| Healthcare Bill Part III; Obamacare | |
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| Tweet Topic Started: Mar 3 2014, 02:20 PM (48,608 Views) | |
| LTC8K6 | Dec 26 2014, 10:42 PM Post #1456 |
Assistant to The Devil Himself
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Employees are receiving letters saying that their January bills will be late, and will arrive close to their February bills. Their insurance cards will also arrive late. My own January bill arrived a while ago. I assume this delay is only for those with a subsidy? BCBSNC. |
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| sdsgo | Dec 27 2014, 12:09 PM Post #1457 |
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Top Ten Indicators Your Employer Has Changed To Obamacare Health Plan (according to David Letterman) (10) Your annual breast exam is done at Hooters (9) Directions to your doctor’s office include “Take a left when you enter the trailer park” (8) The tongue depressors taste faintly of fudgesicles (7) The only proctologist in the plan is “Gus” from Roto-Rooter (6) The only item listed under Preventive Care Coverage is “an apple a day” (5) Your primary care physician is wearing the pants you gave to Goodwill last month (4) The statement… “The patient is responsible for 200% of out-of-network charges”…is not a typographical error (3) The only expense covered 100% is…”Embalming” (2) Your Prozac comes in different colors with little M’s on them (1) You ask for Viagra and they give you a Popsicle stick and duct tape. Obamacare: The efficiency of the DMV, the compassion of the IRS |
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| wingedwheel | Dec 27 2014, 01:37 PM Post #1458 |
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Too late and on his way out the door. Gee thanks Dave! |
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| Baldo | Dec 27 2014, 08:36 PM Post #1459 |
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Meanwhile even the NY Times is reporting As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care WASHINGTON — Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care. The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid. The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average. Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states. In his budget request in March, President Obama proposed a one-year extension of the higher Medicaid payments. Several Democratic members of Congress backed the idea, but the proposals languished, and such legislation would appear to face long odds in the new Congress, with Republicans controlling both houses. Dr. David A. Fleming, the president of the American College of Physicians, which represents specialists in internal medicine, said some patients would have less access to care after the cuts. It would make no sense to reduce Medicaid payments “at a time when the population enrolled in Medicaid is surging,” he said. Dr. George J. Petruncio, a family physician in Turnersville, N.J., described the cuts as a “bait and switch” move. “The government attempted to entice physicians into Medicaid with higher rates, then lowers reimbursement once the doctors are involved,” he said. But Nicole Brossoie, a spokeswoman for the New Jersey Department of Human Services, which runs the state’s Medicaid program, said the increase was not meant to be permanent. “The enhanced rates will not be extended in New Jersey,” Ms. Brossoie said. “It was always understood to be temporary.” The White House says Medicaid is contributing to the “largest coverage gains in four decades,” with 9.7 million people added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid. But federal officials have not set forth a strategy to expand access to care with enrollment, and in many states Medicaid payment rates for primary care services, like routine office visits and the management of chronic illnesses, will plunge back to 2012 levels, widely seen as inadequate....snipped http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0 As many have said time & time again over the last 4 years. Health-care Insurance (Obama-care) does not mean Health-care. The standard of care is something else entirely. One can predict what will happen. Doctors fed up with low reimbursement rates, will simply cease to take Medicaid & Medicare patients who don't have supplemental policies In the end this will be the fate for millions of Americans. As the old Hippie Bumper Sticker from the 60's said, "Ass, Grass, or Gas. Nobody rides for free" except of course for the *#$!$ Politicians |
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| kbp | Dec 28 2014, 08:46 AM Post #1460 |
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Success... Obamacare is the multi-trillion dollar program providing expanded Medicaid, which will pay enough to almost cover the office expense for a doctor to handle patients for the sake of additional experience, and private insurance for a few million, of which 85% need help paying the premium for a policy that provides 100% of them a MINIMUM $2,000 out-of-pocket. ...it could have been worse. |
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| Baldo | Dec 28 2014, 08:20 PM Post #1461 |
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Here is the Urban Institute Study discussed in the NY Times Article. I just extracted a portion Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015? .....Discussion Overall, primary care fees in the Medicaid program would fall an average of 42.8 percent in 2015 if no extension of the ACA primary care fee increase policy were granted. The fee reduction would be even larger — 47.4 percent on average — in those states that do not plan to extend the fee bump using state funds. To put the magnitude of these fee reductions in some context, consider that the projected Medicare fee reduction under the sustainable growth rate formula was 24 percent in 2014. That cut and every potential fee cut under the formula since 2003 has been delayed by Congress. 9 It has been uncertain whether congressional action related to continuing the Medicaid primary care fee bump would occur before the policy expires and time appears to be running out. In general, states that have seen the largest increases in Medicaid reimbursement for primary care under the ACA are less likely to be planning to extend the policy into 2015 using state funds than are states with smaller increases. This situation likely reflects budgetary concerns. However, significant drops in primary care reimbursement may lead physicians to see fewer Medicaid patients, potentially leading these patients to have difficulty finding a physician or getting an appointment. Although payment is not the only factor in physician acceptance of Medicaid (Long 2013), research has demonstrated a correlation between lower payment rates and fewer physicians accepting new Medicaid patients(Decker 2012). Overall, Medicaid expansion states face more significant fee reductions than nonexpansion states (46.2 percent versus 36.8 percent), and states that had low Medicaid participation by primary care providers in 2011 and 2012 also face larger fee reductions than states with historically higher participation. The largest seven states by population size all face primary care fee reductions of more than 40 percent, and none of these states intends to continue the fee increase in 2015. Of those seven states, California, Illinois, New York, and Ohio could be faced with a significant expansion of enrollment in their Medicaid programs while implementing substantial Medicaid fee cuts for primary care. http://www.urban.org/UploadedPDF/2000025-Reversing-the-Medicaid-Fee-Bump.pdf Amazing Discovery! Imagine that? There is a correlation between what a person is paid and what they will do. Newsflash to Marxists It pretty clear to me the Dems just wanted to start out the system not caring if it would work. They just lied about it costs & the long term financial viability. We will leave that for future Congresses & States to work it out. Edited by Baldo, Dec 28 2014, 08:34 PM.
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| kbp | Dec 28 2014, 09:02 PM Post #1462 |
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The cowards, 'Congresses & States,' are hoping the judicial branch will help solve the problem. |
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| Baldo | Dec 30 2014, 12:36 PM Post #1463 |
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Obama Adviser Jonathan Gruber In 2009: Obamacare Will NOT Be Affordable President Obama’s health care adviser Jonathan Gruber said that the Affordable Care Act would definitely not be affordable while he was writing the bill with the White House. As Gruber continues to withhold documents while he awaits a call-back for more testimony before the House Oversight and Government Reform Committee in the new year, more shocking information is coming to light detailing the deceptions that went into the writing of the health-care law. Gruber said that Obamacare had no cost controls in it and would not be affordable in an October 2009 policy brief, presented here exclusively by TheDC. At the time, Gruber had already personally counseled Obama in the Oval Office and served on Obama’s presidential transition team. Obama, meanwhile, told the American people that their premiums would go down dramatically. “The problem is it starts to go hand in hand with the mandate; you can’t mandate insurance that’s not affordable. This is going to be a major issue,” Gruber admitted in an October 2, 2009 lecture, the transcript of which comprised the policy brief. “So what’s different this time? Why are we closer than we’ve ever been before? Because there are no cost controls in these proposals. Because this bill’s about coverage. Which is good! Why should we hold 48 million uninsured people hostage to the fact that we don’t yet know how to control costs in a politically acceptable way? Let’s get the people covered and then let’s do cost control.” Gruber also said that the only way to control costs is to effectively deny treatment. “The real substance of cost control is all about a single thing: telling patients they can’t have something they want. It’s about telling patients, ‘That surgery doesn’t do any good, so if you want it you have to pay the full cost.’” “There’s no reason the American health care system can’t be, ‘You can have whatever you want, you just have to pay for it.’ That’s what we do in other walks of life. We don’t say everyone has to have a large screen TV. If you want a large screen TV, you have to pay for it. Basically the notion would be to move to a level where everyone has a solid basic insurance level of coverage. Above that people pay on their own, without tax-subsidized dollars, to buy a higher level of coverage.” And despite the president’s pitches to the contrary, Obama also knew that his health care bill was unlikely to control costs, Gruber said. “I wish that President Obama could have stood up and said, ‘You know, I don’t know if this bill is going to control costs. It might, it might not. We’re doing our best. But let me tell you what it’s going to do…” Gruber said on a San Francisco podcast in 2012. “If he could make that speech? Instead, he says ‘I’m going to pass a bill that will lower your health care costs.’ That sells. Now, I wish the world was different. I wish people cared about the 50 million uninsured in America…But, you know, they don’t. And I think, once again, I’m amazed politically that we got this bill through.” http://dailycaller.com/2014/12/30/obama-adviser-jonathan-gruber-in-2009-obamacare-will-not-be-affordable/ There you go folks. Obama lied to get elected. He just plain sucker punch the American Voter with smoke & Mirrors and a lot of Ofuscation. Hello Suckers! Thanks for the votes. Now where's my golf club Edited by Baldo, Dec 30 2014, 12:37 PM.
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| MikeZPU | Dec 30 2014, 12:50 PM Post #1464 |
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Haha  
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| kbp | Dec 30 2014, 07:00 PM Post #1465 |
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Gruber said something similar more than once. |
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| kbp | Dec 31 2014, 07:58 AM Post #1466 |
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http://www.cato.org/publications/legal-briefs/king-v-burwell-1/ King v. Burwell By Michael F. Cannon and Jonathan H. Adler The Patient Protection and Affordable Care Act of 2010 (“PPACA”), Pub. L. No. 111-148, 124 Stat. 119, authorizes tax credits for the purchase of health insurance in state-established Exchanges, and only in such Exchanges. Insofar as the IRS has sought to provide tax credits for the purchase of health insurance in federally established Exchanges, its actions are contrary to law and must be set aside. Section 1311 of the PPACA (42 U.S.C. § 18031) declares that “Each State shall … establish” an “Exchange” to regulate health insurance within the state. Section 1321 (42 U.S.C. § 18041) directs the federal government to “establish” Exchanges “within” states that “[f]ail[] to establish [an] Exchange” or implement other specified provisions of the Act. Section 1401 (26 U.S.C. § 36B) offers health-insurance “tax credits” to certain taxpayers who enroll in a qualified health plan “through an Exchange established by the State.” The statute limits tax credits to state established Exchanges in a manner that is plain and unambiguous. The remainder of the statute and the PPACA’s legislative history are fully consistent with those provisions. Such conditions are not anomalous. To induce state cooperation, Congress routinely conditions federal benefits to individuals — via both direct spending and the tax code — on their states carrying out congressional priorities. Congress conditioned federal subsidies on state action on multiple occasions throughout the PPACA. It did so here as well. The text of the PPACA is sufficient to resolve this case. Resort to legislative history only reinforces this conclusion. That history supports the plain meaning of the text, and reveals why PPACA supporters approved this requirement even if many of them would have preferred otherwise. Political necessity required the Act’s authors to give states a leading role in operating health-insurance Exchanges. In so doing, the Act’s authors expressly conditioned premium-assistance tax credits on states establishing Exchanges and performing other tasks. Many of the Act’s supporters preferred a different approach. But after those supporters lost their filibuster-proof majority in the U.S. Senate, no other approach could satisfy the constitutional requirements of bicameralism and presentment. In 2012, the Internal Revenue Service issued a rule that altered that political tradeoff. The IRS rule offers premium-assistance tax credits through Exchanges that were established not by the State, but rather by the federal government. The agency is presently issuing those tax credits in the 36 states that refused or otherwise failed to establish an Exchange. The IRS rule is contrary to the plain language of the PPACA. The statutory text speaks directly to the question at issue. Thus the IRS has no authority to provide tax credits in federal Exchanges. Nor is the IRS due deference in its interpretation of the Act. Contrary to the Government’s argument that the rule supports one of the Act’s general goals, the rule actually subverts congressional intent by altering the balance Congress struck between the Act’s competing goals. It tries to achieve through regulatory fiat what PPACA supporters could not achieve through the political process: a health care bill that does not rely on state cooperation. The Government has not identified any statutory provisions that conflict with the plain meaning of the PPACA’s tax-credit eligibility provisions. Nor has the agency identified a single contemporaneous statement indicating PPACA supporters expected this bill to offer tax credits in federal Exchanges. The IRS simply rewrote the statute. The IRS’s regulation is therefore contrary to law and should be set aside. Read the Full Legal Brief in PDF . |
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| kbp | Dec 31 2014, 08:24 AM Post #1467 |
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http://www.forbes.com/sites/gracemarieturner/2014/12/30/the-irs-violated-the-law-and-state-sovereignty/ The IRS Violated The Law And State Sovereignty The Internal Revenue Service usurped its authority and overturned longstanding norms of federalism in ruling that health insurance subsidies could be available through federally-created exchanges, the Galen Institute and state legislators argued in an Amicus brief submitted Monday in the pending King v. Burwell lawsuit. The U.S. Supreme Court will hear arguments in the case on March 4, and a decision is likely by June. Citing a significant number of previous decisions, the brief argues that Congress is expected to “speak clearly if it wishes to assign to an agency decisions of vast ‘economic and political significance.’” Instead, the IRS illegally made “major policy decisions properly made by Congress” in ruling in May of 2012 that health insurance subsidies could be available to those who enroll through federally-created exchanges. The Affordable Care Act explicitly says that subsidies are available only “through an Exchange established by the State.” Thirty-six states defaulted to the federally-created exchanges in 2014, making their residents ineligible for health insurance subsidies if the Supreme Court rules that the law means what it says. Twenty-one state legislators joined the brief “based on their interest in opposing efforts by the federal government’s Executive Branch to impose policies in violation of the Affordable Care Act’s unambiguous text, under the overarching limits imposed by the Constitution.” All were in office when their states were deciding whether to create state health insurance exchanges. Their states have federally-operated exchanges. An estimated five million Americans in these and other states would lose their subsidies if the Supreme Court rules the IRS acted illegally and the subsidies therefore are invalid. At least 85% of those enrolled in federal exchanges are receiving subsidies for their health insurance, lowering their monthly premiums by an average of 76%. The administration had expected most, if not all, states to create their own exchanges, but only 14 did so. The IRS later changed the law to extend federal tax credits to exchanges established by the federal government. This effectively allowed hundreds of billions of dollars to be spent on subsidies over the next ten years that are not legally authorized by Congress. The Galen Institute/State Legislators’ brief, prepared by former White House General Counsel Boyden Gray, Adam White, and colleagues at Boyden Gray & Associates, focuses primarily on the issues of federalism. It argues that “the notion that the Federal Government may establish and operate a state agency ‘on behalf of the state’ is itself foreign to the concept of dual sovereignty.” In arguing that the subsidies are legal, the Obama administration “fails to consider the provision’s place within our constitutional structure,” the brief argues. The language of the statute is self-contradictory and ambiguous and “cannot justify the agency’s encroachment” upon State sovereignty. [This is where the idea of finding "intent' of Congress from reading the entire law in order to find ambiguity that allows them to rewrite with non-existing records of intent gets real crazy. If you go with the idea certain provisions of the law are ambiguous, as the administration wishes to claim they are, then that creates compound problems in other provisions of the law. They can't claim the specific plain text was a drafting error, but going with their explanation for why the IRS can rewrite the law creates loads of other provisions that then must have been drafting errors.] Regulation of health insurance has traditionally been a responsibility of the states, and the Affordable Care Act contained a number of provisions that reinforced that authority, including a choice of whether or not to establish an exchange. If they did, their citizens would receive subsidies, but their insurance markets would be subject to much greater federal control. The trade-off is that if they did not, citizens and businesses in the state would be protected from a number of the ACA’s mandates and financial penalties. “The IRS Rule eliminated the statutory choice by imposing those tax burdens in all States – even those that declined to establish their own Exchanges. The result is a more expansive exertion of federal regulatory control over health insurance than the statue authorized.” [This is where Roberts can bail out! The penalty is a tax, one States may choose to avoid it they decide not to accept the incentives of tax credits they'd get for establishing their own exchange.] The brief cites case previous law that says “if Congress intends to alter the ‘usual constitutional balance between the States and the Federal Government,’ it must make its intention to do so ‘unmistakably clear in the language of the statute.’” Congress did not do that, making a strong argument that the Supreme Court should decide that the IRS Rule is illegal. Separately, the Galen Institute is working with colleagues on a policy recommendation for Congress to create a safety net for those who would lose their health insurance if SCOTUS agrees that the subsidies in federal exchanges are illegal. Stay tuned for details. |
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| kbp | Dec 31 2014, 08:57 AM Post #1468 |
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'Law360 is a subscription based, legal news service operated by the Portfolio Media company a subsidiary of LexisNexis.' JeffOverley is the Senior health care reporter at Law360. This is his most recent tweet::
and
So Jeff thinks that is a good message, one that plants something to worry about in the minds of any following the #KingvBurwell case... loss of "financial assistance.' Since we're talking just more than ONE PERCENT (1%) of the US population there, I'd think the message should be he wishes to keep spending money from the taxpayers within the other NINETY NINE PERCENT (99%). That "financial assistance" is actually "taxpayers dollars." . |
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| wingedwheel | Dec 31 2014, 09:46 AM Post #1469 |
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Yes a win could possibly cause some backlash. But the law is the law. The law can't be changed by executive fiat. When elected officials pass bad laws they can either repeal it or change it by amending it in the house and senate and sending it to the president. The courts job is to interpret the law as written. But I am not sure that is what they will do. I think Roberts will bail out 0bama and the democrats again. I also think some republican will be happy to see him do it in this case. |
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| kbp | Dec 31 2014, 09:50 AM Post #1470 |
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If any go to the Vox article linked in the first JeffOverley tweet above, be warned that the math of Ezra Klien is inaccurate. Both Ezra and Jeff cite Adler's comment, taken out of context, to plant something to worry about. Ezra's article is correct about a few of his selective facts reported, but it leaves out what the KingBurwell ruling would do to the TAXES collected for "penalty" payment by the "Uninsured" and Employers. The present status of the cost estimating is blowing in the wind with executive orders altering the actual law, but the basic plan for those taxes once all are in place is charges to the tune of about $200 billion every 10 years. Ezra likes to point out there are more Uninsured in the red states, so the "richer" blue states are carrying a bigger load redistributed to the red states. There is some truth to that, mainly in certain taxes of the many added for Obamacare, so it seems silly to brag about paying a higher percentage of TAX INCREASES! Anyway, go with the 'Ezra fact' of there being more Uninsured people in the blue states. That means a greater percentage of the taxes imposed on the Uninsured and Employers will coming from the blue states ...unless SCOTUS decides the tax credits and tax increases may NOT be imposed on States that did NOT establish their own exchange. The mandate tax would then be reduced to only being imposed on the 14 States with exchanges, so that portion of the Obamacare tax & spend would be reduced by something like 72%, just counting the percentage of States participating. A 72% tax & spend reduction sounds good to me! Ezra would then be stuck trying to figure out the blue and red costs of only 14 States that established their own exchange, subject of course to any that establish one in the future. ADD: Ezra also plays fuzzy numbers on the number of States participating in the exchange game. The law does not allow the semi-participation Ezra uses to up his count of States going along with Obamacare exchanges. Edited by kbp, Dec 31 2014, 09:55 AM.
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