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http://www.washingtontimes.com/news/2015/jun/29/ny-health-care-providers-to-share-73-billion-for-o/

$7.3B to be shared among NY health care networks to overhaul

Some $7.3 billion will be divided among 25 networks of health care providers in New York state to use in overhauling the delivery of care and cutting unneeded hospital visits, according to state officials.

Hospitals, physician groups and other providers allied in geographic networks are getting parts of the state’s so-called Medicaid waiver to apply projected federal savings over five years.

Each group proposed measures meant to provide more effective upfront care and reduce more expensive emergency room visits, inpatient stays and hospital beds. They include more outpatient clinics, using electronic patient records and enabling low-income patients to see doctors and psychologists in the same visit.

Funding ranges from $1.2 billion for the network led by New York City Health and Hospitals Corp. to $187 million for the Adirondack Health Institute Inc., a regional collaborative.

Meanwhile, state officials said average spending for New York’s Medicaid patients has declined to $8,233 annually, its lowest level in more than a decade. That’s attributed to earlier measures to redesign the state’s health care program for low-income residents, including a movement from fee-for-service reimbursement to managed care plans.

Medicaid now covers about 6 million New Yorkers, nearly one-third of the state’s population. In the last two years, enrollments rose by 500,000 partly from efforts to reach the uninsured through New York’s health exchange and the federal Affordable Care Act.

“Billions of taxpayer dollars have been saved thanks to the work of our Medicaid redesign team,” Gov. Andrew Cuomo said. The goal over the next five years with the Medicaid waiver funding is to reduce avoidable hospital use by 25 percent.

Each of the 25 systems submitted plans.

After initial checks go out shortly, the recently formed provider systems will be required to meet various benchmarks, particularly reductions in avoidable hospital use. However, this first year will be focused on getting organized.

Some groups cover large upstate geographies, such as the Adirondack Health Institute for the eastern half of the Adirondacks, and another led by Samaritan Medical Center in Watertown for another large swath of northern New York. Within New York City, there are several separate groups.

Each was asked to first examine its existing services and capacity, and the actual need in its communities, to determine what’s financially sustainable. Their assessments and proposals have been posted online, and several projected reductions in hospital beds.

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http://dailycaller.com/2015/06/30/failing-obamacare-co-ops-offer-lavish-executive-pay-and-may-violate-the-law-video/print/

Execs Of Failing Obamacare Co-Ops Have Lavish Salaries

The top paid co-op executive was Thomas Policelli, CEO of Massachusetts’ Minuteman Health. He was awarded $587,000 in 2013, according to the co-op’s tax return. Minuteman was also among worst performing Obamacare co-ops, reporting only 1,700 enrollees at the end of 2014.

Minuteman’s cash-burn rate was 53 percent, with a net operating loss of $21 million last year, according to an analysis by Galen’s Turner and Thomas Miller, a senior health fellow at the American Enterprise Institute.

In nearby Connecticut, HealthyCT paid Kenneth Lalime $352,000. The co-op reported total enrollment of only 7,966 and suffered operating losses of $28 million. Standard & Poor’s estimated its cash-burn rate at 61 percent.

Maryland’s Evergreen Health Cooperative’s Peter Beilenson was paid $263,000. His co-op enrolled only 2,129 customers versus 72,000 for Blue Cross/Blue Shield and compiled a net operating loss of $15 million last year. Evergreen’s burn rate was 125 percent of its capital through the first three quarters of 2014, according to S&P.

Jerry Burgess, president and CEO of South Carolina’s Consumers Choice Health Insurance Company, got the second highest compensation at $490,000.

Under his leadership, the co-op had a $10 million net operating loss last year. It exhausted half of its federally funded cash-on-hand by the third quarter of 2014, according to A.M. Best, an insurance rating firm.

Burgess’s pay is 14 times the average worker income of $34,266 in South Carolina, according to U.S. Census data.

Ralph Prows earned $355,000 as CEO of Oregon’s Health Co-op. The co-op ended up enrolling only 869 people. Prows resigned earlier this year.

David Young, CFO of Tennessee’s Community Health Alliance, received $280,000 in 2013, seven times the average worker’s take home pay of $37,678.

Community Health also suffered the largest deficit of all the health co-ops, spending 314% of its allotted federal revenue in a single year, according to S&P. The Tennessee co-op received $73 million in loan money under Obamacare.

Nevada health co-op has another problem in addition to sky-high salaries, nepotism. Nevada Health CO-OP is top-heavy with members of the long-troubled UNITE HERE union, which represents casino workers in the state and has been accused of corruption by other union officials.

Tom Zumtobell, the co-op’s CEO, received $414,000 in 2013. He is a former UNITE Here vice president and lives in Reno, 450 miles from the co-op’s Las Vegas headquarters. Kathy Silver received $377,000 as the co-op’s treasurer. Silver is the former board president of the local UNITE HERE chapter.

Bobbette Bond, the co-op’s secretary, hauled in $222,000. She was UNITE HERE’s chief lobbyist. Her husband is Donald “D” Taylor, UNITE HERE’s national president and a director of the co-op.

The Nevada co-op lost $20 million last year and burned through 92 percent of its Obamacare funding in the first three quarters of 2014, according to S&P.

Douglas Smith is CEO of Utah’s Arches Mutual Insurance Company co-op. He received $320,000, nine times the state’s average salary of $32,601. His co-op had a burn rate of 74 percent in the first three quarters of 2014 and operating losses of more than $31 million.

Montana’s Jerry Dworak was paid $306,000 in largely rural Montana where the average income is $37,370. Dworak’s salary was eight times the average income in the state.

Health Connection’s CEO Mark Epstein got $296,000 while running up $9 million in operating losses last year. The New Mexico co-op also burned through 42 percent of its funding, according to S&P.

Kentucky’s co-op has been hailed as a success story, enrolling nearly 67,000 people, which is 82 percent of all private enrollees in the state’s Obamacare exchange.

Its burn rate, however, was 53 percent and it had the highest operating losses in the entire nation, at $127 million. Jania Miller, Kentucky’s CEO, got $307,000 in compensation, nine times the average take home pay for a worker there of $35,041.

The only state to show a net profit in 2014 was tiny Maine. Its CEO, Kevin Lewis, was paid $264,000.

Although Maine is known for expensive summer homes, its year-round population earns only $39,481 per worker. That means Lewis earned nine times the average worker’s income.

The National Alliance of State Health CO-OP’s, the industry’s trade association, did not respond to multiple DCNF requests for comment. Nine of the association’s 20 board members were among the highest paid CEOs.

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Small Businesses Threatened With $36,500 IRS Fines For Helping Employees With Health Costs

LTC8K6

Jun 30 2015, 03:04 PM

Well, the majority are getting heavily subsidized, or even free, health insurance.

If I pay for your health insurance, I have a right to demand that you live a healthy lifestyle, right?

I have to demand vaccinations, right?

We won't mention promiscuity though...either homo or hetero or whatever...

LTC8K6

Jun 30 2015, 04:29 PM

You all probably remember me talking about this regarding my employer. This is what I talked the owners out of. I'm glad I did. They were doing this.

It's good that the media is finally getting around to noticing it and warning people 1 day early...

http://www.forbes.com/sites/gracemarieturner/2015/06/30/small-businesses-threatened-with-36500-irs-fines-for-helping-employees-with-health-costs/?mc_cid=289d1b107a&mc_eid=c3f2afe776

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Small Businesses Threatened With $36,500 IRS Fines For Helping Employees With Health Costs

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...The new IRS penalty is more than 18 times greater than the $2,000 employer-mandate penalty under ObamaCare for not providing qualifying health insurance for employees. And employers with fewer than 50 workers are not exempt, as they are from the employer-mandate penalty.

The rule appears nowhere in the Affordable Care Act but was developed by the Obama administration’s regulation writers at the IRS. The rule punishes small businesses for providing the only health insurance support many can afford – a contribution to help employees pay premiums for their individual or family health insurance policies or to help finance direct payment for medical services.

...Rep. Charles Boustany has introduced legislation in the House (H.R. 2911) and Sen. Charles Grassley, in the Senate (S.1697) to remedy the problem. Both bills await congressional action.

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http://www.politico.com/story/2015/07/barack-obama-takes-an-obamacare-victory-lap-119615.html

Barack Obama takes an Obamacare victory lap
Sarah Wheaton

Obamacare is the law of the land, President Barack Obama says, and it’s time for Republicans who oppose it to move on.

That’s the message Obama intends to send during a visit to Tennessee on Wednesday, as he takes a victory lap just six days after the Supreme Court upheld the legislation that created Obamacare in a case known as King v. Burwell.

White House aides say the president isn’t under any illusions that Republicans will drop their objections to the Affordable Care Act just because the administration won the last Supreme Court fight. So while Obama will “discuss how we can move forward and continue building on the progress made under the Affordable Care Act,” according to the trip announcement, he’s not planning to get confrontational, avoiding the more controversial elements, one official said. In particular, the president intends to praise the efforts of Tennessee’s Republican governor, who has embraced key parts of Obamacare and is working to expand Medicaid in his state, a key part of the health care reforms and a top Obama priority.

The goal, White House officials say, is to take the debate off the political front burner and hope Republicans will be open to collaborating with the administration to make the law work better.

[...]

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http://blogs.wsj.com/bankruptcy/2015/07/01/the-future-of-personal-bankruptcy-in-a-post-obamacare-world/

The Future of Personal Bankruptcy in a Post-Obamacare World

The U.S. Supreme Court just put its stamp of approval on the Obama administration’s health-care reform, and a Boston law professor thinks he knows what will happen next.

In his 2014 study, Northeastern University law professor Daniel Austin dug into personal bankruptcy filings to figure out what happened after Massachusetts lawmakers made health insurance mandatory in 2005.

His findings? Massachusetts residents who file for bankruptcy protection these days have way less medical debt compared to the rest of the country. The typical Massachusetts person or couple who filed in 2013 had $3,041 in medical debt, while people everywhere else had an average of $8,594 in medical debt.

In fact, he found that Massachusetts is the only state where medical debt isn’t the leading cause of personal bankruptcy. (A loss of income is the No. 1 reason, he found.)

So what does Prof. Austin think will happen with mandatory health care in all 50 states? Could the system designed to give people access to affordable health insurance make families more financially stable and keep them out of bankruptcy?

“It absolutely should show a reduction in bankruptcies [filed] due to medical debt,” Prof. Austin said in an interview Tuesday.

Plenty of studies have pinpointed medical debt as the No. 1 reason why people turn to bankruptcy for a fresh start. In rallying for health-care reform in his 2009 State of the Union address, President Barack Obama said that 62.1% of consumer bankruptcies are medical bankruptcies, citing a study Sen. Elizabeth Warren (D., Mass.) co-wrote as a Harvard law professor.

Prof. Austin’s study found the percentage of medical bankruptcies to be far smaller. Overall, 18% to 25% of personal bankruptcies filed in the U.S. were prompted by medical debt.

That is, except in Massachusetts. There, he found that 3% to 9% of bankruptcy cases were filed because of medical debt.

Based on his study, Prof. Austin said it wouldn’t be a stretch to say that Massachusetts health-care reform is why the number of Massachusetts residents who file for bankruptcy is falling faster than the rest of the country. (The number of people who file for bankruptcy has been falling for a couple of years now, thanks to an improving U.S. economy and other ivory tower theories.)

For his study, Prof. Austin evaluated 5,400 of bankruptcy cases filed between 2005 and 2013 to determine what kind of debt people have at the time of the filing.

[...]

Excerpts from his study

 

https://www.documentcloud.org/documents/2153989-daniel-austin-medical-bankruptcies.html
MEDICAL DEBT AS A CAUSE OF CONSUMER BANKRUPTCY
By Daniel A. Austin
Associate Professor, Northeastern University School of Law.

[...]

INTRODUCTION
In his 2009 State of the Union Address, President Obama pleaded with Americans to support healthcare reform, stating “[t]his is a cost that now causes a bankruptcy in America every thirty seconds.” That jaw-dropping statistic was based on a study co-authored by Elizabeth Warren (then a professor at Harvard Law School) which concluded that 62.1% of consumer bankruptcies are medical bankruptcies. The figure has been widely cited by lawmakers, academics, and the media in support of expanded government healthcare. Recently, Senator Warren (D. MA) co-sponsored legislation to create a new category of “medically distressed debtor” that would be exempt from stringent bankruptcy filing requirements. On the other side, commentators and lawmakers who oppose greater government involvement in healthcare dispute the Warren findings. The issue of medical bankruptcies continues to be a focal point in the healthcare debate.

(page 2)
...Not surprisingly, the different studies produce a wide range of estimates for medical debt, which feeds opposite positions in the debate over healthcare policy. This study helps to close that gap by drawing upon medical debt and other data from consumer bankruptcy cases filed between 2005 and 2013, and debtor responses to a nationwide survey. The data adduced in this study shows that medical bills are the single largest cause of consumer bankruptcy—but not nearly to the degree that Warren and others have asserted.

[One of his goals was to define (redefine?) the definition here]
(page 16)
C. Coherent definition of “medical bankruptcy”

Part of the reason that the previous studies do not provide a consistent picture of medical bankruptcy is that there is no settled definition of the term. Establishing a coherent definition would better enable the term to be used as a metric of consumer bankruptcy, and provide precise terminology for communicating about bankruptcy and healthcare policy. The definition used in this article is as follows:

• 
  
• A medical bankruptcy is a bankruptcy filed primarily because of medical debts for
  which the debtor is or was responsible.

As used in this definition, “primarily” means more than all other debts or causes. This study adopts two ways to determine whether a bankruptcy was filed “primarily” because of medical debt.

First, a debtor is assumed to have filed bankruptcy primarily because of medical debt if the amount of medical debt is greater than 50% of the debtor’s total unsecured debt or 50% of the debtor’s annual income. A quantity of more than half satisfies the criteria of “primarily,” and means that medical debt eclipsed all other claims in the debtor’s total debt profile. I do not use secured debt in determining medical bankruptcy because medical bills are overwhelmingly unsecured debt and there is no discernible correlation between secured debt and medical debt.

Annual income is a standard yardstick of income, and equates to the debtor’s ability to pay medical and other debts.