Affordable Care Act faces Antitrust challenges

by Dan Diamond, California Healthline Contributing Editor

Wednesday, September 07, 2011

FTC Emerges as Another Obstacle to Health Reform Law
by Dan Diamond, California Healthline Contributing Editor

Many assessments of the Affordable Care Act's long-term viability have focused on Congress' ability to weaken or repeal the law, especially if Democrats lose both chambers in 2012. Others are looking ahead to the Supreme Court's potential impact on the individual mandate's constitutionality.

But another Washington, D.C. player -- the Federal Trade Commission -- is already creating problems for the Obama administration.

True to its name, the Affordable Care Act tries out a number of new ideas to make health care less expensive. As one tactic, the law provides incentives for the creation of accountable care organizations to care for dedicated populations of Medicare beneficiaries.

However, the White House and FTC don't see eye to eye on ACOs' antitrust implications. The White House -- and by extension, the Department of Justice -- has viewed ACOs through the lens of consumer benefit. Meanwhile, the FTC spots a risk that ACOs could help already strong health care providers further fix prices.



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Pre-Existing Condition Insurance Program (PCIP) to pay Brokers

June 1, 2011



The U.S. Department of Health and Human Services is making several changes to the Pre-Existing Condition Insurance Plan (PCIP), and making it easier to qualify.

Beth Uselton is a patient advocate with the Tennessee Health Care Campaign and she said, "For many decades people with pre-existing conditions were often locked out of insurance or small group insurance market."

Uselton said these are important steps to get insurance to the people who need it the most. "The irony is that so many people who have high health needs, or already have a medical condition, are some of the people least likely to be covered by the private insurance market." Broker will be able to direct insureds to this program and earn a commission beginning in the fall More

Big changes in Medicare appear to be inevitable

Obama calls for slowing growth of Medicaid, Medicare to reduce deficit Apr 13
By Jack Torry, Washington Bureau
12:53 AM Sunday, April 24, 2011
WASHINGTON — No matter which sides prevails in the intensely ideological and partisan debate in Washington over the mushrooming costs of Medicare, one thing is certain: The program as we know it is in for big changes.
“Everybody admits doing nothing is not an option,’’ said Michael Tanner, an analyst at the CATO Institute in Washington.

In particular, they contend that health costs continue to rise because of the increase of such diseases as diabetes, caused in large part by preventable conditions such as obesity. They say that until hospitals and physicians become more efficient in preventing and treating the chronically ill, U.S. health care costs will continue to soar. read more

Ryan, Obama both fail Medicare test

Updated: April 16, 2011 - 9:01 PM
They offer contrasting approaches, but there are flaws in each.

Wisconsin Congressman Paul Ryan deserves credit for putting Medicare's soaring costs front-and-center in the raging debate over the nation's runaway spending.

But his prescription for fixing the federal health program for the elderly -- Ryan's plan would provide subsidies to buy private health insurance -- is too harsh and would shift unaffordable care costs onto seniors

The reality is that Medicare's current costs are an existential threat to the program. The total Medicare bill in 1999 was $212 billion: Ten years later, it had increased to $502 billion as the baby boomers prepared to retire.

Obama's speech offered reassuring but vague rhetoric about Medicare's future. He's right that there are alternatives to Ryan's plan, which paints in stark detail what it means to rein in entitlement programs without a tax increase.

But the president needs to provide details..

Now the president and his party need to do the same. The nation can't afford to wait until after the 2012 election..

ANOTHER CONCERN
"When Roosevelt invented Social Security, it was not designed to lift the old out of poverty. It was designed because the cost of caring for the old was crushing middle-aged families. One of the questions that needs to be asked here about the [Ryan] plan is not how does this affect the old, but rather what are the Gen-Xers and -Yers going to do when Grandpa's medical bills come due? Because they're going to come due.''read more

DR. STEVEN MILES, Minneapolis physician and bioethicist
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Agents Likely to be Part of Exchange System

By ARTHUR D. POSTAL
Published 2/16/2011 Subscribe to Life & Health

WASHINGTON BUREAU -- The role that insurance agents play in the health insurance marketplace in 2014 and beyond will likely be left up to the states, according to Joel Ario, head of the insurance exchange bureau at the U.S. Department of Health and Human Services (HHS). more

And now the real work begins

Some parts of the Affordable Care Act simply don’t work for small employers, a New Jersey business owner testified today at a House Ways and Means Committee hearing.
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House republicans Start spin to take credit for HealthCare Reform

By ALLISON BELL
Published 1/19/2011

"House leaders scheduled a vote on H.R. 2, the Repealing the Job-Killing Health Care Law Act bill, to take place just as many civic-minded citizens were coming home from work and flipping on C-SPAN.

House members voted 245-189 to pass the bill at 5:53 p.m. today. All Republicans in the House voted for the bill; 189 of the 193 Democrats voted against it. "read more

Health Care Repeal Snag

January 10,2011
Reporting from Washington — The Supreme Court may not be so anxious to rein in Congress' broad power to pass regulatory laws under the Constitution's commerce clause, the key point of dispute in the pending court battles over President Obama's health insurance law.

By a 7-2 vote, the justices turned down a constitutional challenge to a 2002 law that makes it a federal crime for a felon to have body armor or a bulletproof vest.

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New laws will allow Calif. to begin health reforms

By DON THOMPSON Associated Press
Posted: 12/26/2010 11:03:05 AM PST
Updated: 12/26/2010 11:07:05 AM PST


SACRAMENTO, Calif.—California will create an Internet-based insurance exchange to let consumers comparison-shop for affordable health insurance coverage under two of the many laws taking effect with the new year. read more

Test of "Accountable Care Organizations" going well

Excerpt of an article By ALLISON BELL
Published 12/20/2010 Subscribe to Life & Health


The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

An ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.

The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), is requiring Medicare to use ACOs starting in 2012, and many private health carriers are now testing ACOs.

Elizabeth Mills, a senior counsel in the Chicago officer of Proskauer Rose L.L.P., a law firm, ACO organizers still face regulatory challenges.

The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.

This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.
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A doctors take on universal heath insurance mandate

The Insurance Mandate: Is It Legal?
Published: December 21, 2010

Re “Can Congress Force You to Be Healthy?,” by Jason Mazzone (Op-Ed, Dec. 17), defending a federal judge’s ruling that the health insurance mandate is unconstitutional:

We need to look at the consequences to patients, interstate commerce and the economics of health care if the mandate provision of the Affordable Care Act is overturned. When an individual with limited income chooses to forgo health insurance and comes down with appendicitis, how should the health system respond?

Mr. Mazzone uses the analogy of someone forgoing auto insurance alternatively taking the bus. What is the alternative to an appendectomy?

The care providers must either (1) explain to the patient that he did not choose wisely, provide him with some pain tablets and push him to the parking lot or (2) treat him appropriately. The former is both illegal and unethical; the latter (current practice) is where the commerce issues arise.

The costs of care for illness must be borne by someone. Currently these costs are paid by the state (taxpayers) and, through cost-shifting, the insurance carriers, many of whom are national companies.

The bus analogy, while clever, is inappropriate and trivializes the dire status of our current system and our public’s health.

Tim Carey
Chapel Hill, N.C., Dec. 17, 2010

No Social Security until age 65?

November 11,2010
The author of the recently released report, Andrew Biggs, a scholar in residence at the American Enterprise Institute, a conservative think tank , outlines these advantages:

•Prolong the life of the Social Security trust fund by five years, a modest but significant increase.
•Raise median income of older Americans by $7,500 a year, including both increased Social Security benefits and savings and other pension income.
•Boost gross domestic product by about 5 percent through increased productivity, adding billions to the economy and tax revenues.
Biggs says keeping people working until 66 or 67 isn't a physical problem for most these days. Biggs would offer one big concession. He suggests reducing significantly or eliminating Social Security payroll taxes for people who work and contribute to Social Security longer than 35 years, Eliminating payroll taxes would "sweeten the pot" for those asked to work longer, he says.

for full textclick here

New health law is a prescription for distortion
By: JO CIAVAGLIA
Bucks County Courier Times


The onslaught of misinformation and distortions about the Patient Protection and Affordable Care Act this political season isn't helping the many Americans who are confused about the law.

Who hasn't seen political ads claiming that under the health law, Medicare will be cut $500 billion.

But are any of these claims true?

Yes and no. Mostly it depends on what health coverage you have, who pays for it, how much you earn and how you earn it, according to health care policy and reform experts.


Next year employers will be required to list the value of employee health benefits on W2 forms. No, you won't be taxed on it.

But combine a take-no-prisoners political season with a law as voluminous and complex as the Patient Protection and Affordable Care Act, and confusion explodes. Experts who've studied the new reforms say the truth is out there, but it can be hard to find.

Four out of 10 surveyed believed the health care law would require Americans to provide a government ID card to get hospital care. (It doesn't.)

Almost as many believed that committees would review medical histories of some people and decide whether they can get medical care paid for by the government. (That's also untrue).

Six in 10 think the law increases the federal deficit. (The nonpartisan Congressional Budget Office projects the law will shrink the deficit.)

"The great irony is the law was designed to avoid a government takeover," said Timothy Jost, a law professor at Washington and Lee University who specializes in health care reform and policy. "It's a law that is intended to make private insurance work and it's troubling that it's being attacked as a (government) takeover of the markets

New Healtrh reform drives cost acutting

SAN DIEGO 10/23/2010 — According to Van Gorder of Scripps Ihnstitute of San Diego.
"....the health reform plan, signed by Obama this year, was health insurance reform. It was not a reform that went to the heart of escalating health care costs.

But now Scripps Health, which runs 5 hospitals and 20 clinics in the San Diego area, is in the midst of a corporate restructuring they claim will make a big difference in cost. CEO Chris Van Gorder, in fact, believes their reorganization will eventually save $150 million a year.

Scripps Health was built from the union of several large hospitals. But the vertical corporate structure, in which each hospital had a chief operating officer who ran the place, remained intact. That meant every hospital within the system did things in a different way. They used different staffing levels and different materials. And that has required different levels of funding.

“We know, for example, that at one of our hospitals an open-heart case costs $3,000 more than it does to do the same kind of operation at another one of our hospitals,” said Van Gorder.

He said they’re trying to solve that problem by getting horizontal, in a corporate sense…. by getting rid of the silos and putting everything in one bin.

Van Gorder said the company has reassigned the top managers of its five hospitals to make them responsible for operations across the system. The goal is to standardize hospital operations and bring best practices to each site. This even applies to serving coffee.
“We’re spending $680,000 dollars a year for coffee and we’re using 15 different brands,” said Van Gorder. “If we standardize and buy at a larger scale we can get better buying power.”

Scripps claims it can save $200,000 dollars on coffee alone.

But if this is such a good idea, why didn’t Scripps do it five years ago? Van Gorder says strained relations between Scripps doctors and the company administration in the past have made it difficult to make dramatic changes.

Medicare revisited

Medicare celebrated its 45th birthday on July 30.

In 1965, President Lyndon B. Johnson signed the Medicare bill into law, providing government-sponsored health insurance for Americans 65 and older and younger people with disabilities.

Although every senior in the United States grew up without Medicare, most Americans today accept this single-payer, government-created and government-administered system as one of their rights as citizens, much like the right to vote.

Yet before we reach the age of 65, most of us don't have a clue how Medicare works. We only know it's there.

Misunderstandings about the Medicare program surfaced during recent discussions over the administration's sweeping health reform bill that finally passed in March.

Unclear on the concept, elders in some states vented outrage against the Obama administration, whose bill included Medicare changes, for "meddling" in "their" Medicare.

Others, also unclear on the facts, protested a provision in the bill that would have reimbursed physicians for time-consuming conversations with patients and family regarding the patient's wishes at the end of life. Mistakenly condemning these as "death panels," they raised loud and confusing voices, and the provision was removed from the bill.

But the uninformed ranters remain. To help clarify confusion, here are a few basic facts.

The health reform bill proposed by President Obama and passed by the
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Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.

Among the most immediate changes:

# The infamous "doughnut hole," in which Medicare recipients must pay full price for their medication, will close completely by 2020. This year, those in the hole will receive a $250 rebate. Starting in 2011, a 50 percent discount will be available for brand-name drugs.

# The open-enrollment period, during which a Medicare recipient may choose a prescription drug program, will be extended.

# Starting in 2011, co-payments or deductibles will be removed for annual checkups and mammograms, colonoscopies and some other preventive tests. There will be no charge for these tests.

Other provisions are designed to improve delivery of medical care, prevent frequent readmissions to hospitals and, in the process, cut health care costs.

According to the Kaiser Health Foundation, nearly 18 percent of hospital admissions among Medicare beneficiaries in 2005 occurred within 30 days of being discharged from the hospital. Critics of high costs say that readmission can be prevented by better care in the hospital and improved coordination between patients and doctors after release.

Until now, hospitals, paid separately for each hospital stay, have had no incentive to prevent readmission, experts say. Under the new law, payments to certain hospitals with high readmission rates will be reduced starting in 2013, a spokeswoman for the federal Centers for Medicare & Medicaid Services said in a phone interview.

Among health care providers, pilot projects to streamline health care delivery and coordinate care are already underway.

These are only a few of the changes and modifications included in the new law.

For more information, call the Health Insurance Counseling Advocacy Program (HICAP) at 650-627-9350 or 800-434-0222.

New Health Care Rules begin in June

By Christopher Behnan • DAILY PRESS & ARGUS • May 16, 2010


Staring June 23, the law creates a health subsidy for retirees between the ages of 55 and 64. The program will subsidize 80 percent of approved claims totaling $15,000 to $90,000.

That program is planned to expire in 2014.

Also this year, employers with less than 25 employees that contribute at least 50 percent of premiums per employee may be eligible for a tax credit.

The credit wouldn't be filed until next year's tax return, but employers should start calculating employee hours required to determine full-time equivalency data, Porta said.

The government will count a 4.98 full-time equivalency as four full-time employees rather than rounding it up to five, for a greater credit.
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In that case, employers can bump up their staff's hours slightly to obtain the higher credit, Porta explained.

"It can make a difference. You want to maximize the tax credit," he said.

Health insurers end cancellations

Rueter's
Susan Heavey and Lewis Krauskopf - Analysis
WASHINGTON/NEW YORK
Fri Apr 30, 2010 12:51pm EDT
WASHINGTON/NEW YORK (Reuters) - U.S. health insurers are avoiding the controversial but rare practice of canceling coverage when a customer gets sick, but it is unclear how regulators will enforce the ban, which could affect thousands of policyholders.
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Companies Drop Employer-Sponsored Health Insurance

Clarifying Health
Thursday, April 22nd, 2010

The Health Care Reform bill signed into law on March 23, 2010 is the death knell for employer-sponsored group health insurance. And that’s a good thing.

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Agencies Seek Health Care Implementation Comments

LIfe and Health Magazine

Article by ALLISON BELL
Published 4/12/2010

"Federal regulators are asking members of the public for comments on how the government should implement the Patient Protection and Affordable Care Act..."

"..... how states define 'unreasonable rate increases,' rules for public disclosure of rate increase information, ideas about how to go about excluding plans that impose 'unreasonable rate increases' from the new state health insurance exchange system, and ideas about how to minimize the rate review process paperwork burden."

And now the real work of health care reform begins.read more

Quick analysis of effect of new health care bill

Washington Post article 3/28/2010

Now that all the rhetoric is behind us (you think?) what does the new law mean to each individual. Well there is a site with a situation calculator. Requires just 4 inputs. 1. How you are/not insured now 2. how many in your family 3. Your adjusted gross income. 4. Your marital status. The resultant statement is clear and concise.

Click here for site to analyze what the new bill means to you