House Bill Links Health Care Law and Budget Plan

 

Your Health and How has it become a “Crap Shoot”

Politics and health never have been a good mix. The outcome of the evolution of what political game playing and mixing the financing of health with political greed for power is now evident. While Medicare which was put into effect in 1964 has benefited millions of the elder population it too was passed without concern for cost and more important input from physicians (who were largely ignored when they warned it would eventually bankrupt the country. ) Congress was warned by many physician groups that the demand for healthcare can be infinite and by treating Medicare as another insurer without restriction would inflate the national debt and fuel medical inflation.

Despite many wars much of our national debt can be attributed to Medicare liabilities current and future. Now the surge in Gen X, Y and Millennial adds to the disaster. Coupled with the national recession and evolution of the global economy it all crystallizes into what we now face.

Today's New York Times:

 

House Bill Links Health Care Law and Budget Plan

Sylvia Mathews Burwell, the White House budget director, told executive branch officials to begin preparing by updating their contingency plans. This has become so common that we now have what is a several thousand page manual on shutting off our government.

All or none? The Congress is using our health care as a political football. Neither side will not negotiate and it has gradually evolved into the present quagmire. Congress is having it's usual tantrum and is acting out it's negligence. 2010 was the time when this might have been avoided if the law was read and experts were allowed to apply the appropriate fixes to the bill(s).

“House Republicans muscled through a stopgap bill Friday that would fund the government only if all spending for President Obama’s health care law is eliminated. Senate Democrats and President Obama quickly made it clear they had no intention of going along, putting the government on a course toward a shutdown unless one side relents.'

'The 230-to-189 party-line vote in a bitterly divided House set in motion a fiscal confrontation with significant implications — politically and economically — but with an uncertain ending. Without a resolution, large parts of the government could shut down Oct. 1, and a first-ever default on federal debt could follow weeks later.

Each side predicted that the other would be held responsible, but determined House Republicans knew they were taking a risk even as leaders of the party’s establishment warned about the threat of destructive political consequences.'

Mr. Obama called House Speaker John A. Boehner on Friday evening but only to reiterate that he would not negotiate with him on raising the federal debt limit and said it was Congress’s constitutional obligation to pay the nation’s bills. Both sides described the call as brief and fruitless.

Congressional gridlock. It occurs frequently, not just in healthcare. We pay our Presidents and Congressmen well enough to do the 'people's business'. Through a variety of decisions government has forcibly intruded into your physician's and hospitals duties to provide for your health. The football has been intercepted and a one hundred yard game ending run to the goal is now in progress.

The conundrum is that Congress is really not interested in health....it is only interested in a 'victory dance' sponsored by either Elephants or Donkeys. The result will be a stable full of excrement on the floor....needing to be mucked out by the people's assets in the name of taxes and debt to foreign countries.

There must have been a better way to accomplish this goal.

A brilliant physician, Donald Berwick MD, was run out as head of HHS by his choice of words regarding the NHS of the U.K. Berwick is a highly respected former head of the Institute of Medicine, a credible authority on medicine, but a novice in the world of American politics. Our country has an anaphylactic reaction to words such as 'socialism','entitlement',

Berwick holds a position at Harvard Medical School. His N.H.S.remark was poorly worded and timed also a politically unwise statement in public about his wishes for our US health system. Other physicians, including Mike Leavitt and others have been ground up and spit out by politicians. Congress defies expert opinions in many areas of their decision making. Their bad choices overflow into all areas of society, from IT to immigration.

My health is not a Republican vs. Democratic issue....to be kicked around for political expediency and headline news. Nor should it be for you either.

The real truth is Obama's statement when speaking to a labor group,

““They’re focused on politics,” Mr. Obama told autoworkers at a Ford plant in Liberty. “They’re focused on trying to mess with me; they’re not focused on you.”

Mr. President, no one is focused on your narcissistic goal of being the President who forced the wrong treatment on our health system. Inaccurate dosing, error in prescribing and malpractice.

(see non-disclaimer and waiver on the right hand banner.)

September 21, 2013

GML

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Fait Acompli ? Affordable Care Act

The top of this week’s health news have been the  debate over funding Obamacare and the Debt Ceiling.  There is little doubt that funding the Affordable Care Act will increase the National Debt.  Without accomplishing this the Mandate will be an empty one.

As we mentioned previously politics and health care do not mix well, they are immiscible.  They are two individual complex entities and mixing the two results in a ‘melt down’. The National Debt has become inextricably bound to health care financing as funding from government sources has increased as a percentage of GDP

 National Debt Clock is running.  Of course there are other contributing factors which are in the equation as outlined by this Bank of America Analysis/Merrill-Lynch white paper published in February 2013.

The Republicans know this and despite the unpopular act of closing the federal government they have stood fast, believing that the Affordable Care Act would severely impact the short and long term recovery of our economy. In the political scheme of things (which often are irrational) Republicans have much more to lose by alienating more Americans as the enemy of social progress and Democratic proclamation that Republicans are obstructionist bent on defeating Obama’s singular accomplishment, the Affordable Care Act.

This week signals the opening round of the Health Benefit Exchanges which will allow consumers to search health plans in their state and to register for them. The most significant portion of consumers are those that are presently uninsured.

News this week clearly shows that less than 50% of the population know anything about Affordable Care Act, and even fewer understand or how to access Health Benefit Exchanges (HBE)  This week many kiosks are popping up at shopping malls answering questions and distributing literature about the ACA.  I don’t think this is part of the “NAVIGATOR’  program.  It is most likely budgeted from the marketing budget announced by HHS.  Rumor has it that funds have been limited due to ‘sequestration’.

HBE is one form of Health Information Technology which directly impacts consumers as a necessary focus, unlike mobile health apps.  Because January 1, 2014 is the commencement data for eliminating  prior illness or increasing rates due to prior conditions, the enrollment period is brief. (however like all government programs lately it will most likely be delayed)

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Hurricane Medicine

 

 

No, the title is not about weather or tropical storms. The current cyclone is in health reform, specifically the Affordable Care Act. I think we should stop calling it  ObamaCare.  Labelling any piece of legislation or policy ‘Obama…..” elicits strong reactions, either positive or negative and it triggers partisan political loyalties.

The swirl of controversy regarding the Affordable Care Act continues as it is approaching a category 3 intensity.  The storm has made landfall with it’s outer bands on shore.  The eye of the storm remains offshore tracking along parallel to the beaches, and it is currently stationery pounding health care and the economy with uncertainty.  Should we board up the windows and evacuate or continue to battle with sandbags and a storm shelter.

The Affordable Care Act infrastructure is not complete in many states.  HBX amounts to a health information technology portal (clearing house).  No one installs a new computer system without ‘bugs’.  The platforms may have worked well in the “alpha” rollout. This week we are in the ‘beta’  test.  Betas are never stable and anyone receiving an invitation to use new software is   always warned that it may be subject to unexpectd ‘bugs’.

Our government in it’s proclivity to prove the Affordable Care Act has opened the first act with an unproven system.  This could be a fatal error.

Standard operating procedures for high tech new venture is a competitive process before the contracts are awarded. This project involved over 300 million Americans.

The Air Force gives out contracts for aircraft only after a rigorous planning and demonstration project. No company such as Boeing or Lockheed is going to demonstrate their aircraft to buyers without a very high probability of success. Having your product crash or fail miserably to meet the standards will lose the battle..

 

Success                                                          Failure

This is the way it should be in  not only health care but many areas of government. No doubt this program was let out to bid several years ago using standard grant process.

Anyone who applies for a Federal or State Grant realizes the complexity and length of time to  navigate the process.  It is so complex that specialized grant writers and companies offer these services to enterprises that want a grant.  Some times ‘form’ outweighs ‘function’.

The workings of the individual mandate are striking the shores, and very soon the inner bands of the employer mandate will strike shore.

The Affordable Care Act portends to improve patient wellness, access, and affordability.  Much of this is yet to be demonstrated.

ObamaCare and You: The Health Insurance Marketplace and Small Business (from Health Works Collective)

Small business experts tell a different story than what we are hearing from media sources:

John Arensmeyer is founder and CEO of the Small Business Majority, a nationally recognized small business organization and advocacy group on critical public policy issues facing America’s small businesses —including health care reform. Arensmeyer has said that the Affordable Care Act (ACA) will help lower small businesses' high healthcare costs and give them more choice in the insurance market.

Here are some of the  items discussed:

What is the SBM looking for as the ACA goes live?   Our primary focus is making sure small businesses know what their options are. That they know about the small business exchanges or the individual exchanges. That they have the facts and know if they have any responsibilities -- which most of them don’t, if they are under 50 employees -

What small businesses are leaving insurance for their employees to solve and dropping any existing insurance coverage(s) they currently have for them?

JA: We haven’t heard many stories of that from around the country. There are businesses that have been unable to provide and they’re not all of a sudden going to begin providing. But in terms of businesses that have been providing thinking of dropping it, no, they are thinking the other way, looking at the options in the new marketplaces and seeing if they can continue to offer. 

Will enough healthy folks sign up to balance the sick and newly covered?

JA: Yes, that’s one of the major cost containment features of the new law.

Will exchanges generally feature a narrower network of doctors and hospitals than SBM would prefer? Do you see any hope for expansion?

JA: We don’t see a narrowing of networks within the plans at the moment.

What if any special issues or challenges will you be monitoring?

JA: The biggest issue for us is seeing how information is being understood, or not, by small business owners and how we can improve that. Now we’re making sure that owners know what their options are, making sure that agents and brokers working with them know how the system works. We’ll be looking if there are breakdowns in any of that and how we can fix it.

HWC: What has surprised you about the rollout thus far?

JA: We’re pleasantly surprised by the sheer volume of interest. It’s created some technical issues, but in a way it’s a good problem to have. We’d rather have reports of glitches than reports of no one showing up.

Lot’s of surprises there.  Have we been mislead ?

 

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How did you learn about Obamacare? Social Media

 

At least in name the first stage of Obamacare is here.  With the official opening pitch both federal and state Individual health benefit exchanges have their online portals working or flashing messages when they will be accessible.

I had a chance to test several state portals for health benefit exchanges. The best one is healthcare.gov a central clearing house that directs traffic to the individual state exchanges.  This morning it took 20 seconds to load, actually not a bad load time compared to other web sites.

The portal in California (CoveredCalifornia.com) has a calculator to estimate eligibility and subsidies. It also outlines several levels of plans, the approved insurers and the estimated premiums..

Obamacare does little to change what is required from providers. In  some states the insurers on the HBX are limited.

 

 

 

It mostly impacts insurers to provide a standard benefit package, limit their profits, and determines eligibilty for subsidies and/or tax credits.

The biggest change for consumers is the individual mandate and the employer mandates.  This is put in place to offset insuring the uninsured and  uninsurable with pre-existing conditions.

Another very interesting question is how the reader learned about Obamacare. One of the answers is ‘SOCIAL MEDIA”.  That was a first for this writer.  It confirms how important social media has become in our society.  Social media is not just optional and the use of the internet becomes almost essential for banking, navigating marketplaces,shopping, and for mobile health as well as telemedicine.

No one factors in the dividend from a healthier population, with good preventive care, nor the decrease in disability from chronic disease by early treatment. The additional infusion of capital into health care facilities will stimulate our lagging economic recovery.

The transition period will be a challenge for some, and flexibility is essential to make this acceptable to business and individuals as well.

Effect of Government Shutdown on Medicare

 

MEDICARE

To date, not a single one of the 12 appropriations bills required to fund the government have been signed into law.  Among other things, this means that as of midnight tonight, there is technically no money available to pay the salaries of federal employees (including Members of Congress and their staff), pay the utility bills for government buildings or fund grants made by the federal government.

The IRS is closed

Finally, it should be noted that this appropriations impasse is unrelated to the upcoming Debt Limit debate that will ensue in a few weeks. Like the Appropriations problem, the failure of the Congress and the President to agree on legislation raising the Debt Limit could also result in a government shutdown.

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Marketing the Affordable Care Act

 

Infographic for Affordable Care Act

Countdown for the Affordable Care Act and Covered California

In my travels and daily life this week I have been surveying most people I meet. These are ordinary citizens, single Moms, minimum wage workers. My cohort has been fast food employees,  real estate agents, truck drivers, taxi drivers,  and the type of people we run across every day (In California).  This is not a scientific study.

Few if any of them have reliable and/or affordable health insurance, and I doubt if the figure of 8 million uninsured in California is correct.   I really don’t think statistics are that important except to number crunchers who seem to manipulate numbers to prove their point or determine what it will cost to implement the Affordable Care Act.  You are either insured, or not insured.  Many who have ‘Medi-Cal have it only in name…high shares of cost sometimes as much as 2,000/month and unable to access health coverage due to pre-existing conditions.  The devil is in the details and it is all supposed to be revealed with a wave of a wand and flashing of a magicians’ handkerchief.

Out of the first ten people I met not one of them  new what Obamacare planned to accomplish. The had never heard the term “Affordable Care Act”.  They had no idea what a Health Benefit Exchange is and also did not know when each step occurred for it’s implementation.

The Amazon Shopping Cart Model

The survey was accomplished in Riverside California a city which is fairly metropolitan and is ‘internet enabled” as much as any other city.  If they received Medi-cal  they were entirely passive about receiving the benefit, did not know much about share of cost or how it would change as income rose or as their children left home.

Despite all the television and newspaper reporting about Obamacare most did not “get it”.  The message has not been visible and there are no advertisement in newspapers, magazines or gathering areas such as shopping malls, theaters, or sport’s venues.

On the eve of Obamacare’s launch, the White House is lowering expectations for it, downplaying their assumptions for signups and emphasizing this won’t be a launch so much as the start of a conversation with the American people, and so on and so forth. The truth, of course, is they’re downplaying things because the exchanges, implementation, and promotional efforts for Obamacare are so far behind and have had such little impact on the very people the approach is intended to reach.

How little impact?

A new poll finds a majority of the public -- especially those lacking health coverage -- is unaware that new insurance marketplaces created by the health law are slated to open ... The poll also found deep skepticism of media coverage of the law, with more than half the public saying they don’t trust any media source to provide credible information. Two-thirds of the public were not aware when the new online marketplaces open to allow people without employer coverage to shop and purchase their own health policies, according to the poll by the Kaiser Family Foundation. These exchanges open Tuesday. Despite outreach efforts by the Obama administration and supporters of the law, the poll found the number of uninsured unaware of the opening date is even greater than the public at large, with three out of every four not knowing the marketplaces are supposed to open in October.

The rollout has not gone as expected, or as supporters had hoped. Even hours before open enrollment is set to begin, confusion reigns in states where navigators haven’t even gotten a chance to use the systems they’re supposed to guide people through. These IT problems are significant, but they will come and go in the context of these political battles. Some will seize on them as signs Obamacare will crash and burn. This isn’t the case, though – it’s not the glitches that will undermine Obamacare, it’s the effect it has on the people who already have insurance.

I don’t know whether to laugh or cry. My health insurer, Kaiser Permanente, has finally calculated what our family’s new health insurance rates will be under the grotesquely misnamed Affordable Care Act (a.k.a. Obamacare.) The upshot: my premiums are about to rise by 114.6%. My wife’s rates? Up 109%. Our kids? Don’t ask.

Yes, it’s time to say goodbye to my current plan, with its $232-a-month premium. That plan is being discontinued, I’m told, because it “does not meet the requirements of the ACA.” It was a nice plan, with low premiums, free physical exams, a high deductible and eligibility for a Health Savings account. We got access to Kaiser’s lower in-plan rates for minor medical care, and we had the peace of mind of substantial coverage if anything catastrophic ever happened. But that plan is going the way of Lake Superior sturgeon or the Hetch Hetchy meadows. It’s vanishing in favor of what someone else has decided would be progress. So now I’m being offered what’s dubbed the KP CA Bronze HSA 4500/40%. My new premium will $519.25 a month -- more than double my old rates.

I wish there was some way of regarding this new “bronze” plan as an improvement over what we had before. But that’s really not possible. The new deductible will be higher ($4,500 instead of $4,000.) My primary care benefit is worse (I’m now being told to pay 40% of billed charges, instead of a cap of $40.) My inpatient hospital coverage is worse (I’m to pay 40% instead of 30%.) Terms on emergency-room visits and prescriptions drugs are inferior, too. There’s probably a “silver” or “gold” plan that would match or even top my old coverage. But then I wouldn’t be looking at a mere 114.6% increase in my premium. I’d have to pay even more.

There’s little wonder that Obamacare remains unpopular, even if you don’t call it that. On the eve of its launch, CNN found 38 percent of Americans favor it and 57 percent oppose it – even when described in neutral terms. That measure of success or failure will have more to do with Obamacare’s survival as a long-term policy reality than any of the early glitches – and that’s something the American people themselves will determine according to their own measures.

-- Benjamin Domenech

Other key concerns include

SHUTDOWN APPROACHES AS SENATE POISED TO REJECT CR

HIGH STAKES FOR BOTH PARTIES IN LAUNCH

AFFORDABLE CARE ACT OR RIPOFF?

THE HEAVY LIFT OF LAUNCHING THE EXCHANGES

 

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Secretary Jack Lew’s Message to Congress

 

Health Train Express' investigation reveals the enclosed letter from the Secretary of the Treasury, Jack Lew.

The news is not good. Our country has backed itself into a corner. The reasons are many, and finger-ponying and filibuster will not solve any problems. There is no rational reason to negotiate Obama Care Funding or link Government shut down with the challenges ahead.

Regardless of the outcome the news is disheartening. All of us have known this was coming and we have allowed our congressional representatives to kick the can down the road.

This is the consequence of citizen apathy and allowing politicians to grandstand for their own sake of power and narcissistic argument. This of course does not apply to all our representatives, however some leadership has gained control due to the specific nature of their local constituency.

Text of John Lew's letter to the Speaker of the Houses (and to all Americans)  this document loads very slowly.  If so try this link instead.

All of this takes place behind the center stage of Health Reform. In the desperation of taking credit for a long conceived goal for Americans the current democratic administration and democratic leaders have gained political capital by autocratic methods of decision making.

Republicans are in favor of health reform and are standing fast against the present financial methods of the Affordable Care Act and illegal powers delegated to the Department of HHS, without regard to expert authorities in health. Deadlines are near for a series o mandates, which will have consequential effects on our economy and business. Is Obama care even affordable?

Lew's Letter points out our plight. Some wish to prioritize debts. This is what most businesses do on the brink of insolvency. He argues that our credit worthiness is at stake. Can we guarantee all our creditors will be happy? No. Banks especially stand to lose more interest if we do not increase the debt ceiling.

In my home we have to prioritize some debt at times. The truth will set us free. To obfuscate our challenges with false hope and faulty reasoning as well as outright falsehoods is to damn ourselves and we will suffer the consequences. We are out of time.

We are still powerful even if our debt is excessive irresponsible and self-serving. Our credit-worthiness is a set of numbers that are arbitrarily set by bankers. Have you ever dealt with credit bureaus, and credit scores? Do we default on our loans? No, but we default on many obligations and legal mandates within the United States by offering false promises and misleading explanations.

Truth is always simple when explanations become complex, chaotic and dysfunctional you can be certain issues are manipulated. Statistics can prove anything. Attorneys can argue quite effectively against truth depending on their goals.

Note: These are my own opinions and may freely distributed, shared in social media, conventional newspaper and magazines..

GML September 25, 2013

 

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