Health Reform and Tax Implications

 

The Patient Protection and Affordability Care Act (Obamacare) will neither improve affordability, nor protect patients.  Much like Franz Kafka’s Catch 22, the name itself is an oxymoron, designed to mislead the public.  Wise physicians, hospitals and others are analyzing the law which was passed two years ago.  It has taken that long to analyze the bill which Nancy Pelosi so accurately described as, “We won’t know what’s in it until it passes.” 

My political message here is, “Why do the citizens of her district keep electing her?”  The politics of the situation obviously is that someone is funding her campaigns and many Senators and Congressmen “owe her” for deeds she accomplished for their interests in other areas of legislation. (that is the way it works, like it or not. It is what it is).

In addition to the Internal Revenue Service policing what businesses are doing about providing health insurance to employees, there are several other negative impacts upon the taxpayer wallet.

Attribution:  USAA Insurance remarks on Health Reform

Tax Tips:

Health Care Reform: What Will It Mean for You in 2013?

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Many Americans could face higher tax bills Jan. 1, 2013, as a result of four health care-reform law changes.

Here's a look at what's about to hit — unless Congress otherwise acts — and how you may be able to minimize the impact to you.

"This is a good time to give your health planning a checkup."

What's Coming Jan. 1

1. Limit on flexible spending account (FSA) contributions. Today, employers set their own caps on how much employees can contribute to these plans that let them use pretax money to pay for health care expenses. For 2013, the government will enforce a $2,500 limit per employee.

2. A new Medicare surtax on investment income. Until now, Medicare taxes have only applied to earned income. For 2013, taxpayers filing individually with wages and self-employment income above $200,000 ($250,000 for married couples filing jointly) will pay a 3.8% surtax on the lower of:

• Their net investment income — which includes interest, dividends, capital gains and other amounts.
• The amount of their modified adjusted gross income that is greater than $200,000 ($250,000 for married couples filing jointly).

3. An additional Medicare tax on wages and self-employment income for some. The existing Medicare payroll tax of 2.9% (of which 1.45% is paid by a taxpayer through payroll deductions) will be increased by 0.9% on wages or self-employment income that exceeds $200,000 for single and qualifying head of household and widow(er) filers ($250,000 for married couples filing jointly).

4. Higher hurdle for deducting medical expenses. Currently, out-of-pocket medical costs only are deductible to the extent they exceed 7.5% of your adjusted gross income. For 2013, that hurdle will rise to 10%. But if you're 65 or older, that threshold remains frozen at 7.5% through 2016.

What You Can Do Now

"Between new taxes and the ongoing rise in medical costs, this is a good time to give your health planning a checkup. Here is some preventive medicine of a financial kind you may consider:

• If you have scheduled medical procedures, don't skip them. It may pay to get them over with — and paid for — in 2012 if you can, before the higher threshold for deducting medical expenses hits in 2013.
• Continue to contribute to your employee-offered FSA. While FSAs face a maximum $2,500 per employee for 2013, they're still a valuable and tax-advantaged way to manage health costs. If you haven't missed next year's enrollment period, sign up for an FSA to divert money from your salary into this account that you can tap for qualified health-care expenses. Plan carefully, though, because under the current rules you'll forfeit any unused money left in the account at the end of the plan year.
• If you're eligible, contribute to a health savings account (HSA). Available to people with high-deductible health insurance plans, they can be purchased on your own or sometimes through an employer. HSAs give you a tax deduction for contributions and tax-free treatment of qualified withdrawals for health-related expenses. For 2012, annual contributions to HSAs generally are limited to $3,100 for an individual and $6,250 for families. (Individuals age 55 or older can contribute an extra $1,000 a year.) In 2013, the contribution limits increase to $3,250 for an individual and $6,450 for families.
• If you'll be hit by the new 3.8% surtax on investment income, consider making some portfolio moves in 2012. For example, if you're thinking of selling an investment with a $40,000 capital gain that would be subject to the tax, you could save tax dollars by selling or rebalancing this year rather than next. This also may be a good time to consider allocating more of your fixed income investments to tax-exempt bonds or tax-exempt bond funds and taking full advantage of pretax contributions to employer retirement plans.
• Plan for health expenses through every stage of your life. If you're age 45 or older, that means considering obtaining long-term care insurance — and realizing that coverage gets more expensive the longer you wait. As you explore your options, find out if your employer offers a plan, or learn what long-term care solutions are available to you. 
• Manage your Medicare benefits wisely. If you're approaching Medicare eligibility at age 65 or are already enrolled, learn how you can protect yourself against gaps in Medicare coverage.

What's on the Horizon: Health Reform's 2014 Provisions

• Insurance will be universally available. Health insurers won't be allowed to turn down applicants because of their medical history.
• Medicaid eligibility expands. Medicaid is a health insurance program for low-income Americans that's funded by the federal and state governments and administered by the states. In 2014, eligibility will expand to include Americans younger than 65 with income less than 133% of the federal poverty level. Today, eligibility varies by state and the age of the beneficiary. In most states, a parent is only covered if their income is less than 50% of the poverty level, according to the Kaiser Commission on Medicaid and the Uninsured. (For a family of four, the federal poverty level currently is around $23,000 in most states.)
• Federal help with premiums. If your household income for the taxable year is between 100% and 400% of the federal poverty level and you are not eligible for or offered other acceptable coverage, you may be eligible for health insurance premium tax credits that will reduce your out-of-pocket costs.
• Insurance becomes mandatory. If you can afford it but don't buy it, you'll generally be subject to a penalty that's being phased in over three years, starting in 2014 at a maximum of $285 per family or 1% of taxable income, whichever is greater. By 2016, the Congressional Budget Office projects the maximum family penalty will be between $12,000 and $12,500.
• New price rules. Health insurers won't be able to charge a higher premium because of an unfavorable medical history or a lower one if you're especially healthy. Rates will only vary with age, geographic location, family size, participation in a health promotion program and tobacco use.
• Insurance shopping centers. To promote availability and competition, each state will offer an online shopping exchange where consumers can shop for standardized health plans.
• A change for business owners. Employers of 50 or more full-time employees who don't offer health insurance coverage risk paying an annual penalty tax of $2,000 per full-time employee, excluding the first 30 employees. This penalty is triggered if just one employee is eligible for federal premium subsidies.

Things have gotten crazy ever since the Supreme Court upheld the healthcare reform law (PPACA).  There’s 13,000 pages of regulations and the IRS, Health and Human Services, and many other agencies haven’t even gotten started yet.  There are nearly 200 agencies and various government entities involved in the law. “It’s a delegation of extensive authority, from Congress to the Department of Health and Human Services and a lot of boards, commissions and bureaus throughout the bureaucracy,” said Matt Spalding of the Heritage Foundation. “We counted about 180 or so.”

What You May Have Missed

While there are many new health reform provisions that have yet to hit, many Americans are still trying to catch up with what's already changed. Here are the parts of the Affordable Care Act that already have been implemented:

• Closing Medicare's coverage gap. Out-of-pocket expenses are dropping for those with Part D prescription drug coverage. For now, if you reach the gap in Medicare coverage (sometimes called the "doughnut hole"), you'll get a 50% discount on covered brand-name drugs and a 14% discount on generic drugs. These savings are scheduled to grow over the coming years until the gap is completely eliminated in 2020.
• Small-business tax credit. This credit is valued at up to 35% (up to 25% for qualified nonprofits) of the amount qualified small employers pay for their workers' health insurance.
• A break for early retirees covered by employer plans. Employer health plans may be eligible for reimbursement for some of the cost of providing coverage to retirees age 55 who have not yet reached 65, if they meet certain requirements. Employers have to pass the savings along to those retirees through lower premiums, deductibles or co-payments.
• A first step to help people with pre-existing conditions. Insurance pools have been created to give access to affordable coverage. HealthCare.gov provides a simple tool to help you explore your options.
• Money burned by tanning. A 10% tax is charged for indoor tanning that isn't performed by a licensed medical professional.
• No more lifetime limits. Insurers may no longer impose lifetime dollar caps on most insurance benefits. In addition, some annual dollar limits also are being phased out.
• New restriction on canceling coverage. If your employer makes an honest mistake on your insurance application, insurance companies can no longer retroactively cancel your coverage. Insurers who want to try to rescind coverage must provide 30 days' notice to give you time to appeal the decision.
• Extended coverage for adult children. Young adults can stay on their parents' health plans until their 26th birthday — with their parents' permission. There's no additional cost beyond the normal family premium. It's a different story if you're covered by TRICARE, where you'll pay as much as $200 a month to keep an adult child between ages 21 and 26 on your policy.
• Guaranteed coverage for children. New health plans and work-based plans can't deny coverage to children younger than 19 with pre-existing conditions.
• Preventive-care changes for new private plans. Many newer plans must cover preventive care without deductibles or co-payments.
• Medicare preventive-care changes. Medicare beneficiaries no longer are charged co-payments or deductibles for many preventive services.
• A new restriction on HSAs and FSAs. Tax-free withdrawals to buy over-the-counter medicine are no longer allowed.
• A stiffer penalty for nonqualified withdrawals from HSAs. The penalty tax for nonqualified withdrawals doubles to 20%.
• Medicare Advantage plans face financial squeeze. The government's reimbursements to Medicare Advantage plans face budget cuts over the next several years. In response, these plans may be forced to raise premiums or reduce benefits, or both.

Find more ways to get prepared for 2013.

What to Ask

If you have questions about how these changes could affect your bottom line, speak with a USAA financial advisor or your tax specialist. Here are some questions to ask:

• Does my health insurance policy qualify me to contribute to a health savings account?
• Aside from helping mitigate the Medicare investment surtax, would including tax-exempt municipal bonds or tax-exempt bond funds in my portfolio provide other benefits?
• Is there an advantage to buying long-term care insurance compared to paying those costs out of pocket?
• Children can stay on their parents' health insurance policies until age 26, but are there advantages to buying them a separate policy instead?

You can find more information at the official federal site for the Affordable Care Act, HealthCare.gov.

Healthcare Reform Magazine published an article, on July 1, 2012:

Don’t Get Left Behind: What PPACA’s Survival Means Going Forward

It clearly exposes how satisfied the health insurance and intermediary organization are with PPACA.  Their bottom line is,

Move On and Comply with Healthcare Reform

Our supposed allies have abandoned the fight since their profits will be untouched or even increased.

The Tidal Wave of Bureaucracy continues.

Comments here: or at twitter/@glevin1  or email to:  gmlevinmd@gmail.com and read more here and, is it the Law of the Land ?

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McAllen Texas

 

Dangerous Assumptions in Health Reform

Attribution to :  DMCB, a brainy and literature-based resource by Jaan Sidorov

Is it time to review some of the basic tenents upon which the Accountable Care Act was passed?

Remember the Atul Gawande and McAllen Texas fracas? That New Yorker article captured the national spotlight and put a harsh glare on areas of the United States that had unexplained high rates of health care utilization. Dr. Gawande blamed the local culture of fee-for-service private practice, while the Disease Management Care Blog wondered if it was a statistical fluke and/or the burdens of a chronically ill population.

The article by Atul Gwande was published in the New Yorker Magazine and criticized by DMCB, other highly visible publications, duplicated, quoted, tweeted and distributed widely. The analytic gurus and health officials were suspicious that this analysis was flawed. Statistics can be mis-applied at times to prove anything you want, or innocently yield false results. In this case the goal of finding disparities in health costs was solely based upon Medicare's needs, and misinterpreted by all because it was restricted to billings to Medicare. Private insurer's and cash payments were left out of the data analyzed for the study.

McAllen Texas and Healthcare Utilization: A Function of Statistical Variation, Not Poor Policy

Not mentioned is that both communities are heavily influenced by demographics (high cohort of Latinos).

Some of the Affordable Care Act was based on this flawed study.

“It took a second look when that hapless locale was seized upon by Peter Orszag of the Office of Management and Budget (OMB), Consumer Reports and some notable blogs as the symbol for all that ails American healthcare. Commentators are accusing the ‘McAllens of this country’ of consciously and unconsciously economically ripping off the system with precious little quality to show for it.

Yet, the dubious DMCB (Disease Management Care Blog) and also Health Train Express at that time remained unexcited about Dr. Gawande’s faux discovery and disappointed that others haven’t considered the most likely cause of McAllen’s outlier status. Is there something really special about McAllen or is something else going on?

It took a while, but the Disease Management Care Blog finally caught up with this follow-up study on the contrast in health care costs between the Texas towns of McAllen and El Paso. “

It is the nature of our minds to believe there must be something “causing” outliers. In other words, there must be something about McAllen that attracted all those coins, right? The DMCB, in reading Dr. Gawande’s article, thinks that may be true in Miami (which is number 1 in the U.S), but it doesn’t think that's the case for McAllen as described in the New Yorker magazine article. The gumshoe M.D. reporting clearly shows the McAllen providers are mystified by their status. It’s not as though they planned to take advantage of the system. In fact, they didn’t. That’s because it’s all random.

This is important because most healthcare providers involved in quality improvement learned long ago that ‘identifying’ and then ‘managing’ outliers with targeted interventions is a poor way to promote overall system improvement. Outliers naturally regress to the mean over time and they're not the problem anyway. Rather, the trick is to reduce overall variation around the mean (reducing the standard deviation) and to move all providers toward a better average level of behavior. That’s a lot of complicated work that, frankly, isn’t as enthralling to editors or the readers of The New Yorker. It's too much work.

DMCB summarized,

“While popular media can be forgiven for using simplistic descriptions of extreme outlier anedotes to pander to a political agenda, the DMCB isn’t too sure about Dr. Gawande. However, the DMCB is most frightened by potential reaction of the OMB. Short of complete central planning for the entire health care system, random distributions of performance, expense, quality, claims, satisfaction and countless other measures around a mean will be unavoidable. Of all persons, Dr. Orszag should understand that outliers are an ironic certainty, not evidence of malfeasance. Most are anomalies, not proof of anything. They are, in short, interesting, but not lessons and certainly not the stuff of policy making. “

 

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Why Obama Care Is Still No Sure Thing

 

Part I

The majority of state governors are Republicans, and they have the power to disarm the health-care law.

by  James Capretta and Yuval Levin  from the Wall Street Journal

“Champions of Obama Care want Americans to believe that the president's re-election ended the battle over the law. It did no such thing. The Patient Protection and Affordable Care Act won't be fully repealed while Barack Obama is in office, but the administration is heavily dependent on the states for its implementation.

Republicans will hold 30 governorships starting in January, and at last week's meeting of the Republican Governors Association they made it clear that they remain highly critical of the health law.

States still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both.

At its core, Obama Care is a massive entitlement expansion. Between vastly increased Medicaid eligibility and new premium subsidies, it is expected to bring 30 million more people onto the federal government's entitlement rolls. The law anticipates that the states will take on the burden of implementing the expansions, but states can opt out of both.

Running the exchanges would be an administrative nightmare for states.

The exchanges would create unsustainable pressures on each state's insurance market, treating similarly situated people differently by providing far greater subsidies for those in the exchanges than those in employer plans—yielding perverse incentives that distort consumer and employer decisions and increase costs.”

There is no denying that federal regulations always mandate ‘workarounds’ to overcome perverse incentives and penalties imposed by new regulations.  Obama care will be one of the worst.”

 

REASONS-TO-OPPOSE-EXCHANGES

This white paper from the “Citizen’s Council for Health Freedom”, details the flawed Health Insurance Benefit Exchange.

““President Obama won re-election and Democrats maintained control of the Senate this month, but the states hold the future of Obama Care in their hands. Knowing the harm the law would do to their citizens, to the economy and to American health care, governors should refuse to become its enablers.”

Mr. Capretta is a fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute. Mr. Levin is a fellow at the EPPC and editor of National Affairs.

Part II to follow…………………….

 

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mHealth Summit at the Gaylord Convention Center

 

December 3-5th, Starting today .  #mhs12

The largest event of its kind, the 4th annual mHealth Summit brings together leaders in government, the private sector, industry, academia, providers and not-for-profit organizations from across the mHealth ecosystem to advance collaboration in the use of wireless technology to improve health outcomes in the United States and abroad. mHealthSummit.  This year (2012) the focus is on mobile health apps. As expected and predicted mobile health and apss have been and will be a developers heaven.

If you are like me you can enjoy regular updates by subscribing.  This year’s summit is being held in Washington D.C. at the Gaylord Convention Center.

Today, Monday 12/03/2012 

On the tweet #mhs12 table of contents: (a sampling of today’s morning tweets)

http://www.complete-digital.com/

http://www.techurself.com/

http://www.disruptivewomen.net/

http://techchange.org/

http://chilmarkresearch.com/

http://startuphealth.tumblr.com/post/36758636894/24-hot-mhealth-companies-featured-at-the-startup-health

 

In addition to the StarUp Health Mobile Health Pavilion, StartUp Health’s CEO Steven Krein will moderate a dynamic roundtable featuring a diverse group of the country’s leading thought leaders in mHealth innovation. The panel will be interactive and be taking questions from the audience.

 

 

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It’s The Law of The Land, or is It?

 

For those who state “PACA is the law of the land, so get on with it”; they are sadly mistaken. While our goal is and should be a system that is universal, accessible and affordable to all...PPACA is on a course to certain death as the cancer of bureaucracy overwhelms our ability to pay for it, as will also gridlock our current system. We as physicians and healthcare providers simply can not nor should not sit by idly to let this poorly devised system be set in stone. (author: gml)

The battle begins:

Stuart Taylor, Jr. is an author, journalist and nonresident fellow at the Brookings Institution, and this work is attributed to him.

Analysis: Health Exchanges And The Litigation Landscape

The pending challenges to the law, and related regulations, range from the Goldwater Institute's claim that it gives the Independent Payment Advisory Board unconstitutionally broad powers over Medicare services and payments, to the more than 35 lawsuits by religious employers attacking a Department of Health and Human Services rule that requires them to provide their employees with insurance that covers women's contraceptives without a copayment.

The broadest and potentially most damaging of the legal challenges turns on whether Congress intended that tax credits and subsidies to help consumers buy health insurance be available only through state-created exchanges. Many states are signaling that they may not create their own exchanges, leaving the federal government to do so, as the law requires.

If subsidies and tax credits aren't available in states with federally run exchanges, conservative legal scholars say, then two other lynchpins of the law would also be undermined: the requirements that employers of a certain size offer insurance and that most individuals buy insurance.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Last year, the Internal Revenue Service issued an interpretive rule saying that federal exchanges also would have the power to distribute the tax credits and subsidies.

But Oklahoma Attorney General E. Scott Pruitt, a Republican whose state has refused to set up an insurance exchange, has urged a federal district court to invalidate the IRS rule and thereby nullify the employer mandate in Oklahoma.

With only 17 states having so far committed to creating their own health insurance exchanges -- in part because of concern that the administration has not provided clear guidance on how they should work -- more lawsuits could be on the way, brought by states, employers or both.

These arguments are detailed in a paper to be published in Health Matrix by Adler and Cannon. There are, of course, also forceful counterarguments.

All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us. Learn more

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Sun Tzu and the Art of EHR Adoption

Sun Tzu and the Art of EHR Adoption

TEDMED Greatest Health Challenges

 

Social media for medicine is having a far greater effect than even many pundits predicted.

If you have an idea, post it to your network, and I find using all of them exponentially increases your influence…right or wrong. That requires credibility and reliable sources of information as well as a thick skin. I find there are always smarter (than I am) readers out there willing and able to challenge you. It also requires the proper attribution for the original source. I like to put it in quotes, and then I add my humble by proceeding it with [authors comments].  So far, no letters from attorneys and no inquiries from the Department of Homeland Security.

TEDMED is now producing Google Hangouts every Thursday morning at 11:00 AM on the Greatest Health Challenges.

Thus far there have been two events which I have embedded here:

The Role of The Patient

The Care Giver Crisis

As these proceed I hope to include these in my blog on Thursday.

You will find these videos on the YouTube Channel for Catherine Andrews When you subscribe to her channel, you will receive an email to remind you of each broadcast.

 

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Year End Special Edition about Sources for Health Information for Social Media

BLACK FRIDAY and Health Care

 

What we need is a Health Care Black Friday !  Yes, fellow Friday shoppers here are the stats derived from a ‘big blue’ (IBM) for you Gen Xers) data dive. Why is IBM  watching mobile?

• Online sales are up 20 percent for this same time period over Black Friday 2011.
• The number of consumers using a mobile device to visit a retailer’s site is at 28 percent, up from 18.1 percent in 2011.
• The number of consumers using their mobile device to make a purchase is 14.3 percent, up from 10.3 percent in 2011.
• Shoppers using the iPad led to more retail purchases more often per visit than other mobile devices, with conversion rates reaching 4.2 percent, higher than all other mobile devices.
• Shoppers referred from social networks like Facebook and Twitter generated 0.18 percent of all online sales on Black Friday.

So, you might be wondering how IBM gets all this i

In fact the internet humming (or is it buzz?) on Thursday, soon after that turkey/ham/prime rib) begins .

All Things Digital reported statistics from yesterday.

Last year, it was Cyber Monday — this year, it’s turned out to be Mobile Thursday. What’s next? Social Network Saturday? Self-Driving Car Sunday? (We still have Black Friday, by the way, which is today.)

And, indeed, the Mobile Thursday phrase got some big laps around the track, with numerous online shopping surveys — coming out faster than you can buy that new tablet — using it in their flash reports yesterday and today.

This year’s anecdotal meme: Apple iPads go well with pumpkin pie.

Black Friday is “SOCIAL” as evidenced by the following video.

The poignant focus of All Things Digital’s article,

“If you think about consumers, and you think about the amount of technology that they have at their hands, to reach out to read reviews and talk to friends and families, they’re incredibly empowered. There’s not one purchase decision that they make that is not impacted by some element of social networks. What does that do to the companies that have to deal with that by offering the best products and services, and you see companies are struggling to do that: To make the right offer at the right time with the right price. When they do it well, we all talk about how it went well; and when they do it badly, we talk about how annoying it was.” Is it this way with Health Care (YET) ?

Has this phenomenon spread to Health Care?

I would like to see IBM use their analytics on health consumer habits.

Here might be some of the things patients might search for after dinner.

1.  Bloated feeling in abdomen

2..Nausea when thinking about breakfast the next AM

3..Severe headache after drinking wine with dinner

4..Somnolence after dinner

5  Stimulants after dinner

6. Channel line-up for Football

7. Channel line-up for sports reporting

8. Google maps for directions to home

9. Google maps for directions to Best Buy, Target, Wal-Mart, Sears or nearest mall.

Sirius most frequent question, “Where are the best deals today?”

So Black Friday and Health care have much in common.  They are both social.

I have an idea for the next “Developers Challenge”

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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

Technorati Tags: obamacare,black friday,cbo,aca,affordabe care act,medicaid,medicare,health insurance exchange,subsidized health insurance,election results,enroll america

Tidal Wave Of Health Law Rules Expected In Days And Weeks Ahead

 

Kaiser Health News reports;

With the national health law’s political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law’s complex components.

I expect my Twitter stream(s) to be flowing on many of these topics, as well as commentary on blogs, Facebook, the Wall Street Journal Health pages, and others.

States and insurance companies had put on hold the many changes necessary to comply with PPACA.  The outcome of the 2012 Presidential campaign was murky enough for Secretary of HHS, Kathleen Sibelius to delay state decision making in regard to their intent to participate in Health Insurance Exchange organization and participation using Federal funds.

The anticipation so far has been focused on rules that determine how the new state-based insurance marketplaces called exchanges will operate. But also closely awaited are decisions about how the government will tax medical devices, allot the shrinking pool of money for hospitals that treat the uninsured, and determine how birth control insurance coverage can be guaranteed for employees of religious schools, universities and charities.

Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.

Medical Device Excise Tax. Last February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.

Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures, like dental instruments and latex gloves? Does the tax apply to kits—two or more medical tools packaged and sold together—even if the manufacturer of each individual component had already collected the tax when it was sold to the kit maker?

Brendan Benner, a spokesman for the Medical Device Manufacturers Association in Washington, D.C., said companies are making marketing and sales decisions based on what they expect will happen, but that presents problems. "When you don’t know what the answer to the question is, it’s hard to make a decision," he said.

Hospital Payments. Between 2014 and 2019, the government will cut $36 billion out of the money that goes to hospitals that treat large numbers of poor patients. The cuts were included in the health law under the rationale that many currently uninsured patients would be covered either through the expansion of Medicaid or through subsidized insurance.

The administration has to figure out how it will allocate those cuts among hospitals—a task made more complicated by last summer’s Supreme Court ruling that allows states to opt out of expanding Medicaid. 

Insurance plans. For the administration, some of the trickiest decisions concern how insurance policies must be designed, priced and sold starting next October, when open enrollment begins for the new online marketplaces, called exchanges, that will offer plans to individuals and small businesses. For instance, the law allowed insurers to alter their prices for people based on their age, family size, where they live and tobacco use. The Department of Health and Human Services has to determine how insurers can go about setting those prices.

Political Cartoons

Bundled Payments The administration has already gotten off the ground two major changes to the way the government pays hospitals and doctors. One designates accountable care organizations that reward hospitals and doctors for working together to provide more efficient care. The other begins to pay hospitals on the quality of the care they provide through the value-based purchasing program. By January, the law calls for the government to launch another major initiative: bundled payments. 

Republican Govs' Decision To Forego Exchanges Will Bring In Federal Option, Others Still On Fence

HHS Delays Health Exchange Decision Deadline To Dec. 14

States Declare Their Health Exchange Intentions

This report can also be found at Digital Health Space

 

Technorati Tags: health benefit exchange,hhs challenge,aco,bundled payment,medical device taxes,kaiser health news

Web Health Awards

 

Follow the Web Health Awards on Twitter #whasf .

Today through Wednesday a series of important announcement occurs from Web Health Awards. 

The awards program is organized by the Health Information Resource Center[sm] (HIRC), an 19-year old clearinghouse for professionals who work in consumer health fields.

The Web Health Awards, and the new Web Health Awards | MOBILE are extensions of the HIRC’s 19-year old National Health Information Awards[sm], the largest program of its kind in the United States.

Because of the dynamic nature of digital health resources, the Web Health Awards competition is held twice each year: Winter/Spring and Summer/Fall.

 

 

Entry Classifications
Organizations submitting entries for the Web Health Awards and the new Web Health Awards | MOBILE must select an Audience (Consumers or Health Professionals) a Division (type of organization that produces the entry) and a Category (type of entry being submitted). Web Health Awards | MOBILE features a subset of entry categories focused specifically on mobile devices.

(Click here for a detailed list of entry classifications)

All winners in the Summer/Fall 2012 Web Health Awards receive international recognition on webhealthawards.com, a colorful award certificate, a listing of all winners, national publicity from the HIRC, and a one-year license to use the awards program logo for marketing and promotional purposes.

The National Health Information Awards 

Now in its 19th year, the National Health Information Awards program honors high-quality consumer health information. The awards program is organized by the Health Information Resource Center (HIRC), a national clearinghouse for consumer health professionals who work in consumer health education fields.

These awards reward developers of mobile health and other software application for healthcare monitoring, coaching, and tracking treatment plans.

Health Train Express and Digital Health Space share in congratulating and promoting the awardee’s innovative work.

 

Technorati Tags: health information awards,mhealth,mobile,hirc web health awards

15 Healthcare Leaders Who have Something to Say

 

2012 has seen the rapid development of mobile health applications and more public awareness of home based preventive medicine, mobile coaching and data tracking using smartphones, and table PCs.

Then in November, after a long and contentious presidential campaign health reform  the PPACA became center stage, although it was replaced by the economic crisis, the Benghazi Embassy attack,  and finally the General Petraeus scandal. 

Public opinion remains deeply divided on how to initiate health reform. Some are exhausted by the battle which was lost by a very narrow margin in the closest Presidential campaign recorded in recent memory. Some now want to roll over and state PPACA is the ‘law of the land’, and ‘resistance is futile.

Significant professional and public reticence remains to initiate parts of PPACA, stemming from loss of local and regional controls, fiscal responsibility in  a time of crushing debt and the partisan manner in which the law passed.

Those who still feel strongly will plan to stop or delay it’ implementation attacking the law on the basis of state’s rights, constitutional issues, restriction of free trade, and ethical issues during the bill’s promotion by Health and Human Services.

 

some of the most memorable quotes from healthcare leaders during the past year. Check out our favorite quotes and the leaders who said them:
 

1. "It's not hotel amenities. It's not china plates for meals. While those things are very nice, a true patient/family-centered care model is really at the core of the heart of care."
Who said it: Michele Lloyd, vice president for Children's Services at NYU Langone Medical Center,

 

 

2. "In a Muggle world--the world we live in--the provider can't go into the room of paper charts and flourish their wand and say, 'All the patients with diabetes!' and the charts fly out and hover in the air. 'All those who didn't come back to see me, over here!' Send in an owl."
Who said it: Health IT coordinator Farzad Mostashari, M.D., discussing the problems with using paper records at CHIME's Fall CIO forum last month.

3. "People might think you're crazy by giving out all those contact numbers. When I first did it, the staff thought it was a bad idea. They said, 'You'll never have time to do anything else besides answer the phone.'"
Who said it: Windsor Regional Hospital CEO and President David Musyi, a FierceHealthcare advisory board member, who has taken an unconventional approach to patient and staff communication, freely giving out his email, office number, home number and cell number to the public.”

Openness and transparency often simulate better communications with less time involvement. Many studies have shown that opening access leads to a paradoxical decrease in demand upon time, quicker resolution of challenges and increased efficiency. Organizational restructuring can lead to reduced costs and less bureaucracy.
 

Technorati Tags: ppaca,bengazi embassy,borg,obamacare,fiercehealthcare,David Musyi,Michele Lloyd,Farzad Mostashari,chime,NYU Langone