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Friday, November 23, 2012

Happy Thanksgiving….now for BLACK FRIDAY


Health Train Express and Digital Health Space wish you all a very pleasant holiday Season. 

While you are awaiting the festivities here is the offering, along with the pre-game snacks and drinks (and football)


Election Results ! It's over, or is it ?

Health Train Express (me) spent the past 36 hours watching reactions to President Obama's re-election with a clear majority of electoral college votes, and a narrow margin in the popular poll count.

Business interests remain very vocal about the delay in economic recovery with Obama's plan. Some corners attempt to remain optimistic about solidifying plans for growth, hiring, and analysis of the ACA for health reform. However, when the boots hit the ground emotion is overridden by the hard cold facts of mandatory health insurance (which is a good idea), and the merging of health insurance premiums with the  (ie, buy health insurance, pay a fine, or have your assets levied or seized) and a multiplicity of tax changes on January 1, 2013.

In healthcare there is one side that remains fervent about reform that will provide coverage to all citizens. In a country such as ours it is truly shameful this has not come about by now. Perhaps we have been involved in too many military actions. Ten or more years of military engagement using increasingly high tech weapons that minimize risk and casualties to our forces almost begs the question how and why do we expend as much on defense as on health care for our citizens.

Responsible participants examine ObamaCare and see a good beginning in it's framework, and a good chance of it being amended so that it truly is affordable to the country as a whole, while assuring adequate coverage for all.

The healthcare community remains divided, some of it on the basis of analysis of what it will cost providers, hospitals, with the addition of 'cost saving' health information technology. That claim has yet to be demonstrated. The transition from procedural billing codes to an as yet undefined paradigm other than the hospital DRG system or capitated prepaid payment plan is another major factor in health reform. Couple this unknown with the proposed accountable care organization whose payment system is a combined incentive/penalty system based on outcomes and reduced admission rates, remains largely un-defined. Also added to the task is conversion to a new expanded ICD 10 code system. Each of these tasks is in and of itself, an added burden.

While if and when this occurs health providers and hospitals will deal with a dual reimbursement system simultaneously for a time and perhaps indefinitely as business, insurers, and health insurance benefit exchanges face the task of which system and/or which ACO with which to do business.

There will be a significant number of outliers who will not participate in ACOs. In some regions which are rural there will be little competition and difficulty organizing an ACO with adequate coverage.

All of this places an unduly large task of responsibilities for timely conversion on the provider and hospital to meet yet another edict from HHS.

Here are some individual issues and opinions:

Its place assured alongside Medicare and Medicaid, President Barack Obama's health care law is now in a sprint to the finish line, with just 11 months to go before millions of uninsured people can start signing up for coverage.

But there are hurdles in the way.

Republican governors, opposed to what they deride as "Obamacare," will have to decide whether they somehow can join the team. And the administration could stumble under the sheer strain of carrying out the complex legislation, or get tripped up in budget talks with Congress.

"The clarity brought about by the election is critical," said Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation. "We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges. But we are on a very positive trajectory." 

In the two years since passage of the Affordable Care Act, the Obama administration has been consumed with planning and playing political defense. Now it has to quickly turn to execution.

States must notify Washington a week from Friday whether they will be setting up new health insurance markets, called exchanges, in which millions of households as well as small businesses will shop for private coverage. The Health and Human Services Department will run the exchanges in states that aren't ready or willing.

Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.

In all, more than 30 million uninsured people are expected to gain coverage under the law. About half will get private insurance through the exchanges, with most receiving government help to pay premiums.

The rest, mainly low-income adults without children at home, will be covered through an expansion of Medicaid. While the federal government will pay virtually all the additional Medicaid costs, the Supreme Court gave states the leeway to opt out of the expansion. That gives states more leverage but also adds to the uncertainty over how the law will be carried out.

A steadying force within the administration is likely to be HHS Secretary Kathleen Sebelius. The former Kansas governor has said she wants to stay in her job until the law is fully enacted. "I can't imagine walking out the door in the middle of that," she told The Kansas City Star during the Democratic convention. Her office declined to comment Wednesday.

Republicans will be leading more than half the states, so governors are going to be her main counterparts.

Some, like Rick Perry of Texas and Rick Scott of Florida, have drawn a line against helping carry out Obama's law. In other states, voters have endorsed a hard stance. Missouri voters passed a ballot measure Tuesday that would prohibit establishment of a health insurance exchange unless the Legislature approves. State-level challenges to the federal law will continue to be filed in court.

But other GOP governors have been on the fence, awaiting the outcome of the election. All eyes will be on pragmatists like Chris Christie of New Jersey and Bob McDonnell of Virginia, whose states have done considerable planning of their own to set up exchanges.

Bloomberg Business Week goes into greater detail on the decisions states and the feds must make very soon.

Part and parcel for Health Care Reform and the Health Care Act is to help people understand the Act. Louis W. Sullivan, former Chief of HHS.

Although senior voters trusted both candidates with the future of the Medicare and Medicaid programs, and though the American people were deeply dividedregarding the Affordable Care Act, 45 percent of voters saying the law should be fully or partially repealed and 47 percent wanted it intact or expanded, in the end President Obama won the election and now faces the challenge of grappling with these issues over the next four years, especially health care.

Louis W. Sullivan clearly states he is strongly in support of the Health Care Act,

“Thus, I believe the principal imperative for President Obama is to focus on the law’s implementation since it is his landmark achievement, putting the United States on a path to universal coverage. Specifically, I believe the president should first give priority to communicating to the American people how the complex law works.Although the law was passed by the Congress more than two years ago, many Americans are still confused, trying to figure out what it means for them and their families. This unfortunate situation has its roots in the fact that President Obama and his team did not get the facts out sufficiently in 2010, before the opponents of the legislation were able to successfully spin the issues and confuse the public even more.”

So who will the act benefit?

Millions of Americans will be eligible for subsidized health insurance under the Affordable Care Act, starting in 2014.

Most of those people, however, have absolutely no idea that they’re qualified to sign up.

“More than three quarters of the uninsured who will be eligible for coverage, either in Medicaid or the exchange, are unaware of those new opportunities,” says Ron Pollack. He chairs the board of Enroll America, a nonprofit aimed at ensuring that Americans do get coverage.

Enroll America has been around for about a year now. It’s meant to be a temporary organization, solely devoted to ensuring that people know about the benefits coming online in 2014.

The CBO estimates that the health reform law will cover 30 million more Americans in 2022. But it also predicts that 30 million Americans will remain uninsured. Some will be illegal immigrants, who aren’t eligible for the reform law’s insurance subsidies. About 6 million are expected to live in states that do not participate in the Medicaid expansion.

That still leaves millions of Americans eligible for benefits but not enrolled. The CBO, for example, expects that nearly 6 million of those newly-eligible for Medicaid just won’t sign up for the program. They already have some reason to be skeptical: The health law’s High Risk Insurance Plans, meant to be a bridge to 2014 for those with preexisting conditions,have seen lackluster enrollment.

This leaves open a pretty wide playing field for a group like Enroll America. If it does its job really well, the number of Americans who go way past 30 million. If it doesn’t, the number who sign up could fail to meet CBO projections.

Now that the Affordable Care Act is here to stay, Enroll America is about to kick into high gear: They have a little over a year to educate millions of Americans about the new benefits that they’ll have access to, and how to get them.

Enroll America has contracted with two research firms to figure out how best to communicate with potential beneficiaries, what might be the best messages and who would be best to deliver them. The group recently wrapped up a national survey on questions like these, and is now sifting through the results.

They will start next week with focus groups in three cities aimed at answering these same kind of questions. “The focus groups will drill down on key demographic groups that can be disproportionately helped by the law,” Pollack says. 

In the coming months, they expect to start convening other nonprofits, as well as officials from Health and Human Services, to share research on best messaging strategies. 

Pollack also hopes that  with the Affordable Care Act’s fate secured, fundraising for his group might become a little easier, too.

And with that…………let’s get on with “BLACK FRIDAY”

NOTE: This post will not be duplicated at Digital Health Space

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