitals “never had to meet the distance requirements."


 Necessary provider hospitals get paid more
from Medicare than non- designated hospitals. As towns expand new hospitals are
build close to the older standing hospitals. 

Maybe having a rural hospital in a
small city will increase economic growth of the area? It attracts industry and
more jobs. Many communities need two rural hospitals.

Both hospitals receive necessary
provider status and increased payment.

 Alan Morgan, CEO of the National Rural Health
Association, blasted the report. He said the OIG report would kill rural health
and access to healthcare. The closing of 800 rural hospitals would also close
emergency services in local communities, eliminate rural health clinics, access
to mental healthcare and nursing home support.

Morgan said, OIG
viewed this with blinders on
, not looking at how healthcare is delivered in
rural America.

"It's
about access and this report is only about finances and not access. It is a spending and finance issue and we seem to
have forgotten the rationale for the creation of this program, which was an
access issue."

If the Obama administration is trying to help
seniors and the underprivileged it should study this decision more carefully. I
can only imagine the cost of the unintended consequences to all taxpayers.

I believe the Obama administration wants to
destroy the entire healthcare system and replace it with a single party payer
system.

It is time to go after the real excess cost
drivers in the healthcare system. It is a mistake to destroy the infrastructure.

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

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Some More Obamacare Deceptions

Stanley Feld M.D.,FACP, MACE

 Does anyone remember the CLASS Act as part of
the Obamacare promise for affordable healthcare coverage? I do. It sounded
great but I knew it couldn’t be done without tremendous cost to the federal
government.

It would drive deficit spending through
the roof.

The CLASS Act (Community Living
Assistance Services and Support) was shut down 19 months after passage of
Obamacare.

 There was little discussion
of the CLASS Act until Kathleen Sibelius’ announcement to discontinue
CLASS.  

 She said,

 The administration was shutting down CLASS. After 19 months of research and consultation, “we have not
identified a way to make Class work at this time.

The thing that bothers
me the most about Obamacare is the sneaky machinations the Obama administration
uses to hide the bad news about Obamacare from the American public. When the American
public finds out they are disappointed and feel deceived.

However, it also feels
so complicated that they tend to ignore it.

 When the Obama administrated delayed the
employer mandate for a year employers were relieved. None of the traditional
media made a big deal about delaying the employer mandate which meant that Obamacare was
in trouble.

 Some conservatives and conservative outlets
cried, “Why not delay the individual
mandate as well?”

The reason is obvious.
The Obama administration wants the entitlement to start whether it is ready or
not so it cannot be repealed or discontinued. People do not like to relinquish
a freebie.

As soon as that
discussion was over the government announced that the verification process for
subsidies might not be ready until October 1, 2013.

If the tests find security
problems in the verification systems, the information officer could delay the
marketplace opening or decide to open the insurance exchanges with
less-than-optimal assurances that users’ personal information is adequately
protected.

The Obama administration
then announced it would provide premium subsidies on an “honor system” so as
not to delay the onset of the individual mandate.

“The administration promises no one will lie
because once they get the verification process started they will be able to
find out who lied about the subsidies
.”

The Obama administration’s
navigators program is a program to train and pay people to go into the
community and sign up people to enroll in the Obamacare health insurance
exchange
.  

“More than 100 groups
will split $67 million to help people “navigate”
the new Obamacare health insurance
exchanges.”

These “navigators” will have to undergo mandatory federal
training and become certified.

The 67 million dollars is more money than the
administration initially
said would be available but short of what advocates
say will be needed to help people sign up”.


It sounds like another cash for clunkers program.


When are Republicans or
Conservatives going to say something to make the public aware of what is going on?

To add insult to injury
congress exempted itself from Obamacare because of economic hardships leaving
ordinary people to be subject to penalties if they do not join the health
insurance exchanges.

 The Obama administration has given over 2,000 group
waivers.

The Obama administration
and Harry Reid and Nancy Pelosi are working on the Unions’ problems with
Obamacare. One could bet that it will be fair to the Unions as the rest of us
are ignored.

 With all of the IRS’s problems of late it is
frightening to think of the IRS monitoring abuses of Obamacare.

The IRS employees union
is presently seeking a way to get a waiver from Obamacare.

And speaking of haunting, does anyone in this
country look forward to being scrutinized by the IRS on every aspect of his or
her personal health care decisions, especially after we learn of the
politicizing and privacy abuses by that agency?”

 Does anyone remember the 60 lawsuits the
Catholic Church initiated challenging President Obama’s contraception mandates?

The church claims the mandate to provide contraceptives represents an attack on
religious freedom and the first amendment.

Despite all this the
traditional media and President Obama keep saying Obamacare is right on
schedule.

We have heard nothing
about the extra costs Obamacare is generating for start-up and implementation. 

Last weekend Harry Reid let the cat out of the bag. President Obama real goal is to have Obamacare fail and replace it with a single party payer system.

  

Harry Ried and a single party payer

 http://youtu.be/SXgSKwYMnWo

The biggest political maneuver by President
Obama of all is the maneuver to delay the law’s caps on out of pocket expenses for consumers
such as for deductibles and co-pays.

This is perhaps the most
attractive benefit of Obamacare after guaranteed insurability.  

"Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group
health plan and a health insurance issuer offering group or individual health
insurance coverage may not establish lifetime limits on the dollar value of
benefits for the any participant or beneficiary.”

Annual limits on cost-sharing are
specified by Section 1302(c) of the Affordable Care Act; in addition, starting
in 2014, deductibles are limited to $2,000 per year for individual plans, and
$4,000 per year for family plans.

This is a wonderful
benefit. If someone gets sick he is only liable for $2,000 if single and $4,000
if he has a family.

The problem arises when the
healthcare insurance industry calculates the premium with this benefit included.
The insurance premiums skyrocket. Premiums are scheduled to dramatically
increase in 2014.

President Obama’s
problem is that 2014 is a congressional election year. Skyrocketing premiums in
2014 may make Obama fans and the Democratic base angry with President Obama and
the Democrats running for congress.  

President Obama having
gotten away with all his other delays in implementation simply delayed this
part of the law until after the election.

The American public
doesn’t realize that he has delayed perhaps the best benefit in the law from
the public’s viewpoint. His hope is the public will not notice the delay with
the help of the traditional media’s lack of coverage.

In 2015 he will sock the
increased premiums to the public. He will then blame it on the
Republicans. 

There are two basic
issues. The first is the need for the public to realize all these deceptions in
Obamacare.

The second one is the
public is beginning to realize that it cannot trust President Obama or congress
to represent its welfare.

It is time for
Republicans to stand up and put an end to this charade. I hope someone has the guts
to do it.

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

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A Review Of The Deception In Obamacare

Stanley
Feld M.D.,FACP, MACE

The goal to provide
affordable healthcare and access to care for all Americans is an admirable
goal.

Obamacare is making
Americans dependent on the government for their healthcare access and health
decisions. This is bad.  

President Obama is doing
this slowly but surely. The goal is to first destroy the present healthcare
system. The more he destroys, the more the stakeholders, healthcare insurance
industry, hospital systems, physicians, drug companies and patients game the
system

Americans are known to
be individualists. They cherish their freedoms. However, over the last 50 years
many entitlements have been introduced at the price of forfeiting many
freedoms.

Some entitlements have
been for consumer protection. Others have not.

Obamacare is about
government control and takeover of the healthcare system. President Obama
understands that he cannot force people to do what they do not want to do.

However they will do
anything when they have no choice. He is creating a no choice environment
slowly but surely. He is doing it with a bad law, lots of lies and
disinformation, and a golden tongue,

He changes and ignores
parts of the law he wrote to fit he needs by executive order, disrespects the
will of the people and congress and folds to pressures of lobbying from his
base. He marginalizes his enemies.

His changing the law
without the consent of congress is probably unconstitutional. However no
Republican has questioned his tactics.

He stays on the
offensive and keeps Republicans on the defensive. Republicans must have someone
who could parry his offenses and put him on the defense even though he has the
unequivocal support of the traditional media.

On Friday August 9th
was a perfect example of this offensive.

 The idea that you
would shut down the government unless you prevent 30 million people from
getting healthcare is a bad idea.
..

I'm assuming they will not take that path…I have
confidence that common sense, in the end, will prevail.

He explained his delay
of the employer mandate by saying going through congress would be the
"normal thing" to do "but
we're not in a normal atmosphere around here when it comes to
'Obamacare.'"

The president called efforts to defund and repeal Obamacare the
Republicans' "holy grail" and an "ideological fixation."

You have got to give it
to him. No one would ever think Obamacare is having so much trouble because it
is a lousy law, that is impossible to build out its structure, Impossible to
implement, impossible to execute and impossible to enforce.

The majority of the
country and majority of the stakeholders are against the bill. President Obama
just goes right ahead despite the will of the people.

Obamacare did not get
one single Republican vote. President Obama’s twist and turns have kept
Republicans in a reactive and defensive mode.

Every time Republicans
go on the offense they are blamed for the bad law’s (Obamacare’s) failure. They
do not answer back.

I believe the majority
of the people know what President Obama is about. They do not trust him. The
lack of trust renders him ineffective.

Someone needs to turn
the tables on him.

I also believe President
Obama is about to turn the tables on himself. His says he is all ears for a
good idea but Republicans have not presented him with one.

This is not true. The
problem is President Obama doesn’t listen.

The list of lies and
misrepresentations are enormous. These lies and misrepresentations have
resulted in the lack of trust.

 Below are some of the things promised that so
we should not forget.

 1. Imposing President Obama’s idea of
transformation by social engineering in which the majority of the population
does not agree with.   

 2. Imposing 21 hidden taxes that few knew
about before the bills passage. Few knew the effect of these taxes on small
business until after passage of Obamacare. These tax increases amount to
the biggest tax increase in our history.

This occurred after
President Obama pledged no new taxes for anyone making less than $250,000
dollars. All of these taxes are passed on to consumers.

3. The medical device
tax alone is a job-killing and innovation-stifling medical device tax.  33 Democrat senators are now opposed to this tax. He does not have the support of his
party on this tax.

4. Independent Payment
Advisory Board (the IPAB) is going to ration healthcare. Sarah Palin called it aka death
panels. Howard Dean, recently termed it a "health care rationing body" that
Congress should be "getting rid of." The Obama administration insists
there is not going to be rationing of care.

5. The original CBO
cost estimate was a reduction in healthcare costs in 10 years. The
CBO used six years of costs and ten years of taxes. The next estimate using
rigged numbers given to the CBO by the Obama administration was less than $1
trillion.

The ten-year CBO cost
estimate has now reached $2.6 trillion. We have not heard from the Obama
administration about this new estimate.

6. Health
insurance premiums are soaring despite President Obama’s recent statements that
healthcare premiums are falling. All employer and employees will say President
Obama is wrong.

Four years ago President
Obama promised the public that, “Obamacare
would 
reduce a "typical family's premium by up
to $2,500 a year."

 7. We will all recall these famous lines, “If you like your doctor, you
will be able to keep your doctor. Period.”

  If you like your healthcares plan, you will be able to
keep your health care plan. Period.

  “No one will take it
away. No matter what.”

No statement is more
dramatic but false.

8. Obamacare is making an already serious shortage of doctors worse. Many physicians are opting out of Obamacare, Medicare and Medicaid.

To make thing worse
patients will have to pay physicians directly. The Obama administration
published a new rule for seniors. CMS will not reimburse patients the 70% of
their out of pocket expenses for physicians that do not accept Medicare or
Medicaid.

The result will be an
increased out of pocket burden for all patients, rich and poor.

9. Many employers
are likely to drop health coverage. There has been widespread reduction of work hours to avoid paying an Obamacare
mandated penalty to provide employee health insurance.

 Obamacare has created a burden on economic
growth. It has resulted in the creation of "seven times more part-time jobs"
than full-time jobs. It has decreased the living wage for millions of Americans
and created millions more uninsured patients.

These part time workers
will be forced to buy insurance through the health insurance exchanges. This
will balloon the federal deficit even further.

10. The states have been
given the option to participate in health insurance exchanges and expanding
Medicare and Medicaid. Thirty three states have refused to participate. They
know they cannot afford to increase their states’ budget deficit.

11. The healthcare
insurance industry thought it would make a killing by insuring people through
the health insurance exchanges. In Medicare and Medicaid they bill the
government for doing the administrative services. President Obama has changed
the promised health insurance rules. Several insurers are leaving all of the states. More are to follow.

12. Recent surveys show that 63 percent of voters think the law
needs to be changed, and a 57-percent majority feeling that implementation is
"a joke."

This is happening despite
the traditional media helping President Obama’s political campaign to promote
Obamacare.

These are just a few of
the reasons for the mistrust of the administration.

Next will be a summary
of President Obama’s probable unconstitutional delays in the law without
congressional permission.

Max Baucus was
corrected. Obamacare is an expensive train wreck.

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

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Another Friday Afternoon 3 P.M. Press Release

Stanley Feld M.D.,FACP, MACE

It seems
that all official Obama administration reports that portend bad news for the
administration’s policy are released late Friday afternoon when everyone is
heading home for the weekend.

It is a
time when the news of the reports and press releases are least noticed.

The late
Friday afternoon report on August 2, 2013 was released the afternoon congress
was going on summer recess for the month of August.

The HHS Inspector General announced that Obamacare’s privacy protections program
is way behind schedule. It will not be ready by October 1st when
policies will be available to the public. It opens the door for rampant
violations of the law.  

'Based on OIG’s analysis, Obamacare’s exchanges
may end up illegally exposing Americans’ private records to hackers and
criminals."

The Privacy Act of 1974
mandates that each agency of the federal government utilize administrative and
physical security systems to prevent the unauthorized release of personal
records.

The Federal Information
Security Management Act of 2002 requires the executive branch to ensure that
Americans’ private records are protected from misuse and security breaches.

The Obama administration is
ignoring these laws. On his road show this week he said the health insurance
exchanges will start selling insurance on October 1,2013 to go into effect
January 1, 2014.

“In the
case of the Obamacare hub, any serious security breach could result in
identity theft.”

The Obamacare “Hub”
computer system cost the government $267 million so far.
  It is
supposed to provide the government with the means to see which applicants
qualify for what programs.

On another Friday afternoon during the July 4th weekend,” Sarah Kliff and Sandhya Somashekhar of
the Washington Post discovered that the Obama administration had
buried in the Federal Register the
announcement that the government won’t be able to verify whether or not
applicants for Obamacare’s insurance exchange subsidies are actually qualified
for the aid
, in the 16 states that are setting up their own exchanges."

 "Instead,
until at least 2015, these states will be able to “accept the applicant’s
attestation [regarding eligibility] without further verification.”
 

This appeared in the Federal
Register two days after the July 3rd announcement that the federal
government would postpone for one year a requirement that employers with 50 or
more full-time workers provide health coverage.

I think these announcements
warrant the term ”Weekend Surprises
or DBA “I hope no one notices.”

“The Obamacare health insurance exchanges
mandate the creation of a “data hub” through which exchanges can access
personal records from seven different agencies—the Internal Revenue Service,
the Social Security Administration, the Department of Homeland Security, the
Veterans Health Administration, the Department of Defense, the Office of
Personnel Management, and the Peace Corps—in order to determine eligibility for
exchange subsidies and mandate penalties.”

Under FISMA, the Obama administration must
adhere to the guidelines of the National Institute of Standards and Technology
in achieving these safeguards, before the Obamacare exchanges can legally
operate.

 It seems it is much more convenient to ignore the law
written by the Obama administration and Democrats. Unfortunately, Republicans
have not pointed this out to the people.

It gets worse. This policy
not only ignores the law of the land it encourages fraud and abuse.

 According to the law, a person or family is
not eligible for Obamacare’s subsidies if your employer has offered you what
the government considers “affordable” coverage.

Employers are not going
to have to report whether or not they’ve offered “affordable” coverage. How can
the government verify whether or not workers are eligible for subsidies? 

 The Centers for Medicare
and Medicaid Services said. “The exchange may accept the applicant’s
attestation regarding enrollment in an eligible employer-sponsored plan…without
further verification, instead of following the procedure in
§155.320(d)(3)(iii).”

The Obama administration
will also allow people to gain means-tested subsidized coverage on the
exchanges without having to have the IRS do means testing on their income.

According to CMS,

 “For income verification, for the first year of operations, we are
providing Exchanges with temporarily expanded discretion to accept an
attestation of projected annual household income without further verification.”

 Another President Obama
trick.
If enough people enroll in the new entitlement it will be politically
impossible for Republicans to repeal Obamacare in the future.

These ad-lib rules
deliberately encourage tens of billions of dollars of waste, fraud, and abuse.  

Who is going to suffer
in the long run? Hard-working taxpayers. These taxpayers will not receive
subsidies. Many of them do not support Obamacare.

Where is the Republican
outrage?

President Obama
anticipated the Republican outrage this week on his political road show.

President Obama blamed Republicans for doing
everything in their power to torpedo Obamacare implementation
during a Friday afternoon “press conference” before going on his $7.6 million
dollar a week vacation on Martha’s Vineyard.

 “The “one unifying principle” for Republicans
was keeping 30 million people from getting healthcare, hurting the elderly,
removing care for the ill.

“There’s not a
pretense how they’re going to replace it with something better,” Obama said. He
accused Republicans of an “ideological fixation.” He then compared the
Obamacare rollout glitches to glitches in Apple rolling out a new iPad. “I make
no apologies” for such glitches, he state
d.

Then he said it
would be foolish for Republicans to “shut down the government to prevent 30
million people from getting healthcare.”

Notice President Obama's use of words.

Pure unadulterated well crafted demagoguery.

When are the Republicans’ going to respond? When are the
people going to recognize President Obama’s game.

Hopefully not before it is too late.

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

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Maybe Obamacare Is Not Such A Good Idea

Stanley
Feld M.D.,FACP ,MACE

Dear
President Obama;

Maybe Obamacare
is not such a good idea.

I suspect
you will not read this nor have you read my letters to you when you were first
elected.

The letters
were about how our healthcare system became so dysfunctional and what solutions, that will work,
are needed to repair the healthcare system.

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president–elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Respectfully,

Stanley Feld M.D., FACP, MACE

President Obama did not listen to me at all. It looks like his
agenda was not to "Repair the Healthcare System." It was to destroy it and
replace it with a government control single party payer system.

I continually think about the statement President Obama made to
Barney Frank and John Kerry when passing the law. They said the law must have a
public option and a single party payer to work.

President Obama told them not to worry about the public option.

Now Obamacare is experiencing objections from the interest
groups whose support is needed.

The unions, government workers in congress, the IRS, the healthcare
insurance industry, small businesses, large corporations, large fast food
businesses, privately insured Americans, Medicare insured seniors, physicians, hospital
systems all have objections to the law now.


Many states realized they would get stuck with the bill for the
health insurance exchange. Thirty-three states did not want to participate.
Many did not want to increase their budget deficits.   

All these stakeholders are realizing that President Obama has thrown
them under the bus despite his initial promises.

Obamacare does not serve the vested interests of any of these
stakeholders. 

Some of the stakeholders are going to get special treatment with
waivers.

For Obamacare to work, everyone must participate. The mandate was
included in the law to force everyone to participate.

The Supreme Court called it a tax to allow the Obamacare law to be
constitutional.

A basic insurance principle is that everyone must participate to spread
the risk for the insurance industry.

The present system and Obamacare exempts the insurance companies from incurring risk.
It also exempts patients from being responsible for their own health and
healthcare dollars. When Americans spend their own money the free market works as
we have seen in many industries. They support the best product within their
means.

The government could support the underprivileged by providing them with
their healthcare dollars and teaching them how to use them.

The biggest villains in the healthcare system are the healthcare
insurance companies. They take 40% of every healthcare dollar spent by private
and public insurers off the top.

The healthcare insurance industry is the administrative service
provider for all public employees, public healthcare entitilments and private health insurance plans. The 40% overhead is charged
to all. The charge is not transparent.

Obamacare sets the conditions for continued abuse by the healthcare
insurance industry.

The Obama Administration estimates that
of the projected 7 million exchange enrollees next year, 2.7 million need to be young adults (with a low
risk of being sick) to make the premiums work.

 If young people don’t show up for Obamacare,
premiums for everyone else in the exchanges will skyrocket—which, of course,
dramatically increases the cost for taxpayers.

Congress
and congressional government workers wanted to be exempt from Obamacare because

 “The 2010 law
generally requires lawmakers and aides who work in their personal offices to
get coverage through the exchanges.”


That implies that they would no longer receive
coverage through the Federal Employees Health Benefits Program…

It does not clearly
authorize the government to pay premiums for federal employees who obtain
insurance through the exchanges.


Nor does it
authorize the government to reimburse federal employees who buy health
insurance on their own.”

Congress and their aides have
the best insurance coverage in the nation. Taxpayers subsidize their healthcare
insurance.

Through the years this
subsidy has been discussed.  Many have objected
to the cost of this Congressional benefit.

Congress has
objected to Obamacare changing the healthcare insurance they have enjoyed. Congress wants to be exempt from Obamacare.

President
Barack Obama privately told Democratic senators he is now personally involved
in resolving
a heated dispute over how Obamacare treats Capitol Hill aides and
lawmakers, according to senators in the meeting.”

Few on Capital Hill objected to President Obama changing the
rules of the law himself to protect their benefit.

A question should be asked, “Why should Congress and
congressional aides be treated differently than the general population?”

“At issue is whether
Obama’s health care law allows the federal government to continue to pay part
of the health insurance premiums for members of Congress and thousands of Hill
aides when they are nudged onto health exchanges.”


Currently, the government
pays nearly 75 percent of these premiums.

 The government’s contributions are in jeopardy
due to a controversial Republican amendment to Obamacare, which
says that by 2014, lawmakers and their staff must be covered by plans “created”
by the law or “offered through an exchange.”

President Obama declared,
“I'm on it”
to clear up Capital Hill’s objections to Obamacare’s effect on
Capital Hill’s healthcare insurance.

The IRS employees also want to be exempt from Obamacare.

IRS
chief Danny Werfel, the head of the agency charged with administering Obamacare
said that he would rather keep his own insurance than get coverage under the
system created by President Barack Obama's single domestic policy
achievement. 

Danny Werfel made this statement before the
House Ways and Means Committee,

"I would prefer to stay with the current policy that I'm
pleased with rather than go through a change if I don't need to go through that
change."

Like
most
other federal workers, IRS employees currently get their health insurance
through the Federal Employees Health Benefits Program, which also covers
members of Congress.

House Ways and Means Committee Chairman Dave Camp said he has long
believed, every American ought to be exempt from
the law, which is why he supports full repeal,”

IRS employees have the
responsibility to enforce much of the health insurance law
,
especially in terms of collecting the taxes and distributing subsidies that finance
the whole system.

IRS agents, in addition to
collecting taxes will also collect data and apply penalties for those who fail
to comply with many of Obamacare’s requirements.

The special favors are coming
next. The Obama administration will only create more dysfunction in the
healthcare system. President Obama’s published goals are good. However, the law
is bad and its execution is worse.

Maybe he ought to consider
my Ideal Medical Savings Accounts as a free market solution to our healthcare
system’s problems.

If you do
not like what is going on, please write your senator, congressman and the
President and tell them that,

“Maybe Obamacare Is Not Such A Good
Idea.”

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

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Physicians Opting Out Of Medicare And Obamacare

Stanley Feld M.D.,FACP,MACE

I have discussed the disillusionment of Obamacare by several
major stakeholders, hospital systems, insurance companies, union leaders and
large corporations in my last three blog posts.

As Obamacare gets more complicated physicians are opting out of Medicare and will
not participate in Obamacare.

All most physicians want is to practice the best medicine they can
using their intellectual property or surgical skills.

Physicians are people who want to help people. They are not street
crooks.

Obamacare is trying to commoditize medical care, decrease physician
value and reimbursement.

Commoditization of medical care will decrease physicians’ freedom to
exercise their medical judgment. Medical decision-making will be in the hands
of distant involved bureaucrats. Access to care will be determined by
bureaucratic rules and not the patients and their physicians.

 Physicians are opting out of Medicare, Medicaid and
Obamacare.  They have become totally frustrated
with Medicare and Medicaid reimbursement rates and the mounting rules and
regulations.

Marilyn B. Tavenner R.N., the
administrator of the Centers for Medicare and Medicaid Services told congress
that an insignificant number of physicians have dropped out of Medicare and
Medicaid.
This is clearly not true.

A
CMS report said 9,539 physicians who had accepted Medicare in the past opted
out of the program in 2012, up from 3,700 in 2009. That compares with 685,000
doctors who were enrolled as participating physicians in Medicare last year,
according to CMS, which has never released annual opt-out figures before.


The number of physicians opting out of Medicare last year
nearly tripled from three years earlier, according to the Centers for Medicare
and Medicaid Services.

This is not an insignificant number of physicians when
America is experiencing a shortage of primary care physicians.

A study in the
journal Health Affairs this month found that 33% of primary-care physicians
didn't accept new Medicaid patients in 2010-2011,”
even though they continue to participate
in Medicare.

Some physicians are limiting the number of Medicare patients
they treat even if they don't formally opt out of the system.

The reason is Medicare reimbursement is so low and getting
lower. It some cases reimbursement is lower that the cost to deliver the care.

 A study found that 4%
of family physicians are now in cash-only or concierge practices.

 The Obama administration issued an
executive order this year where Medicare would not reimburse anything to
patients paying cash to non-participating physicians.

This is putting an increased burden on Medicare patients.

All told, health experts say the number of doctors going
"off-grid" isn't enough to undermine the Affordable Care Act.”

The Obama administration’s bureaucrats are not facing
reality. Today, before the expansion of Medicaid it is difficult for Medicare
and Medicaid patients to find a physician.

Joe Baker,
president of the Medicare Rights Center, said his patient-advocacy group has
had an increase in calls from seniors who can't find doctors willing to treat
them.

Many physicians will not accept Medicaid patients. CMS
administrators want the public to believe this is not true. They say the number
of physicians not taking Medicaid is insignificant.

Medicaid physicians have to see as many as 200 patients or
more a day to make a living.  There are
not enough minutes in a day to see that many patients and have a quality care visit.
These physicians have employees who are seeing patients for them. These
physicians then sign off as seeing the patient.

This volume then triggers a probe on their practices and
accusations of fraud. As Medicaid gets expanded through Obamacare to cover the
uninsured, there will be even fewer and fewer Medicaid physicians and a greater
physician shortage.

Medicaid physicians are not interested nor can they take the
government abuse.

Employers are cutting back on hiring full time employees and
hiring part time employees to avoid the rising insurance costs.

Marilyn B. Tavenner, the administrator of the
Centers for Medicare and Medicaid Services,
told Congress that she
had heard of only “isolated incidents” in which employers tried to cut back
hours. Representative Steve Scalise, Republican of Louisiana, told her that she
must be “living in some cocoon” because he heard of such actions almost every
day.

Every large corporation is converting as many
full time workers to part-time workers as possible because of Obamacare in
order to avoid the Obamacare mandate. Part-time workers have felt the
disastrous impact on wealth production and economic activity.

These are the revised statistics from the Bureau
of Labor Statistics for May and June.

The establishment
survey showed a gain of 162,000 jobs.

The previous two months were revised
lower. The employment change for May revised down by 19,000 (from +195,000 to
+176,000), and the employment change for June revised down by 7,000 (from
+195,000 to +188,000).

The unemployment rate dropped 0.2 to 7.4%. 

Explaining
the Unemployment Rate Drop

  • Employment
    rose by 227,000 of which 103,000 were part-time jobs. 
  • The Civilian Labor
    Force Declined by 37,000 even though population rose by 204,000.
  • Those "Not in
    Labor Force" rose by 240,000.
  • Participation Rate
    fell 0.1 to 63.4%, a mere 0.1 higher than the low of 63.3% dating back to 1979.

July BLS Jobs
Statistics at a Glance

 

  • Payrolls
    +162,000 – Establishment Survey
  • US Employment +227,000
    – Household Survey
  • US Unemployment
    -263,000 – Household Survey
  • Involuntary Part-Time Work +19,000 –
    Household Survey
  • Voluntary Part-Time Work +84,000 –
    Household Survey
  • Baseline Unemployment
    Rate -0.2 – Household Survey
  • U-6 unemployment -0.3
    to 14.0% – Household Survey
  • Civilian Labor Force
    -37,000 – Household Survey
  • Not in Labor Force
    -240,000 – Household Survey
  • Participation Rate
    -0.1 at 63.4 – Household Survey

Read more at http://globaleconomicanalysis.blogspot.com/2013/08/establishment-survey-162k-jobs-may-and.html#llfksKs7fC6lhCcU.99

 Marilyn B. Tavenner making the above statement to congress
makes her a liar or a person not in touch with reality. Have can the American
people entrust our healthcare decisions to these bureaucrats?

The Obama administration needs both the primary and
secondary stakeholders’ cooperation if Obamacare has the slightest chance of
succeeding.

I do not think Obamacare can survive. It will sink under its
own weight as it tries to control all of the stakeholders through oppressive
regulations without regard for their vested interests.

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

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More Government Control

Stanley Feld M.D., FACP, MACE

I have covered the discovery of the
tricks Obamacare has played on hospital systems, insurance companies, union
leaders and large corporations in the last three blogs.

The Obama administration needs all three
groups to cooperate if Obamacare has the slightest chance of success.

Physicians are now starting to react to
Obamacare and its restrictive regulations.

It is clear to me that the Obama
administration has no respect for physicians, their intellectual property,
their surgical skills, their honesty or their character. 

The Obama administration has labeled
physicians as commodities and thieves. Obamacare devalues physicians and figures
whatever reimbursement it offers physicians will accept.

Ezekiel Emanuel M.D., Obamacare policy advisor, expresses a vivid example of this disrespect in
his recent article in the New York Times entitled “Don’t Give Up On Healthcare
Costs.”
 

Dr. Emanuel discusses S.G.R., or the Sustainable Growth Rate
formula. 

The formula is seriously flawed in its attempt to contain rising
healthcare costs. 

The formula is rigged to penalize physicians
yearly for their reimbursement for treating Medicare patients. Every year
Congress waives the penalty for that year. This waiver is commonly known as the
“doc fix.”

The yearly penalty has been accumulating since 2002
so this next year it is scheduled to reduce physician payment by 24.5%.

Neither the AMA nor the traditional media
has articulated the meaning of the S.G.R to the public in a comprehensible way.

The S.G.R provides no incentive for individual
doctors to be more efficient since the target level applies to total nationwide
physician costs.

The cuts from the formula are indiscriminate. The
cuts would affect high quality, cost-effective doctors the same as it would
inefficient free spending physicians. It would also affect underpaid primary
care physicians.

The goal should be to incentivize all physicians to
be efficient and cost effective providers in their treatment and patient recommendations.

Ezekiel Emanual’s disrespect shines through when he
says,

Physicians
desperately want the S.G.R. repealed and replaced
so they can charge what they
want without the potential of massive cuts hanging over them each year.”

Congress agrees with physicians that S.G.R. is seriously flawed. The House Energy and
Commerce Committee is starting to mark up the repeal of the S.R.G formula. It
is going to replace it with a 0.5% yearly increase in physician reimbursement
until 2018. In 2019 the government will link Medicare payment to the quality of
care each physician provides.

The measurement of physician performance will be
measured, by big data provided by the Enhanced Quality Reporting System. The
EHQRS is being developed using the ICM-10 coding system. ICM-10 uses 68,000 codes
vs. 18,000 codes in ICM-9.

Ezekiel Emanual M.D. doesn’t like this
formula. It does not provide incentives for physicians to accept bundle reimbursement
for the treatment of their patients.

Dr. Emanual believes  

fee-for-service
payment incentivizes quantity over quality. Physicians make more money by
ordering more tests, seeing patients more frequently in follow-ups and
providing more treatments. The payment system is a key accelerator driving up
Medicare costs — and therefore the federal government’s deficit”.

Dr. Emanual does not trust physicians to
do the best job possible. He also ignores the defensive medicine issue. He
believes,

“In 2009, the
Congressional Budget Office did a comprehensive assessment of the potential
cost savings from medical malpractice reforms
.

Its conclusions: A
package that included a $250,000 cap on noneconomic damages, a $500,000 cap on
punitive damages and a one-year statute of limitations for claims by adults
would save about $11 billion a year
40
percent from reduced malpractice premiums and the rest in the form of fewer
defensive procedures like M.R.I.’s.

 Dr.
Emanuel concluded that $11 billion
dollars a year savings is insignificant because it is a cost saving below $26
billion dollars a year
.
He contends tort reform is a distraction from real
efforts to control healthcare costs and should be ignored. The CBO
scoring information has lead Dr. Emanuel to an inaccurate opinion.

Douglas W. Elmendorf’s,
head of CBO
at the time, conclusion was not nearly as definitive as Dr. Emanuel’s
conclusion.

The malpractice issue of defensive
medicine and over testing is real. The Massachusetts Medical Society survey of
defensive medicine is real. Most physicians in Massachusetts are
liberal/progressive and so the sample is not biased toward conservatives.

The
truth is a full accounting reveals that more than 10 percent of America's
health expenditures per year are spend on tort liability and defensive
medicine.

The
percentage of healthcare costs is even greater when the Massachusetts
Medical Society survey
is taken into account. The amount spent for
defensive medicine can be extrapolated to actual costs from this survey.  

I have
written a series of blogs analyzing the impact Massachusetts Medical Society’s
survey. The extrapolated costs turn out to be about $700 billion dollars a
year. The real cost of defensive medicine is somewhere between $242 and $700
billion dollars a year.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

 In
2008 damage awards alone for medical malpractice claims reached $5.9 billion
dollars.
  The total of medical tort costs was $16 billion for legal
costs, underwriting costs and administrative expenses. From 1986 the average
jury award was $100,000. In 2006 the average award increased to $637,000. No
one knows what the award value is for cases settled out of court.

Each
year, 25% of practicing physicians are sued. 90% of physician sued are found
innocent. The average defense cost is $100,000. This cost is not included in
the CBO scoring

The
fear of lawsuits causes most doctors to practice "defensive medicine"
as the interviews of Massachusetts physicians points out.  The result is
unnecessary testing, referrals, and procedures to protect themselves from
allegations of medical negligence.  

A
recent survey of doctors published in the Journal of the American Medical
Association found that 93% of physicians admit to practicing defensive
medicine. A 2008 survey by the Massachusetts Medical Society found that about
25 % of medical procedures are defensive in nature.

This
waste results in increased healthcare insurance premiums. The premium increases
result in an increase of at least 3 million uninsured people per year. When
these uninsured people get sick they avoid going to a physician. This results
in a decrease in work productivity. It is estimated that the annual decrease in
productivity is more than $40 billion dollars a year.

In
states where tort reform has been instituted by placing caps on so-called
non-economic damages, the malpractice costs have decreased 39%. This drop in
costs is a result of decreased malpractice suits. The decrease is economically
bad for the plaintiff attorneys. Annual malpractice premiums have gone down at
least 13%. In fact, the medical malpractice business for plaintiff attorneys
has about dried up in Texas.

Dr. Emanuel and the
administration want to connect the leverage they have with the SGR formula to
getting physicians to accept a bundled rate for treating a patient.

Dr. Emanuel “would tie an
S.G.R. repeal to a slow reduction in fee-for-service payments to those
physicians who do not switch to bundled payments and other payment models.”

In other words, accept risk
for treatment that an insurance company would normally accept risk for while
ignoring the malpractice implications of missing a diagnosis or not seeing a
patient at appropriate intervals.

Isn’t the government going
to test physician’s treatment with 88,000 codes in ICM -10 and the Enhanced
Quality Reporting System?

Isn’t the government going
to force the decisions of the Independent Physician Advisory Board on
physicians?

Now the government wants to
force physicians to accept the potential liability for not using their medical
judgment.

This is not aligning physician
incentives with efficient treatment cost. It is dictating medical treatment to
physicians.

This is putting physicians
well on the Road to Serfdom.

Physicians are getting
tired of all of this. They are about to quit treating Medicare patients.

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

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The Healthcare Insurance Industry Abandons Selling The Individual Insurance Policies In Health Insurance Exchanges

   
Stanley Feld M.D.,FACP,MACE

 

 
 

http://youtu.be/Kyv8ZRkXnfU?t=58s

President Obama is on the campaign trail. He is selling the
virtues of Obamacare to the young uninsured.

He wants the healthy young to buy the health insurance exchange
insurance policies in order to pay for the sick. He wants to prevent
Obamacare’s failure.

His speeches are political. They have little substance and are
loaded with disinformation and hyperbole.

The campaign is a political ploy to blame the Republican Party
for Obamacare’s impending failure.

Last week Harry Reid said he has to increase taxes by another
trillion dollars. This increase will make the economy worse, not better.

When is the public going to learn that socialism doesn’t work?
Taxing and spending does not improve economic growth. Socialism and increased
taxes stifle innovation and productivity.

I think it is time for a
couple of Ayn Rand’s truisms as they apply to Obamacare. Men pursue their
vested interests. They resist being forced to follow orders that contradict
their vested interests. The key in any system success is to align all the
stakeholders’ vested interests. Obamacare does not achieve this goal.

“It only
stands to reason that where there's sacrifice, there's someone collecting the
sacrificial offerings.”

Where
there's service, there is someone being served. The man who speaks to you of
sacrifice is speaking of slaves and masters, and intends to be the master.

Ayn
Rand

America is going through a period of
time where it is evident that something is wrong.  Americans and the traditional media are keeping
our eyes wide closed.

The hardest thing to
explain is the glaringly evident which everybody had decided not to see.

Ayn Rand

Peggy Noonan said it in a paragraph
in this weekend's blog.

"One irony here
is that the Obama White House, always keen to increase the reach and power of
government, also seems profoundly disinterested in good governing
. It is
strange. The long-term project of liberalism involves encouraging the idea of
faith in government as a bringer or guarantor of greater justice. But who needs
more government if government works so very badly, and is in its operations
unjust?"

"This White
House is careless with the reputation of government. They are a campaigning
organization, not a governing one."

Ayn
Rand goes on to say,

 “You
can avoid reality, but you cannot avoid the consequences of avoiding reality.”


Ayn
Rand

 A problem occurs when
constituents finally realize government is not defending its vested interests.
Change is demanded.

Americans are finally
waking up.  

We have seen this phenomenon
in my last two articles when I wrote that unions and hospitals finally realized
that Obamacare does not serve their vested interests.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/07/obamacares-games-for-stakeholders-and-the-unintended-consequences.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/07/hospital-systems-are-finally-realizing-there-are-problems-with-obamacare.html

This is also the reason
Aetna decided to not sell healthcare insurance policies in the California’s
health insurance exchange.

 

 “Aetna Inc.  will stop selling
health insurance to individual consumers in California at the end of the year,
withdrawing as the federal health law is expected to reshape the market in
2014.”

Aetna did not comment on
the reasons it is dropping out of the individual market in California.

“A company spokeswoman declined
to comment about the reasons for Aetna's individual-business withdrawal.”

The dominos are starting
to fall as more healthcare insurers realize what is going on.

“Aetna isn't one of the 13
insurers participating in the California state's new consumer insurance
marketplace set to launch this fall under the federal law.”

“Like several other major
national carriers, it has said it would join only a limited number of these
exchanges. A carrier can still offer consumer plans without being in the
exchange.”

President Obama and other supporters argue that the health
insurance exchange is a success because it is encouraging competition and
pushing down prices. It is not true.

 “Insurance-industry experts say
similar moves by other carriers in other states may emerge
in coming months, as
companies with limited market share decide to avoid the uncertainty tied to the
law's changes.”

The Obama administration’s concept of competition and price
reduction is tenuous. President Obama and other CMS official keep saying that
healthcare insurance prices will decrease.

The healthcare insurance industry originally calculated it would
make a killing by selling insurance through the healthcare insurance exchanges.

As the rules and regulations for health insurance exchanges are
slowly rolled out by the administration is it clear to the health insurance
industry they could get killed by selling insurance in the health insurance
exchanges.

The addition of a 3.5% tax on each policy sold is enough for the
insurance industry to realize the health insurance exchanges will cause them to
lose money.

These surprises do not serve the vested interests of the
healthcare insurance industry.

The Obama administration keeps announcing that health insurance
exchanges are decreasing healthcare premiums.

The public and businesses are experiencing double-digit
increases in healthcare insurance premiums since Obamacare was passed.

 The reason is clear. The increases are the result of all the additional
benefits President Obama brags about in his public relations campaign.

Obamacare contains community ratings for pre existing illness
and parental insurance for young adults under twenty-six.

These are important policies. The problem is it leads to an
increase in premiums for everyone.

Healthcare premiums have already increased 20- 30% since the
passage of Obamacare. BlueCross Blue Shield of Tennessee just announced,

 BlueCross BlueShield of Tennessee expects a 20 to 30 percent
increase in rates in the individual market starting next year and a 10 percent
increase in the small group market.”


“BlueCross BlueShield exec warns of
health care cost ‘explosion.’
 

A healthcare Insurance CE0 told a business group at the Nashville Area Chamber
of Commerce
that health care reform will cause “a lot of disruption in the
marketplace.”

The premium hikes will
be needed to offset new taxes
 on insurance payers such as his, he said.

We are getting
ready to have a health care cost explosion
,”  

“Details on the plans being offered on the exchanges, including
affordability, aren't yet known, but 
John
Maki
, vice president of regional sales at BlueCross
BlueShield of Tennessee
, said the company is looking at
offering traditional PPO plans, HSA-compatible plans and several other
"unique plan designs."

Only two commercial carriers have
applied to sell health insurance on Tennessee's new federally run insurance
exchange. They do not know if their submissions will be accepted. The deadline
for submission by other companies has passed.

Meanwhile, a New York Times editorial is conditioning Obamacare
fans as to who is to blame for the failure of the health insurance exchanges
. The
Times is putting the blame squarely on the shoulders of the Republican Party.

“To their shame and discredit, Republicans are trying to block
efforts to inform people
about the law and are using scare tactics to keep them
from enrolling.”

This is a typical Obama
administration tactic to blame the other guy for the impending failure of its
policy.

Obamacare is failing under
its own weight and the administration’s inability to implement the law.

The New York Times goes on,

The Republican mantra is that the nation will face economic and
medical catastrophe
— a “train wreck,” they say — unless health care reform is
stopped in its tracks.”

Obamacare is a train wreck. Max
Baucus Senator Democrat from Montana and author of Obamacare and head of the
finance committee said it.

Top officials in Ohio
and Indiana who oppose the law have issued dire, misleading forecasts
— roundly
debunked by analysts — that the law will raise premiums to astronomical levels.”

“roundly debunked by analysts”  This is not true. The Obama
administration’s analysis is biased and selective. By stating the analysis as a
fact the New York Times’ editorial board is expressing their bias without facts.

The New
York Times is once again acting as a shill for the Obama administration.  The New York Times is misleading the public.

Obamacare
is a bad law. It does not align any of the stakeholders’ vested interests. All the stakeholders are starting to realize it.

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

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Permalink:

Hospital Systems Are Finally Realizing There Are Problems With Obamacare

Stanley Feld M.D.,FACP, MACE

Hospital systems loved the prospect
of Obamacare. Physicians would be forced into full time salaried hospital
system positions. Hospital systems would own physicians’ intellectual property
and surgical skills.

Physicians would be the hospital
systems’ cash cow. Its brick and mortar model was failing. Surgery and recovery
from surgery was improving. Length of hospital stays was decreasing.

The problem hospital systems were
discovering was that physicians were not as productive when salaried as they
were when they owned their own practices.

Surgery was being performed as
outpatient surgery in freestanding surgery centers. Physicians own most of
these surgery centers independent of hospital systems.

The advantage of these outpatient
surgery centers to patients is they are cheaper, price transparent and have
comparable outcomes.


The healthcare insurance industry has
even encouraged their use. The Obama administration doesn’t like them because they
encourage patient choice and independence.
This is the opposite of Obamacare's goal of government dependence and control of patient choice.

Hospital systems thought Obamacare
would provide millions of newly insured patients. This would translate to
higher profits for the hospital systems.

Obamacare’s supposed
goal was
improving access to care for low-income families and individuals. Hospital systems were led to believe that they would treat more
patients with health insurance through expanded Medicaid eligibility.

With the
introduction of health insurance exchanges, low-income individuals would be
able to purchase healthcare insurance coverage at a subsidized rate.

The subsidy would
come in the form of a tax credit. Hospital systems did not realize that low-income
families do not pay taxes so they would not pay any tax to apply a tax credit.
These families making up to $38,000 dollars a year could not afford the lowest
insurance of $12,000 dollars a year. They would opt to not buy the health
insurance exchange offerings.

The health
insurance exchanges would not reduce the amount of uncompensated care provided
by the nation's hospitals.

Suddenly hospital
systems realized that their hospital consultants were wrong.  While it sounded good on paper, many hospital
finance administrators are terrified that Obamacare will result in a hospital
system taking great losses as a result of decreased reimbursement and a
decrease in the promised insured population.

Tim
Nguyen, corporate controller at Palomar Health, a San Diego–based system with
690 licensed acute care hospital beds and $2.5 billion in gross annual revenue
,
says there is a catch-22 built into the healthcare legislation that will
ultimately hurt hospital systems.”

 There is another catch to Obamacare. I cannot
tell if this was an unintended consequence or purposeful deception by the Obama
administration.  The exchanges will have
different tiers with different deductibles and copays.

California's
health exchanges will have four tiers when the program goes live in January
2014, Nguyen explains: platinum (where the patient pays 10% of total healthcare
expenses); gold (20%); silver (30%); and bronze (40%).”

"These
patients will still be responsible to pay
, and they probably don't make that
much money and are likely to choose the silver or bronze tier to keep the
premiums low. … That will increase our bad debt even though they have
insurance."

The low- income
families will believe they have good insurance coverage. If they get sick they
will be responsible for the high deductibles and co-pays.

If they choose to buy
the insurance they will use the hospital facilities without realizing that the
insurance does not cover everything.

 After hospitalization
they will be hit with a bill they cannot afford. The hospital system will
pursue payment but will not be able to collect. The hospital will have to write
it off.

 There is total
uncertainty about the rules. However, before a hospital system should accept
the program they should know the rules. Their participation can ruin them financially.

Marlene Zurack is senior vice president of
finance and chief financial officer for New York City Health and Hospitals
Corporation (HCC). HCC is a municipal integrated healthcare delivery system
with $7.1 billion in total operating revenue when combined with HHC's MetroPlus
health plan.

HCC cares for indigent and low-income
patients. It is subsidized by the Medicaid's Disproportionate Share Hospital
program.


She is doubtful that the insurance exchanges
will result in a net benefit to her organization. She insures 1.4 million
people. The systems treat 475,000 uninsured patients. She has two problems with
the health insurance exchanges.

She does not know how many of the uninsured
will get insurance, what level of insurance will they buy and how much of a
difference the insurance payment is from the Medicaid's Disproportionate Share
Hospital program.

“HHC
is likely to lose revenue in the end
, Zurack says, due to cuts being made to
Medicaid's Disproportionate Share Hospital program, which distributes payments
to qualifying hospitals that serve a large number of uninsured individuals.”

In
reality, Zurack says, the cuts will be extremely damaging to hospitals that
serve this population.

New York City Health and Hospital Corporation
is scheduled to lose $17.1 billion dollars between 2014 and 2020 due to federal
cuts In the Medicaid Disproportionate Share Hospital program.

Obamacare is becoming a reality. Hospital
systems such as HCC are realizing the financial impact of Obamacare.

Accountable
Care Organizations are Obamacare’s signature tool to improve access to care and
decrease the cost of care.

The promise to hospital
systems’ is that by increasing efficiency ACOs could increase hospital systems’ profit.

Incorporated into the ACO scheme
is profit sharing with the government if there are reduced costs. Included is
reduction in payment if costs exceed benchmark costs.

Only 10% of hospital systems
have signed up in the last two years. The Obama administration has done a lot
of bragging about enrollment
.

Originally there were thirty-two “Pioneer”
hospital systems. The Mayo Clinic and the Cleveland Clinic rejected being
Pioneer participants. The goal of ACOs is to develop integrated care delivery
systems.

Last week 9 of the original 32
Pioneer ACOs withdrew from the original program.
CMS gave no explanation for
them leaving.

I believe they realized they
couldn’t integrate their delivery system the way the government wants.

They cannot make any money
participating in the Medicare Shared Savings Program.

Seven of the nine are applying to transition
to the Medicare Shared Savings Program, while two are abandoning the program
completely. CMS declined to identify which ACOs are leaving the Pioneer program
and which are simply shifting to the MSSP.

 The nine departing
ACOs are
:

  • Prime Care Medical Network Inc., an IPA-based ACO serving San
    Bernadino and Riverside counties in California.
  • University of Michigan Health System in Ann Arbor.
  • Physician Health Partners LLC, a medical management company in
    Denver.
  • Seton Health Alliance, a network of providers comprised in the
    11-county Austin area.
  • "Plus ACO," a partership between North Texas Specialty
    Physicians and Texas Health Resources
  • Healthcare Partners Nevada ACO LLC, a multispecialty medical
    group and IPA serving Clark and Nye counties in Nevada
  • Healthcare Partners California ACO LLC, a multispecialty medical
    group and IPA serving Los Angeles and Orange counties in California.
  • JSA Care Partners LLC, a primary medical group and IPA serving
    the Orlando, Tampa and South Florida area.
  • Presbyterian Healthcare Services, an integrated delivery system
    serving the Albuquerque area.

 “Plus
ACO”, a partnership between Texas Health Resources and North Texas Specialty
Physicians
, has plans to leave the Pioneer ACO program by mid-August, but the
two organizations say they are open to "remaining in the Pioneer ACO
program if we can find an economically viable way to do so."

 ACO’s are doomed. Obamacare is falling apart.

President Obama immediately went on the campaign
trail telling the country how great Obamacare is already.  

 
 

http://youtu.be/Kyv8ZRkXnfU?t=58s

He continues to ignore problems with Obamacare’s implementation
and costs. He has no regard for America’s financial stability.

Americans’ are starting to understand his attitude.

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

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