Thursday, August 29, 2013

Individual Mandate Regulations

The Department of Treasury has issued the final implementing regulations for the "Shared Responsibility  Payments,"  more commonly known as the "individual mandate."

A quick scan reveals no surprises, a more detailed reading to follow.

The mandate is controversial and the large role of the IRS in enforcing the mandate is also controversial.

Scaring Grandma

October 1st is a major implementation date for the Affordable Care Act (ACA), often referred to as Obamacare.

On October 1st the state health insurance exchanges will open and a new era in health insurance begins. 

There are no significant Medicare changes on October 1st.

There is a great deal of confusion, as evidenced by media reports, among Medicare beneficiaries. Some of the confusion is natural, considering the complexity of Obamacare, and some is intentional (my own political party spreading and encouraging the misinformation). And the con artists and scammers are using this to con the elderly.

The ACA does not make immediate or dramatic changes to Medicare. The ACA will make changes to Medicare, many of them in the relationship between providers and the government, many largely irrelevant to patients. The U.S. health care system will evolve into something different, impacting all of us in some way or another.

There are plenty of real problems with the design and roll out of Obamacare, there is no need to scare senior citizens.

Friday, August 9, 2013

The Provider Blues

The Other Side of the Equation

Obamacare is in the news every day, with much discussion of jobs and exchanges and insurance and many other topics. My beat is the other side, the provider side, and a great deal of confusion and chaos lives there.

What are providers supposed to be doing?

improve quality
cut costs
install complex EMR systems able to link into EHR networks
work through a massive transition to ICD-10 coding
move into a complex “big data” environment
move to innovative delivery and revenue models
(ACOs, bundling)
overall, develop and implement new and unknown clinical and business models

So what's the problem?

No one, in or out of government, can tell us what the destination is. This is a ginormous lab experiment with patients as the white mice.

ACA - Trouble in Paradise

ACA - reality sets in

A letter from union leaders to Sen. Reid and Rep. Pelosi (July 2013)

Dear Leader Reid and Leader Pelosi:

When you and the President sought our support for the Affordable Care Act (ACA), you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat. Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.

Like millions of other Americans, our members are front-line workers in the American economy. We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision.

Now this vision has come back to haunt us.

Since the ACA was enacted, we have been bringing our deep concerns to the Administration, seeking reasonable regulatory interpretations to the statute that would help prevent the destruction of non-profit health plans. As you both know first-hand, our persuasive arguments have been disregarded and met with a stone wall by the White House and the pertinent agencies. This is especially stinging because other stakeholders have repeatedly received successful interpretations for their respective grievances. Most disconcerting of course is last week’s huge accommodation for the employer community—extending the statutorily mandated “December 31, 2013” deadline for the employer mandate and penalties.

Time is running out: Congress wrote this law; we voted for you. We have a problem; you need to fix it. The unintended consequences of the ACA are severe. Perverse incentives are already creating nightmare scenarios:

First, the law creates an incentive for employers to keep employees’ work hours below 30 hours a week. Numerous employers have begun to cut workers’ hours to avoid this obligation, and many of them are doing so openly. The impact is two-fold: fewer hours means less pay while also losing our current health benefits.

Second, millions of Americans are covered by non-profit health insurance plans like the ones in which most of our members participate. These non-profit plans are governed jointly by unions and companies under the Taft-Hartley Act. Our health plans have been built over decades by working men and women. Under the ACA as interpreted by the Administration, our employees will treated differently and not be eligible for subsidies afforded other citizens. As such, many employees will be relegated to second-class status and shut out of the help the law offers to for-profit insurance plans.

And finally, even though non-profit plans like ours won’t receive the same subsidies as for-profit plans, they’ll be taxed to pay for those subsidies. Taken together, these restrictions will make non-profit plans like ours unsustainable, and will undermine the health-care market of viable alternatives to the big health insurance companies.

On behalf of the millions of working men and women we represent and the families they support, we can no longer stand silent in the face of elements of the Affordable Care Act that will destroy the very health and wellbeing of our members along with millions of other hardworking Americans.

We believe that there are common-sense corrections that can be made within the existing statute that will allow our members to continue to keep their current health plans and benefits just as you and the President pledged. Unless changes are made, however, that promise is hollow.

We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions.

We are looking to you to make sure these changes are made.

James P. Hoffa
General President
International Brotherhood of Teamsters

Joseph Hansen
International President

D. Taylor