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Healthcare Bill Part III; Obamacare
Topic Started: Mar 3 2014, 02:20 PM (48,666 Views)
kbp

ER Visits Rise Despite Law
Health Act Isn't Cutting Emergency Volume So Far; Government Says It's Too Early to Draw Conclusions

...Too Early to Draw Conclusions

But they're concluding it is a success?

...it could have been worse
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Baldo
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I read an interesting article that was really a bit complex that they haven't seen an uptick in visits to hospitals or doctors as of yet with all of these "millions" of new Obama enrollees

They didn't quite know what to make of it. The data is from just a short time.

It could be just a time lag in that it takes a while to get an appointment, maybe people just not using it, could be the large amount of Medicaid patients where getting an appointment takes longer because there are less doctors accepting it and/or travel distances are greater, or even maybe the enrollment numbers are falsely high.

Interesting ideas that will need to play out. Of course it probably is too early as the roll-out was terrible and some people still haven't even pay their first premium. There are probably lots of reasons

But it was an interesting metric I never really thought about. Here we are spending extra hundreds of billions and we are not seeing a rise in medical visits?
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kbp

A survey conducted for the time frame AFTER the Obamacare went into action has indicated ER visits are up, and they will continue to rise.

http://newsroom.acep.org/2014-05-21-ER-Visits-Up-Since-Implementation-of-Affordable-Care-Act
ER Visits Up Since Implementation of Affordable Care Act
Nearly half of emergency physicians responding to a poll are already seeing a rise in emergency visits since January 1 when expanded coverage under the Affordable Care Act (ACA) began to take effect. In an online poll conducted by the American College of Emergency Physicians (ACEP), 86 percent expect emergency visits to increase over the next three years. More than three-fourths (77 percent) say their ERs are not adequately prepared for significant increases....



We also had the stat's of what happened in Oregon after they had expanded Medicaid coverage, which showed a big increase in ER visits. The overwhelming majority of people on Medicaid and qualifying for Obamacare subsidies will not be that set aside time to plan their life, so the 'preventative care' solution to reducing ER costs was just pure BS.

The solution to be offered will likely include funding to teach the socio-economic class involved, which will come with promises of savings sometime way off into the future for spending mo' money today!
Edited by kbp, May 23 2014, 07:54 AM.
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kbp

Baldo
May 22 2014, 10:47 AM
I read an interesting article that was really a bit complex that they haven't seen an uptick in visits to hospitals or doctors as of yet with all of these "millions" of new Obama enrollees

snip
yeah, yeah, yeah... and the official response to reports showing the opposite is "it's too early to make any conclusions...."
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kbp

http://www.forbes.com/sites/michaelcannon/2014/05/23/two-charts-illustrate-the-difficulty-of-ascribing-obamacares-unpopularity-racism/

Two Charts Illustrate The Difficulty Of Ascribing ObamaCare's Unpopularity To Racism

Retiring U.S. Sen. Jay Rockefeller (D-WV) claimed this week that part of the American public’s ongoing opposition to ObamaCare is due to racism:

  • I’ll be able to dig up some e-mails…from people who made up their mind that they don’t want [the Affordable Care Act] to work because they don’t like the president. Maybe he’s of the wrong color, something of that sort. I’ve seen a lot of that and I know a lot of that to be true.
USA Today and the Washington Post each reported that Rockefeller was just saying publicly what many Democrats say privately. “It’s only a part,” Rockefeller was quoted in the Post. “But it is a part of life, and it is a part of American life and world life, and it’s a part of — just a part — of why they oppose absolutely everything that this president does.”

I agree with Rockefeller. No doubt there are some Americans who oppose everything the president does, including ObamaCare, because he is black. And no doubt Rockefeller has seen a lot of, you know, “that.” As someone who represented West Virginia in the U.S. Senate for 25 years alongside former Klansman and fellow Democrat Robert C. Byrd, Rockefeller is no doubt aware that racism is not confined to any one political party.

For a number of reasons, though, it’s difficult for supporters to pretend racism plays any significant role in public opposition to ObamaCare.

Take the following chart from the Huffington Post, which tracks public opinion of Obama’s health care plan over the entire course of his presidency. When Obama took the oath of office in January 2009, the public actually supported his health plan. At around the same time congressional Democrats first translated his plan into legislative language in June 2009, however, the public turned against it.

Obama Health Care Law: Favor/Oppose
[go to link for image, too large to post]

Perhaps it took the racists an entire presidential campaign and six months of his presidency before they realized Barack Obama is African-American. Then, once that dawned on them, they figured they had better start rallying against his health plan. But a better explanation might be that lots of Americans were pleased to have our first black president, pleased that he seemed to want to do something to help the uninsured, but then displeased when they got a closer look at what he had in mind.

Likewise, the below chart from the Kaiser Family Foundation shows that the dark-blue states embraced the Affordable Care Act by establishing a health insurance Exchange. States that declined include such racist backwaters as Maine, Wisconsin, Delaware, and the president’s home state of Illinois, which holds the distinction of being the only state to vote for Obama three times.

[go to link for image, too large to post]

Progressives and Democrats are no doubt miffed by the ongoing public opposition to their most coveted prize. To ascribe that opposition to racism, however, is itself a form of prejudice.

A charitable, open-minded adult might respond to the public’s rejection of his ideas by re-evaluating them, rather than by taking the self-soothing route of smearing his detractors with charges of racism or guilt by association. Racists aren’t the only people who need to reconsider their priors.
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kbp

Quote:
 
http://www.weeklystandard.com/blogs/democrats-privately-calling-obama-detached-flat-footed-incompetent_793544.html

Democrats Privately Calling Obama 'Detached,' 'Flat Footed,' 'Incompetent'

CNN's John King reports that Democrats are privately calling President Obama "detached," "flat footed," and "incompetent."

"Forget for a moment that Republican outrage," said King on his CNN show this morning. "More and more Democrats in key 2014 races are calling for the president to get a spine, they say, and fire his Veterans Affairs secretary. And what more and more Democrats are saying privately is scathing, calling the president and his team detached, flat footed, even incompetent.

"Maggie Haberman," said King turning to a panelist, "that's what strikes me, what democrats are saying privately in the wakes of the healthcare.gov problems, they see a president who doesn't want to take command, doesn't want to act fast. Raising the competence question. Some Democrats, who believe in government, [are saying] this White House doesn't appear to have its hand on the lever."

Haberman of Politico agreed, cited more examples, and added: "All of this adds up to somebody who just doesn't seem at all involved."

I'm not sure what they want him to do, what "lever" he needs to pull.
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foxglove

Planned Parenthood Dr Hopes to ‘See More Women Choosing Long-Acting Forms of Contraception’

http://cnsnews.com/news/article/penny-starr/planned-parenthood-dr-hopes-see-more-women-choosing-long-acting-forms


http://www.nationalrighttolifenews.org/news/2014/03/planned-parenthoods-aggressive-push-for-obamacare/

"... School-Based Health Clinics. ObamaCare directly appropriates $200 million for the construction and expansion of school-based health clinics. (It also authorized additional funding for operational services through 2014, but funding was not appropriated. Efforts are ongoing to extend the authorization).

How much of a foothold Planned Parenthood will get into these school-based health clinics over time remains to be seen. In July 2011, the Los Angeles Unified School District was awarded $489,888 in ObamaCare funding to enhance and expand the school district’s school-based health centers, such as for renovations and updating equipment. In announcing the receipt of the funding, the LA school district said that it had “requested the funds to renovate the clinic at Roosevelt High School,” as well as for other clinics. A year later, in June 2012, the Los Angeles Times reported that Planned Parenthood was providing “a medical assistant, the contraceptives and the pregnancy and STDs testing” at the Roosevelt High School clinic, through a collaboration after the school nurse practitioner reached out to Planned Parenthood.

Referrals for abortions on minors by ObamaCare-financed school-based clinics is also a concern. Lake County, Illinois is the site of a controversy regarding the construction of a $500,000 school-based clinic, with the half a million dollars in funding coming from ObamaCare. Concerns were raised that the future clinic would make abortion referrals for minor girls without their parents’ consent. A June 2013 article in the Daily Herald only reinforces these parents’ concerns, with the Herald stating that “pupils would need a consent form signed by a parent or guardian to enroll at the health center. . . . Illinois law allows for a minor to receive an abortion referral from a medical provider, including school clinics, without parental notification.”

But the list goes on: Four Planned Parenthood affiliates alone – in Virginia, Texas, and two in Florida – received a total of $3.3 million in ObamaCare PREP funds to provide comprehensive sex education. In addition, the state of California awarded a total of $1 million in ObamaCare PREP sex education funds to certain Planned Parenthood centers in California. (Efforts are ongoing to extend this ObamaCare program past Fiscal Year 2014).

Is it any wonder that Planned Parenthood is working so hard to keep ObamaCare from failing?"

http://www.renewamerica.com/columns/huston/090912

http://www.proliberty.com/observer/20091132.html

http://www.wordjourney.com/news/christian-news/afa-says-that-obamacare-includes-in-school-planned-parenthood-clinics/


Has Obamacare ushered in the concept of school clinics which may bypass the parents of a child to give whatever the clinic professional decides? If birth control is given at the clinics, will it be the long-acting, more expensive types?

I wonder if the Obamacare's free birth control was not really directed to women with jobs but for teenagers in schools?
Edited by foxglove, May 25 2014, 07:57 PM.
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LTC8K6
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http://michellemalkin.com/2014/05/25/batten-down-the-midterm-election-hatches-hhs-stops-releasing-obamacare-updates/


Batten down the midterm election hatches: HHS stops releasing Obamacare updates
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LTC8K6
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http://www.nytimes.com/2014/05/26/us/irs-bars-employers-from-dumping-workers-into-health-exchanges.html?_r=0


I.R.S. Bars Employers From Dumping Workers Into Health Exchanges

Quote:
 
When employers provide coverage, their contributions, averaging more than $5,000 a year per employee, are not counted as taxable income to workers. But the Internal Revenue Service said employers could not meet their obligations under the health care law by simply reimbursing employees for some or all of their premium costs.

Christopher E. Condeluci, a former tax and benefits counsel to the Senate Finance Committee, said the ruling was significant because it made clear that “an employee cannot use tax-free contributions from an employer to purchase an insurance policy sold in the individual health insurance market, inside or outside an exchange.”

If an employer wants to help employees buy insurance on their own, Mr. Condeluci said, it can give them higher pay, in the form of taxable wages. But in such cases, he said, the employer and the employee would owe payroll taxes on those wages, and the change could be viewed by workers as reducing a valuable benefit.

Andrew R. Biebl, a tax partner at CliftonLarsonAllen, a large accounting firm based in Minneapolis, said the ruling could disrupt arrangements used in many industries.

“For decades,” Mr. Biebl said, “employers have been assisting employees by reimbursing them for health insurance premiums and out-of-pocket costs. The new federal ruling eliminates many of those arrangements by imposing an unusually punitive penalty.”

When an employer reimburses employees for premiums, the arrangement is known as an employer payment plan. “These employer payment plans are considered to be group health plans,” the I.R.S. said, but they do not satisfy requirements of the Affordable Care Act.
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kbp

LTC8K6
May 25 2014, 09:21 PM
http://michellemalkin.com/2014/05/25/batten-down-the-midterm-election-hatches-hhs-stops-releasing-obamacare-updates/


Batten down the midterm election hatches: HHS stops releasing Obamacare updates
Quote:
 
http://energycommerce.house.gov/press-release/committee-learns-who’s-paid-obamacare-april-15-only-67-percent-enrollees-federal
Committee Learns Who’s Paid for Obamacare: As of April 15, Only 67 Percent of Enrollees in Federal Marketplace Had Paid First Month’s Premium
April 30, 2014

...the committee plans to ask the insurers in the federally facilitated marketplace to provide an enrollment update by May 20, 2014...

No luck searching the "energycommerce.house.gov" for any updates. Maybe the numbers did not look like something the House committee wanted to publish, maybe the administration pressured the insurance companies to not cooperate with the committee, maybe... who knows?

Edited by kbp, May 26 2014, 09:06 AM.
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kbp

LTC8K6
May 25 2014, 10:50 PM
http://www.nytimes.com/2014/05/26/us/irs-bars-employers-from-dumping-workers-into-health-exchanges.html?_r=0


I.R.S. Bars Employers From Dumping Workers Into Health Exchanges

Quote:
 
When employers provide coverage, their contributions, averaging more than $5,000 a year per employee, are not counted as taxable income to workers. But the Internal Revenue Service said employers could not meet their obligations under the health care law by simply reimbursing employees for some or all of their premium costs.

Christopher E. Condeluci, a former tax and benefits counsel to the Senate Finance Committee, said the ruling was significant because it made clear that “an employee cannot use tax-free contributions from an employer to purchase an insurance policy sold in the individual health insurance market, inside or outside an exchange.”

If an employer wants to help employees buy insurance on their own, Mr. Condeluci said, it can give them higher pay, in the form of taxable wages. But in such cases, he said, the employer and the employee would owe payroll taxes on those wages, and the change could be viewed by workers as reducing a valuable benefit.

Andrew R. Biebl, a tax partner at CliftonLarsonAllen, a large accounting firm based in Minneapolis, said the ruling could disrupt arrangements used in many industries.

“For decades,” Mr. Biebl said, “employers have been assisting employees by reimbursing them for health insurance premiums and out-of-pocket costs. The new federal ruling eliminates many of those arrangements by imposing an unusually punitive penalty.”

When an employer reimburses employees for premiums, the arrangement is known as an employer payment plan. “These employer payment plans are considered to be group health plans,” the I.R.S. said, but they do not satisfy requirements of the Affordable Care Act.
“I don’t think that an employer-based system is going to be, or should be, replaced anytime soon,” President Obama said recently...

Barry does like more taxes!

I guess they hit a problem of the method allowing the employers to load the exchange with the higher risk employees.

This reads to me like a complete re-write of what the "health reimbursement arrangements" allows, which will throw many employer sponsored plans into a mess of a problem. The reimbursement was NEVER taxable income, it was "excluded from the employee’s gross income," as the IRS has always stated.

>>>>>>>>>>>>

LTC,
What's that do to your employer's plans?


.
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kbp

Quote:
 
http://www.irs.gov/pub/irs-drop/n-13-54.pdf
Application of Market Reform and other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements
Notice 2013-54


II. BACKGROUND
A. Health Reimbursement Arrangements

An HRA is an arrangement that is funded solely by an employer and that reimburses an employee for medical care expenses (as defined under Code § 213(d)) incurred by the employee, or his spouse, dependents, and any children who, as of the end of the taxable year, have not attained age 27, up to a maximum dollar amount for a coverage period. IRS Notice 2002-45, 2002-02 CB 93; Revenue Ruling 2002-41, 2002-2 CB 75. This reimbursement is excludable from the employee’s income. Amounts that remain at the end of the year generally can be used to reimburse expenses incurred in later years. HRAs generally are considered to be group health plans within the meaning of Code § 9832(a), § 733(a) of the Employee Retirement Income Security Act of 1974 (ERISA), and § 2791(a) of the Public Health Service Act (PHS Act) and are subject to the rules applicable to group health plans.

B. Employer Payment Plans
Revenue Ruling 61-146 holds that if an employer reimburses an employee’s substantiated premiums for non-employer sponsored hospital and medical insurance, the payments are excluded from the employee’s gross income under Code § 106. This exclusion also applies if the employer pays the premiums directly to the insurance company. An employer payment plan, as the term is used in this notice, does not include an employer-sponsored arrangement under which an employee may choose either cash or an after-tax amount to be applied toward health coverage. Individual employers may establish payroll practices of forwarding post-tax employee wages to a health insurance issuer at the direction of an employee without establishing a group health plan, if the standards of the DOL’s regulation at 29 C.F.R. §2510.3-1(j) are met.

Maybe I misunderstood how it works????
Edited by kbp, May 26 2014, 09:55 AM.
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LTC8K6
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Assistant to The Devil Himself
I don't know what to think. Seems like one says you can, the other says you can't...
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LTC8K6
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Assistant to The Devil Himself
3. Guidance on Employee Assistance Programs
Question 9: Are benefits under an employee assistance program or EAP considered to
be excepted benefits?
Answer 9: The Departments intend to amend 26 C.F.R. §54.9831-1(c), 29 C.F.R.
§2590.732(c), and 45 C.F.R. §146.145(c) to provide that benefits under an employee
assistance program or EAP are considered to be excepted benefits, but only if the
program does not provide significant benefits in the nature of medical care or treatment.
Excepted benefits are not subject to the market reforms and are not minimum essential
coverage under Code § 5000A. Until rulemaking is finalized, through at least 2014, the
Departments will consider an employee assistance program or EAP to constitute
excepted benefits only if the employee assistance program or EAP does not provide
significant benefits in the nature of medical care or treatment. For this purpose,
employers may use a reasonable, good faith interpretation of whether an employee
assistance program or EAP provides significant benefits in the nature of medical care or
treatment.

http://www.irs.gov/pub/irs-drop/n-13-54.pdf
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kbp

I'm not sure how that "EAP" comes into play.

The understanding I'm getting is that as far as HRA's are concerned, they're disregarding Revenue Ruling 61-146.
http://www.irs.gov/pub/irs-drop/rr-65-146.pdf

IRS rules are very difficult for me to comprehend. They always reference loads of other rules and leave me searching for definitions to determine what they mean by the way they use some words.
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