Contraception mandate may go to Supreme Court

The Obama Administration is headed back to court to defend another aspect of the Affordable Care Act. The Administration announced yesterday that it will appeal a June decision that issued an injunction against a government mandate that requires employers to provide coverage for abortion-inducing and contraceptive medications. The ruling came in a suit filed by the Hobby Lobby.

Last year, the Department of Health and Human Services ruled that employers must provide their employees with insurance that contains coverage for abortion-inducing and contraceptive drugs. Many employers, including the Catholic Church, contested the mandate on the grounds that it violated their religious beliefs.

Traditionally, religious exemptions were allowed for such controversial laws. Accommodations for religious believers are required by the Religious Freedom Restoration Act. The Obama Administration’s rule included a narrow exemption for churches, but not other religious organizations. Bishop David Zubik noted that the exemption could not even have been applied to Jesus and his disciples.

As dissent against the rule grew, President Obama announced a unilateral compromise in February 2012. As Examiner reported at the time, the compromise would still require religious groups to cover the abortion-inducing drugs in their insurance plans, but they would not be charged for them. Instead, the president would force insurance companies to provide the coverage at no cost to the religious groups. Presumably, the cost would be spread among other nonreligious insureds. There was no relief for private businesses who had moral objections to the mandate.

Several businesses filed suit against the mandate. In a June 2013 ruling, a judge issued a temporary injunction against government enforcement of the mandate for the Hobby Lobby, a company owned by evangelical Christians. According to Fox News, the company’s insurance provides 16 forms of birth control, but its owners oppose birth control methods that can prevent implantation of a fertilized egg in the uterus, such as an intrauterine device or forms of emergency contraception, because they believe that life begins at conception.

The company had argued that the government’s action was a violation of the freedom of religion and the Religious Freedom Restoration Act. According to the Wall St. Journal the act, passed in 1993 with only three nays and signed into law by President Clinton, requires that any “substantial burden” on the exercise of religion be “in furtherance of a compelling governmental interest” and be the “least restrictive means” of furthering that interest.

The injunction would apply until the 10^th circuit federal appeals court could rule on the merits of the case. It also gave the government until Oct. 1 to decide whether to appeal the decision to the Supreme Court. On Sept. 19, the Obama Administration asked the Supreme Court to reverse the Hobby Lobby decision according to Reuters.

In a separate case, the Alliance Defending Freedom, a Christian legal group, also filed a petition with the Supreme Court on Sept. 19 in a similar case. Conestoga Wood Specialties, a Mennonite-owned business in Pennsylvania, had filed a suit similar to that of the Hobby Lobby. A three judge panel of the third circuit federal appeals court ruled against Conestoga in July and denied the company an appeal to the full court. The ruling subjects the company to fines of $3 million per month if they do not comply with the mandate to provide their employees with abortion pills and contraceptives.

Reuters notes that because federal appeals courts are split on the issue, the Supreme Court is likely to take up at least one of the cases. If the high court does hear a case on the issue, a ruling would be expected during the current term which starts in October and ends in June 2014. In 2012, the Supreme Court upheld the Affordable Care Act’s individual mandate. In upholding the law, the Court opened a host of other issues, including the question of religious freedom for employers. Fox News notes that there are 63 other cases challenging the mandate, 34 of which involve for-profit businesses.

Originally published on Elections Examiner

Health care reform after Obamacare

The Supreme Court’s ruling that upheld Obamacare does not mean that the law’s days are not numbered. It is likely that Republicans will sweep this year’s elections and repeal the law before it goes into effect. If the law does go into effect, the Court’s decision that Congress cannot force the states to participate in the Medicare expansion contained in the law means that the complex law is even more unworkable. Gov. Nathan Deal told Georgia Health News that the state had not made a decision on whether to participate in the Medicare expansion. Without major reform, Obamacare will collapse under its own weight, wreaking havoc on the American health care system and the federal deficit as it does so.

The question is what comes after repeal. The status quo of the health industry is also untenable. Reform is badly needed, but it should focus on lowering health care costs through free markets and competition. Obamacare does nothing to lower costs. To the contrary, it increases them and then mandates that people buy the more expensive insurance.

Successful healthcare reform will have several aspects that Obamacare did not. First, successful reform will be bipartisan. The Affordable Care Act was one party’s vision of how the health insurance industry would work. It was crafted in secret behind closed doors and passed by a party line vote that required the procedural trick of using a budget reconciliation to avoid a Republican filibuster. Democrats did not seek Republican input and failed to win a single Republican vote in either house.

Second, successful health care reform must reduce the costs of health care and insurance. If insurance is made more affordable through market reforms, more people will want insurance. The Affordable Care Act essentially ignored competition and the marketplace in exchange for top-down mandates, price controls, and government collusion with the pharmaceutical industry. The result was an immediate increase in the price of health insurance. Many insurers also stopped writing unprofitable policies, resulting in shortages in some markets.

Finally, successful health care reform will simplify and streamline regulations for the industry. The Affordable Care Act, at 2,409 pages, was neither simple, streamlined, nor efficient. It included at least 18 new tax increases, $19 billion in spending through 2013, and created 159 new federal agencies and programs. The bill was so complex that Nancy Pelosi, at the time the Speaker of the House, famously said in a Fox News clip, “We have to pass the bill so that you can find out what is in it.”

Successful health care reform would re-introduce competition into the health care marketplace. There are several ways of doing this. One is to stop the favorable treatment of employer health plans. Currently, premiums for employer-provided health plans are not taxed, but, if a worker wants to buy an individual policy instead of the one at work, premiums are not tax-deductible unless their medical expenses exceed 7.5 percent of their Adjusted Gross Income. If premiums for all health insurance were deductible, it would provide an incentive for people to shop around for the insurance that best suits their own needs.

Another common theme in competition is encouraging states to allow their residents to buy and sell insurance across state lines. The effect here would be two-fold. First, it would provide a larger market for the state’s insurance companies. If the state’s companies offer quality insurance at competitive prices, their sales and profits should increase. Economies of scale would drive down prices.

Second, states that do not have competitive health insurance laws would see their business go to other states. Each state sets it own standards and regulations for health insurance. States that mandate more benefits typically have higher costs for insurance. By allowing interstate insurance sales, citizens of states where insurance is expensive could buy more basic policies in other states. If the insurance companies and state governments see a sufficient loss of sales in highly regulated states, it would encourage reforms to allow them to compete. Otherwise, the insurance companies would go out of business and the state would lose tax revenue.

A third idea is to open more low-cost clinics. In many cases, patients at a doctor’s office never see a doctor for a routine visit. Instead they are treated by a nurse practitioner. In recent years, pharmacies and retail stores such as Wal-mart and Target have opened small health clinics. These clinics are a boon to the working poor because they often do not require appointments, they provide a fast resolution for routine medical problems, and they are much less expensive than an emergency room or traditional doctor’s office. Additionally, these clinics often have extended hours and are open on weekends. For more complex problems, the clinics refer patients to local primary care physicians or hospitals. The Journal of the American Medical Association sees retail clinics as a way to deal with the current shortage of physicians and as a way for every American to have medical care within a few miles.

Partnerships with private companies provide a great resource for helping to lower health care costs that was totally ignored by the authors of the Affordable Care Act. The possibilities can be seen in Wal-mart’s $4 generic prescription plan. The plan, introduced in 2006, was quickly matched by other retail pharmacies. Today, customers of Publix can even get prescription antibiotics at no cost. The downward pressure on prescription prices started by Wal-mart arguably did more to help consumers than the federal government’s prescription drug entitlement and it was accomplished without government mandates and at no cost to taxpayers.

If the goal of health care reform is to cover as many Americans with health insurance as possible, then it is only logical that reform should reduce the price of health insurance as much as possible. Basic economic law states that as price decreases, demand for a product increases. As health insurance premiums go down, more people will buy policies.

One answer to the high price of health insurance is to allow and encourage companies to write no-frills major medical policies. Every time government mandates that health insurance offer a new benefit, the price goes up. Major medical policies don’t cover everything from mental health to Viagra, but they do protect people against the cost of a catastrophic illness. This is all many people want or need. Consumers should be able to choose high deductibles and be allowed to opt out of coverages like pregnancy, preventive medicine, and contraception in exchange for lower premiums. When regulators try to make a policy all things for all people, the result is expensive and prices many people out of the market.

Additionally, health care pricing should be made more transparent. Few people know how much a visit to the doctor’s office actually costs because most people with insurance pay only a predetermined copay, $20 for example. The only way to find out the actual cost of the visit is to look at insurance documents long after the visit. Such a system makes it impossible to compare prices of competing physicians and hospitals and encourages increased consumption. These factors drive up the cost of health care by limiting the exposure of consumers to the true costs.

Similarly, participants in government programs such as Medicaid and Medicare consume health care at prices that are below market rates according to the Washington Post. The deficit from these government price controls is then passed along to private consumers, further increasing health care costs for everyone else. True health care reform must take steps to control the costs of Medicare and Medicaid, while preserving these programs as safety nets for the truly needy. The Republican “Path to Prosperity” budget plan includes provisions to reform Medicare according to Kaiser Health.

One popular provision of the Affordable Care Act is the requirement that insurance companies cover people with pre-existing conditions at below-market rates. The problem is that the rule gives people an incentive to not purchase insurance until they are sick. A better solution to the problem of pre-existing conditions would be to create assigned risk pools at the state level.

In an assigned risk pool, states require insurance companies to accept otherwise uninsurable customers in proportion to the amount of business that they do in the state. Because these policies are high in risk to the insurance company, their premiums and deductibles are higher. This encourages people not to wait until they are sick to purchase insurance. Georgia has long had assigned risk pools for auto and home insurance. Such a proven concept would make sense for health insurance as well.

A final path to lowering health care costs is tort reform. Tort reform involves limiting the ability of patients to sue for medical malpractice. Malpractice lawsuits, sometimes with outrageously large punitive damage awards, have caused premiums for malpractice insurance policies to increase. This higher cost is then passed along to consumers by doctors and hospitals. Tort reform does not prohibit lawsuits or collecting legitimate damages, but it does discourage frivolous lawsuits and excessive punitive damage awards. Understandably, lawyers oppose tort reform and, because lawyers are a Democratic constituency, Obamacare did not address the issue.

Texas passed a tort reform law in 2003. My San Antonio says that before the reform one in four doctors was sued each year. Eighty-five percent of the suits never went to trial, but still cost an average of $50,000 to defend. Cases that went to trial cost $1.4 million each. These costs led to increased insurance costs for doctors and, ultimately, higher costs for consumers.

According to American Medical News, malpractice insurance premiums have decreased by 30 percent since the law was enacted. The state also saw medical license applications increase by 83 percent when compared with before the reform. A spokeswoman for Gov. Rick Perry said, “Comprehensive medical liability reform has improved access to medical care, particularly in underserved areas….”

Mississippi’s experience was similar. Tort reform was enacted there in 2004. In the following years, malpractice insurance rates fell sharply, lawsuits decreased by 90 percent, and doctors stopped fleeing the state according to a 2008 Wall Street Journal article cited on the blog Captain Kudzu.

There is no single answer for how best to reform the health care industry. Solutions should consider economic realities as well as the needs and desires of the American people. Instead of federal mandates, states should be encouraged to experiment with their own solutions. Obamacare, which became law over the overwhelming opposition of the people, does none of that and is destined to fail.

Read this article on Examiner.com:

http://www.examiner.com/article/health-care-reform-after-obamacare

Standardizing health insurance is a bad idea

Is this one size fits all? (Daniel Barcelona)

In a letter to the editor in USA Today, Uwe Reinhardt of the Woodrow Wilson School of Public and International Affairs at Princeton University put forth the idea that health insurance companies could achieve economies of scale if health insurance policies were standardized across all fifty states into a few basic models.  Reinhardt compares his “one size fits all” model for health insurance to the business model of such restaurant chains as KFC, McDonald’s, and Burger King or hotels such as Holiday Inn and Marriott.

What Mr. Reinhardt fails to appreciate is that while these companies have standardized their own business, they do not represent the entire market.  For example, while KFC has standardized its chicken recipe across its entire chain and a McDonald’s burger and fries tastes the same from New York to L.A., consumers are not limited to those choices.  Instead, consumers have their choice of hundreds of restaurants, both standardized franchises and nonstandard Mom-and-Pop eateries. 

Even within the chains that Mr. Reinhardt cites, consumers are not limited to one choice.  In KFC, diners can choose from original recipe, extra crispy, grilled, chicken strips, chicken sandwiches, pot pie, or wings.  Once you finally decide on your chicken, deciding on side dishes can be equally difficult.  If the KFC is also a combination Taco Bell, then there are even more options.  Restaurants are also constantly innovating and introducing new products to entice customers, which further expands the choices available.

In Mr. Reinhardt’s world, consumers would be limited to a standardized and limited menu.  They would not be able to choose from foods that are limited only by the restaurateur’s imagination and the diner’s daring.  It would be a choice between the bland but reliable menu of burgers and fries versus the ability to go wherever and eat whatever you want.  Thanks to competitive markets and innovative entrepreneurs, diners can choose from burgers, pizza, steaks, seafood, Mexican, Indian, Chinese, Thai, or practically any food that they crave.

In different parts of the country, diners have different tastes.  In Georgia, we appreciate good barbecue and fried chicken.  A hometown company, Chick-fil-a, is one of the most popular chains in Atlanta, but can scarcely be found in the north and west.  In other parts of the country, such as the northeast, seafood is king.  New York is known for its thin-crust pizza.  In Miami, you can find great Cuban and Latino food.  In Texas, they like their barbecue, but with beef instead of pork.  In the southwest, you’ll find a Mexican flavor.  When you get to California, you might be stuck with vegetables and tofu unless you can find an In-n-Out Burger.  Would it be possible to try to standardize the different tastes, desires and needs of a country of 300 million people into a single standardized menu?  Would it be wise to even try?

In the health insurance world, having nonstandard policies means that consumers can choose what is important to them.  If a young person only wants coverage for emergency accidents or illnesses, then he can choose and inexpensive, high deductible plan.  Seniors might want a lower-deductible plan with more coverage for prescriptions and preventive care.  If you are a man or woman who cannot have children, then you would probably not value maternity coverage in a health policy and might well object to paying for a coverage that you will not need.

Likewise, people in different parts of the country have different health concerns and needs.  Americashealthrankings.com gives a synopsis of the health situation for each state.  Georgia ranks 36th due to air pollution, a high incidence of infectious disease, and a low high school graduation rate.  This is a sharp improvement over Georgia’s 43^rd place rank last year.

Allowing companies to innovate and bring nonstandard polices to the insurance marketplace is the best way to expand health insurance coverage.  Governments should allow consumers to choose the plan that best meets their health insurance needs, not be forced to buy the plan that a bureaucrat deems to be the best value for everyone.  People are individuals.  They have different wants and needs.  Regulators need to realize that.

Instead of limiting choices to a few standardized policies, governments and health insurers should take a cue from the restaurant world and expand the available options to let people buy the coverage that best suits their needs.  As the Burger King would say, “Have it your way.”

http://www.examiner.com/conservative-in-atlanta/standardizing-health-insurance-is-a-bad-idea"> 

Coping with Obamacare's price increases

If you have received your open 2011 enrollment package for your company’s health care benefits, like me you may have experienced some sticker shock this year. With the passage of the health care reform law, many Americans are finding that their health insurance premiums are going up and that their benefits are going down.

To make the most of your health insurance dollars, take a little extra time this year and examine all the alternatives that your company offers. One of the first things to consider is whether you and your family use your health insurance a lot or a little. If you rarely go to the doctor or get prescriptions filled, then you probably don’t need the most expensive plan with all the bells and whistles. For people who rarely use their insurance, a high deductible plan might save money.

Major medical plans typically have a deductible and many do not include copayments. This means that you will be responsible for paying your health insurance costs until you meet the deductible. For example, if your plan includes a $1,000 deductible, you will have to pay the first $1,000 of medical expenses for the year. After the deductible, these plans usually pay a set percentage, usually 80-90% of the medical bill. This leaves the employee to pay the remaining 10-20%. This is called coinsurance.

Aside from lower premiums, an added advantage to these plans is that they reward price shopping. Since the employee is always paying a percentage of the bill, rather than a set fee, it is in their interest to find a good deal. For example, an employee paying 10% coinsurance would save $5 per office visit by choosing a doctor who charges $100 rather than one who charges $150. (The employee’s share would be $10 of the $100 bill or $15 of the $150 bill.) Again, coinsurance only is a factor after you have met your deductible.

On the other hand, if you or someone in your family has several maintenance prescriptions or has to go to the doctor frequently, then you might want to pay a higher premium for a plan with better benefits. For example, an HMO plan might have a copayment for doctor visits that is $10 regardless of how much the doctor charges. As an added bonus, HMO plans do not generally include deductibles.

One way of determining which plan is best for your family is to look at your medical history for the past year. If this was a typical year, medically speaking, you can estimate how much your costs would have been with each plan and choose the one that is most cost effective.

Consider also whether you expect to have any surgeries or other health problems in the coming year. If you are expecting to use your health insurance a lot in the coming year, obviously you should choose the plan with better benefits. An alternative would be to schedule your surgery before the end of the current year.

Especially if you are considering a high deductible plan, consider a Flexible Spending Account (FSA) if your company offers one. FSAs allow an employee to put money into an account for health spending. This money is deducted from your paycheck before taxes, so it lowers your tax liability for the year while it increases your health care spending power. As your health care bills come due, the money is deducted from your account to pay them.

There are downsides to FSAs. One is that that the money must be used for health care items. This can include doctor visits, prescriptions, glasses, contacts, hearing aids, etc. Another major problem is that the money in an FSA must be used before the end of the year. Any money left in the FSA at year’s end is lost since it cannot be rolled over to the next year. Therefore you should carefully plan how much money to deposit into your FSA to avoid a last minute rush to spend or lose the funds in your account.

Additionally, if both spouses are eligible for health insurance through their employer, consider both plans. First, it is probably not cost effective to buy duplicate coverage through both employers. Consider which plan gives you the best “bang for the buck,” the best coverage for the dollars that you spend. You may also want to look at having each spouse get an individual plan through their own employer. Take all the possibilities into account and find what works best for you.

In this economic climate, you should also consider which spouse’s job is most stable. If you choose to purchase health insurance through only one employer and that spouse loses their job, you would have to rely on COBRA until the end of the year. You can only make changes to a group health plan during open enrollment unless certain events, such as having a child or getting married, occur. COBRA is currently subsidized by the government but is still more expensive than most health plans.

One additional consideration is that you might want to forgo your employer’s group health plan altogether. For many employees, the employer pays a percentage of their premiums and this makes the group plan much cheaper than an individual plan. To find out if an individual plan is most cost effective for you, contact an insurance agent and submit an application. Remember to apply for the individual plan well before you need to make a decision on your group health plan. This way you can determine the actual premium based on your medical history and make an informed decision. Make sure to let the agent know that you do not want the insurance effective until your group plan lapses. If the individual health plan turns out to be more expensive, you can cancel this coverage before it takes effect and elect for the group plan as long as you don’t miss the open enrollment deadline.

Finally, if you are unhappy with the changes that Obamacare has brought to your health insurance, remember to vote on November 2. The upcoming election will determine the future of health care in the United States. Find out how your representatives voted on Obamacare and find out which candidates will vote to repeal the current law and replace it with a free market solution.

Photo credit:
jscreationzs's portfolio is:
http://www.freedigitalphotos.net/images/view_photog.php?photogid=1152

Obamacare causes shortage of children's health insurance

A much ballyhooed provision of Obamacare was the requirement that insurance companies immediately begin covering children with new policies regardless of pre-existing conditions. In the legislative rush after Senator Scott Brown’s election, this provision was actually left out of the bill that finally became law. Without an effective date, it looked as though the provision might not go into effect until 2014 with most of the rest of the law. In response to the Democratic legislative boo-boo, HHS Secretary Kathleen Sebelius and America’s Health Insurance Plans (AHIP) quickly agreed that insurance companies would honor the intent of the law and immediately begin to issue children’s health insurance regardless of pre-existing conditions.

Recent reports indicate that the problem still might not be solved. In a striking lesson on economic incentives and the Law of Unintended Consequences, it appears that Obamacare‘s pre-existing condition provision might actually make it more difficult for parents to find affordable health insurance for their children.

In the past, child-only health insurance policies were relatively inexpensive. During my time as an insurance agent, such policies often sold for less than $100 per month. However, due to the recent regulatory changes, it has become more difficult for insurers to market child-only policies that don’t lose money.

The problem is that in the past parents had to buy policies for their children before they got sick. The premiums that they paid to insurers pooled the risk of illness for large numbers of children. Premiums went to pay for health care as well as administrative costs and, if the insurance company was well run, a profit.

Under the new law, parents no longer have to buy policies before their children become sick. In fact, the government has created an incentive for parents to wait until their children get sick to buy insurance. Because there will be a dramatic rise in the number of insured sick children, actuaries at the insurance companies realize that they will soon have to pay out much more in claims than before while premiums received are likely to stay low or even fall. Paying out more in claims without receiving more in premiums means that insurance companies lose money. If insurance companies lose money, they cannot stay in business.

In order to minimize their losses, some insurance companies are reportedly choosing not to sell child-only policies. Where parents could buy inexpensive coverage for their children in the past, they now must buy policies for the entire family in order to cover the children. It is also likely that the remaining companies in the child-only insurance market will increase their prices. Those companies who are not able to adapt will lose money and eventually go out of business.

It is likely that when (or if) the remainder of the Obamacare law goes into effect in 2014, a similar pre-existing conditions clause for adults will trigger an increase in premiums for other health insurance policies. We might even see entire insurance companies leaving the health insurance market or failing on a massive scale.

In the near future the Democrats will paint the situation as a failure of the markets and blame corporate greed rather than a failure of government control of the marketplace. They will probably portray another expansion of government power and control as the solution. In a vicious cycle, the new reform will have even more unintended consequences and require even more government regulation. This may even be part of a Democratic long-term plan to phase out private insurance companies and replace them with a single-payer plan.

It would be funny if it were not so tragic. The insurance reform that purported to lower costs and expand coverage is driving up costs and creating regulatory shortages. Less than four months into the elites’ grand plan to remake the American health insurance industry is in serious trouble and sinking fast.

Reform – Replace – Repeal

Sources:
http://www.msnbc.msn.com/id/36044366
http://www.nytimes.com/2010/03/31/health/policy/31health.html?_r=1
http://thehill.com/blogs/healthwatch/health-reform-implementation/110775-stronger-rules-for-childrens-health-coverage-may-raise-insurance-costs
http://www.ky3.com/news/local/96623269.html
July 30, 2010
Houston TX


Photo credit:
Tom Clare
http://www.freedigitalphotos.net/images/view_photog.php?photogid=947

Does Obamacare mandate BMI screening?

One of the latest rumors to circulate on the internet about the Obamacare nightmare is that it will require all Americans to undergo BMI (Body Mass Index) screening by 2014. Presumably, the BMI results will be used to ration health care in some manner as finite numbers of doctors, nurses, and hospitals struggle to cope with unlimited demand for their services.

To find the truth, I examined the full text of HR 3590, The Patient Protection and Affordable Care Act, as well as its companion bill HR 4872, the Health Care and Education Reconciliation Act. This takes some time, even scanning with the search function on a browser, since the HR 3590 contains a whopping 906 pages and HR 4872 adds an additional 55 pages. That is quite a number of dead trees for a law that is supposed to simplify and lower the cost of health care. If you would like to examine the text of the laws for yourself, the site that I used is: http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm.

I conducted my examination by searching both documents for “bmi.” This resulted in a large number of hits, but only two referred to “Body Mass Index.” The majority were some form the word “submit,” which says a lot about Obamacare in itself.

The first reference is in section 2703 State Option to Provide Health Homes for Enrollees with Chronic Conditions on page 203. BMI is mention here as one of the medical conditions that defines the term “chronic condition” (specifically a BMI over 25). There is no mention of mandatory screening for BMI.

The second reference to BMI was in section 4004 Education Outreach Campaign Regarding Preventive Benefits on page 428. In this section, BMI mentioned as one of the factors that that people will be able to use to determine their disease risk on a website. Again, there is no mention of mandatory BMI screening.

The second bill, HR 4872, contained several references to “submit,” but no references to Body Mass Index.

At this point, I was ready to declare the mandatory BMI screening a hoax. Just before I published this article however, someone pointed me in the direction of a document called HIT (Health Information Technology) Standards 170.302. This document purports to show Secretary Kathleen Sebelius’ new certification standards for electronic health records (EHRs).

Further, a CNS News report (http://cnsnews.com/news/article/69436) refers to section 3001 Office of the National Coordinator for Health Information Technology of the American Recovery and Reinvestment Act of 2009, the stimulus bill, rather than the Obamacare law itself. The text of this law can be found here: http://www.opencongress.org/bill/111-h1/text.

Section 3001 in Part C Duties of the National Coordinator Subpart 3 paragraph (a) (ii) states that the National Coordinator shall “update the Federal Health IT Strategic Plan” with “utilization of an electronic health record for each person in the United States by 2014.” This constituted the basis for Sebelius’ new EHR standard.

The Code of Federal Regulations Part 170 can be found here: http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf. On page 61 (of 228) this document does state that EHRs will calculate BMIs. An additional document (http://healthcare.nist.gov/docs/170.302.e.2_BMI_v0.2_fulldoc.pdf) refers to certification criteria for EHRs and specifically shows that BMI will be part of the vital signs included in EHRs.

Therefore, it appears that the rumor is true as far as the claims that Obamacare will require an EHR for all Americans and that the EHR will be required to include a calculation for BMI. The speculative claim that the BMI will be used to ration health care is so far unsubstantiated. I will leave it up to the reader to decide whether and how much to be alarmed by the BMI requirement.

I will say that it is extremely likely that Obamacare will result in health care rationing. Massachusetts enacted what President Obama called an “essentially identical” plan in 2006 and the result has been skyrocketing costs (http://bit.ly/dvTxyU). Rapidly increasing demand with a static level of supply led to sharply increasing costs. To deal with these increasing costs, Governor Deval Patrick enacted price controls in the form of denying insurance companies to increase rates.

Jon Kingsdale, who directed in Massachusetts’ version of Obama’s health insurance exchanges, said recently, “"If you're going to do health-care cost containment, it has to be stealth. It has to be unsuspected by any of the key players to actually have an effect." He further stated that the solution to the problem was finding a “significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less'” significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less'” (http://bit.ly/dvTxyU). In other words, the government will have to quietly ration care.

Reform the reform!



Sources:
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
http://cnsnews.com/news/article/69436
http://www.ihealthbeat.org/articles/2010/7/13/final-rules-on-meaningful-use-ehr-standards-released-today.aspx
http://www.opencongress.org/bill/111-h1/text
http://healthcare.nist.gov/docs/170.302.e.2_BMI_v0.2_fulldoc.pdf
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
http://www.slate.com/id/2221031
http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html?KEYWORDS=massachusetts+health+costs

Bangor ME
July 19, 2010

Health care cover-up

When the House of Representatives voted to pass President Obama’s health care reform bill on March 21, 2010, it was opposed by a majority of Americans. In addition to opposing the bill itself, many Americans objected to the manner in which the bill was passed. To avoid the stronger Republican opposition after the election of Scott Brown from Massachusetts, the house passed a previously passed senate bill and then both houses voted on a separate bill containing fixes for the first bill. This was unprecedented.

Now it seems that there was even more political chicanery involved in the passage of the bill. Several weeks after the passage of the health care bill, on April 22 Medicare’s Office of the Actuary released a report that was full of bad news for President Obama and the Democrats [1]. This report from a nonpartisan office stated that the reform bill will actually increase health care costs, in spite of President Obama’s repeated assurances that the bill would control costs.

Further, the report stated that the bill’s cuts in Medicare could drive up to 15% of hospitals and health care providers into the red [1]. These losses could lead to fewer health care providers as demand increases. This would lead to more limited access to health care, especially for seniors who depend on Medicare. Cuts to Medicare’s Advantage program would also mean that many seniors will face higher out-of-pocket costs.

The one bright spot in the report for Democrats was that the percentage of Americans with health insurance is estimated to increase. However, even the White House admits that the bill still won’t cover all Americans.

In addition to the bad news contained in the report, it was also revealed that the report had been submitted prior to the health care vote. Reports are that the report had been submitted to Secretary of Health and Human Services Kathleen Sebelius more than a week prior to the vote [2]. Sebelius’ staff reportedly refused to review the report until after the vote. Conflicting reports [3] are that the report was received only three days before the vote, which was not enough time to review it.

In either case, it looks bad for the Democrats. It is now apparent that the rush in getting the bill passed was related directly to the HHS report. In either case, the vote was pushed through on a Sunday so that the contents of the report would not be made public before the bill became law. The Democrats knew that bad news was coming and delayed it.

In fact, one HHS staffer said as much: "The reason we were given was that they did not want to influence the vote, which is actually the point of having a review like this, you would think" [2].

He goes on to say that the contents of the report were widely known in Democratic circles: "We know a copy was sent to the White House via their legislative affairs staff, and there were a number of meetings here almost right after the analysis was submitted to the secretary's office. Everyone went into lockdown, and people here were too scared to go public with the report" [2].

After years of Democratic complaints about governmental lies, here we have a black-and-white case of intentional deceit. While President Obama and congressional Democrats were claiming that the health care bill would reduce costs, they were aware that actuaries within their own administration were pointing out the flaws in their plan. Even now, more than a month after the vote, are still claiming that the obscenely expensive bill will actually decrease the federal deficit.

All of this points to the fact that the intent of the Democrats is to mislead. They know and have known the truth about their bill for a long time. They concealed the truth in order to deceive the American people and their elected representatives into passing the bill.

We can only hope that the American people will remember this deceit and the arrogance of the Democratic leadership in November.

Repeal – Replace – Reform

Notes:
1. http://news.yahoo.com/s/ap/20100423/ap_on_bi_ge/us_health_care_law_costs
2. http://spectator.org/archives/2010/04/26/what-lies-beneath
3. http://online.wsj.com/public/article/SB10001424052748704423504575212303032885376.html

Kansas City MO
April 29, 2010

Are Insurance Companies Evil?

Activists on the left have recently denounced insurance companies as evil. Some believe that health insurance companies are evil because they profit off the misery of others. Charges have been made that health insurance companies make money by denying medical benefits to their policy holders and that they, and the Republicans, actually want people to die so that they can make more money. This is similar to the claim a few years ago that oil companies were evil because they made “obscene profits” as oil prices reached record highs.

Like the charges against the oil companies, the charges against the insurance companies are patently false and do not stand up to logical evaluation. In the first place, health insurance companies cannot and do not force anyone to buy their service. For each and every policy holder, the decision to do business with their insurer was entirely voluntary. Even in the case of people who participate in health insurance plan chosen by their employer, the decision to participate is still a voluntary choice by the employee. If the employee does not like the health insurance company that provides their company’s group plan, they have the options to either not buy health insurance at all or to select an individual health insurance plan of their own choice.

Health insurance companies do not make money by denying care. Health insurance companies make money by selling policies. If a health insurance company continually denies care that should be provided under the terms of their policy, people will exercise their option to buy a policy from another insurer. They also have the option to sue the insurer for breach of contract if the insurer does not follow the terms of the policy. In general, health insurance companies want to be seen as “a good neighbor,” as one insurance company slogan says. Companies do not get a reputation as a good neighbor if they are constantly losing lawsuits from their insureds.

What about the claim that health insurance companies are evil because they profit off the misery of sick and dying people? The purpose of health insurance companies is to make a profit. If a health insurance company does not make a profit, they will not stay in business. A health insurance company that is no longer in business can provide medical care for no one.

Granted, some companies do abuse their customers. We have all heard cases of insurance companies who improperly deny coverage or cancel the policies of sick customers. These cases, while rare, are serious. In many such cases, the insurance company attracts the attention of regulators or legislators who help to rectify the problem. Additionally, the company also attracts unwanted negative publicity which invariably hurts their bottom line. An insurance company cannot operate this way indefinitely and stay in business.

Insurance companies are held accountable by numerous parties. First and foremost is their customers. If an insurance company has poor customer service, their customers will go elsewhere. No one is required to deal with any particular insurance company or even to buy health insurance at all (yet). Second, insurance companies are held accountable by their shareholders. Negative publicity and poor management adversely affect stock prices and investment values. Shareholders can also vote with their feet. If a company has a poor record of paying claims and is financially unsound, they can also be rated poorly, which affects their ability to sell policies. Finally, if an insurance company breaks a contract or violates the law, they can also be held accountable by the courts or government regulators.

Some people in the public discourse today, seem to believe that profits are unethical in general. In truth, the desire for profits encourages people to make wise choices. A company cannot be profitable without a buyer for their goods or services as countless businesses from General Motors to the US Postal Service have discovered. However, if a company does not make a profit, it cannot stay in business. Furthermore, the lure of profits draws more companies into the business, increasing competition and driving down costs for consumers.

Businesses don’t necessarily set out to do a public good, yet that is precisely what happens. Business owners do not open their business to provide jobs for their fellow citizens, yet that is the result of a successful business. Business owners do not open their business out of an altruistic need to provide people with their wants or needs, yet that also happens. Businesses are not created to pay taxes to the government, yet, if the business is successful, its taxes do support the government.

It is no different for insurance companies. The insurance company is in business to make money for its owners and shareholders. In the course of making money, they also provide medical care for their policy holders. They also provide jobs directly for their underwriters, adjusters, actuaries, and support and management personnel. Indirectly, insurance companies help to provide jobs for physicians, nurses, and their staffs.

Insurance companies are not inherently evil. However, like any human endeavor, they are tainted by human frailties. Insurance companies serve a valuable role in society by spreading the risk of an expensive illness or injury among thousands of policy holders. Without insurance companies, thousands of people would not be able to afford advanced treatments that save or prolong their lives.

The Problems With Universal Healthcare

In recent years, there has been a strong push for a universal healthcare plan in the United States. Many would like this reformed healthcare system to emulate the European national health plans. People across the country see that our healthcare system is in crisis, with millions of people who are uninsured and prices that are skyrocketing.

The American healthcare crisis is actually one of affordability rather than access to healthcare. There are very few people who cannot find healthcare; the problem is that many people cannot afford the healthcare that is available. This is true even though laws require hospitals to treat patients regardless of their ability to pay.

A common myth is that universal government healthcare would be free or cost less than private healthcare. This belief violates several economic principles. First, the money to pay for health professionals, medicines, and facilities has to come from somewhere. If consumers don’t pay for these services directly, they will pay indirectly through higher taxes. Second, as the perceived price decreases, demand will increase. In other words, when people believe that they won’t have to pay for their healthcare, they will use more health services.

As demand increases to exceed the available supply of health services, the government will have to take action. The government will have to limit the amount of services to keep the cost of the healthcare system from exploding. There are several ways to do this. First, they might impose rationing and limit the availability of services. A second option would be increase the amount that patients pay for their healthcare. This could be similar to the health insurance premiums and co-payments that many health insurance policies contain now. A third option would be for the government to do nothing and simply allow shortages to build in the system.

A third problem is that government healthcare will likely create a shortage of healthcare professionals. The government will undoubtedly attempt to rein in costs by imposing price controls. It has already followed this strategy in government healthcare programs that have already been enacted such as Medicare. Medical training, especially for doctors, is a long and expensive process. The motivating factor for many doctors is the financial reward at the end of the process. When the government removes the financial incentive for becoming a doctor, fewer people will choose to become doctors and shortages will result. This is especially likely due the increasing need for doctors in the United States and the Baby Boom generation ages.

These problems can be seen in national healthcare plans around the world. Even highly touted plans such as those in Britain and Canada commonly have long wait times for care that is easily available in the United States. Last year it was revealed that government bureaucrats in England had attempted to solve the problem of long emergency room waits by keeping thousands of patients, some critically ill, in ambulances for as long as five hours before moving them to the emergency room waiting list. This, in turn, meant that the ambulances were not available to help other sick or injured people. It should not be surprising that many Europeans and Canadians who can afford it travel to the United States for health care rather than waiting in line for “free” care at home.

The problems are not just in other countries. In 2006, Massachusetts passed a state healthcare plan. Former Governor Mitt Romney touted the legislation in his bid for the 2008 Republican presidential nomination. More recently, the state has begun to experience many of the same problems plaguing nations with socialized healthcare.

Recent statistics show that visits to emergency rooms in Massachusetts have increased since the health reform went into effect. The percentage of uninsured patients in ERs has not changed (in spite of laws making health insurance mandatory), while the percentage of more affluent patients, who in the past got care at a doctor’s office, has increased.

Similarly, the dramatic increase in the numbers of people seeking care has made it difficult for many patients to see a primary care doctor. This is compounded by the fact that doctors are allotted a certain amount of time that they are paid for with each patient. If they exceed this time, they are not compensated for the extra work.

The Massachusetts government had hoped that the legislation would encourage more employers to provide health insurance for their employees. Instead, the newly insured people of Massachusetts are primarily involved in state paid or subsidized programs. 16% have their health insurance paid by the state through Mass Health, while 41% are enrolled in the subsidized Commonwealth Care. In all, about three-fifths of Massachusetts residents receive free or subsidized health insurance. Approximately 5% of the people of Massachusetts remain uninsured.

The high number of people receiving government assistance for their health insurance has led to rapidly increasing costs for the state. The cost of Massachusetts’ plan has increased by a staggering 42% since 2006. In order to control costs, current Governor Deval Patrick is considering price controls, limits coverage, more exclusions, and an overall spending cap.

The federal government already faces similar problems with Medicare. Medicare is an unfunded liability that poses huge problems for our budget over the next few years. Medicare will soon begin paying out more money than it takes in and will be bankrupt by 2019 unless changes are made to increase Medicare taxes, cut benefits, or some combination of both.

Some countries in Europe may go a step further by limiting the treatment available for the elderly, terminally ill, and infants. The amount of return in the form of tax revenue from these patients is limited, so the government health bureaucracy doesn’t want to spend resources on expensive cures and treatments. In Holland, euthanasia is already common, both for the elderly and for infants with health problems, sometimes without parental consent.

The best way to solve the healthcare crisis in the US is to reintroduce competition. Most Americans are locked into employer health plans with specified co-payments. Because there is no choice of coverage and no price difference between doctors, there is no incentive to shop around for a better deal. Most people don’t even know how much their doctor visits cost beyond the co-payment or deductible.

Employer paid health insurance should be eliminated in favor of health savings accounts (HSAs). Consumers should contribute money to their account and use it to pay for care. If money is not spent, it should stay in the account, earning interest, until needed or until the consumer meets the requirements to withdraw it for other purposes. This would encourage people to shop for a good and inexpensive doctor, and also discourage frivolous claims.

Similarly, state governments should resist the temptation to make health insurance all things for all people. When laws mandate coverage for things that not all people want, it drives the costs up for everyone. For example, not all people want or need coverage pregnancy, sex changes, chiropractors, or “recreational” drugs such as Viagra. People should be allowed to buy simple and cheap major medical policies for no-frills coverage. If such a policy is not available in all states, people should be allowed to cross state lines to purchase it.

Some of the best advances in affordable coverage in recent years have come from the private sector. For example, Wal-mart introduced $4 generic prescriptions and was followed by several other chains. Now consumers can get prescription antibiotics totally free at Publix. Similarly, some stores now offer on-site clinics staffed by nurses for minor healthcare.

Universal government healthcare has been tried around the world and has typically not worked well. If it is enacted in the United States, we can expect to move from our private health system to one that has the efficiency of the DMV, the cost of the Department of Defense, and the bedside manner of the IRS. Is this the change that most Americans are looking for?







Sources:
http://www.dailymail.co.uk/news/article-515332/A-E-patients-left-ambulances-FIVE-hours-trusts-meet-government-targets.html
http://blogs.wsj.com/health/2009/04/24/as-insurance-coverage-increases-ers-get-busier/
http://www.npr.org/templates/story/story.php?storyId=97620520
http://www.hschange.org/CONTENT/1021/
http://online.wsj.com/article/SB123811121310853037.html
http://online.wsj.com/article/SB120373015283387491.html
http://www.telegraph.co.uk/news/uknews/1576704/Dont-treat-the-old-and-unhealthy-say-doctors.html
http://www.discovery.org/a/2478

Ft. Worth TX
4/27/09