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Thread: ObamaCare: A false Promise

  1. #16
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    Re: ObamaCare: A false Promise

    I was requested to write an article on it for the Ruston-Lincoln Chamber of Commerce newsletter for November. I can post it here if anyone is interested.
    PSA: Please realise the impotence of proof reading before you post.

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    Re: ObamaCare: A false Promise

    Quote Originally Posted by RhythmDawg View Post
    I was requested to write an article on it for the Ruston-Lincoln Chamber of Commerce newsletter for November. I can post it here if anyone is interested.
    Please do!

  3. #18
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    Re: ObamaCare: A false Promise

    Quote Originally Posted by RhythmDawg View Post
    I was requested to write an article on it for the Ruston-Lincoln Chamber of Commerce newsletter for November. I can post it here if anyone is interested.
    Quote Originally Posted by LABulldog View Post
    Please do!
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    It's a mockery.

  4. #19
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    Re: ObamaCare: A false Promise

    Quote Originally Posted by LABulldog View Post
    You better thank your lucky stars if you are concerned over a $60 per year increase in your premium! I work for a large engineering firm who has their insurance with LA Blue Cross Blue Shield. My company pays right at 50% of our premiums and in 2008 my premium increased $20, in 2009 it increased $60, in 2010 it increased $20 and in 2011 it increased $54 PER PAYCHECK and I get paid every other week. Now granted I pay the "employee plus wife & dependents" (family rates) but I would love to have a $60 per year increase. Health insurance has really gotten out of hand and it's getting worse. I truly dread what will happen if and when "Obamacare" kicks in.
    sorry, I should have written that more clearly. My paycheck was deducted $280 per month 2 years ago. Now it is right at $400 per month. TI am in the same boat you are. Sorry if that wasnt' clear before. My monthly premium has been bumped $60 each month 2 times in the last 2 years.

  5. #20
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    Re: ObamaCare: A false Promise

    I am exploring america's airports today. I will post it when I arrive at my hotel. I did get to clap at DFW today for about 60 troops arriving home in unis. It was pretty cool. Everyone in the terminal stopped walking and started cheering.
    PSA: Please realise the impotence of proof reading before you post.

  6. #21
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    Re: ObamaCare: A false Promise

    So, I was asked, " Hey, can you write an article about all the stuff going on in healthcare?" "Uhhhhh, you want the 2 paragraph politician version or the 1000 page exposition?"

    So here is the watered down version of the major issues in healthcare, with a focus on implications...not a debate of the issues:




    If you are not aware of the effects of the current economic turmoil on the healthcare industry, you may want to start paying attention. *There are numerous industry-changing initiatives being evaluated, and in many cases, implemented, right now. *Financial shortfalls on the federal and state levels are driving major changes in our healthcare delivery system, and will affect individuals, businesses, physicians, and hospitals. *The consequences of this industry overhaul will be felt in Ruston, across Lincoln Parish, and will impact the State of Louisiana as a whole. *The next eight months will likely redefine healthcare in this country for the next several decades, and you may not recognize the final result.
    *
    *
    The State Budget
    *
    The State of Louisiana has struggled over the past year to reconcile a $1.6 billion budget shortfall by cutting that amount from a $25.5 billion budget. *A 6% budget cut doesn’t sound that difficult, does it? *Unfortunately, it isn’t that simple. *When you subtract the $11.5 billion in federal funds, $4.6 billion in constitutionally-protected dedications, $1.7 billion in agency fees, and $5.1 billion in non-discretionary funds from the remaining $7.7 billion General Fund, you are left with $2.6 billion in discretionary funds. *Now we are trying to cut $1.6 billion from $2.6 billion. *A 62% cut becomes a little harder to fathom. *What is included in that $2.6 billion? *37% is Higher Education, 29% is Healthcare, and 34% is classified as “Other,” and includes line items such as Legislator salaries.
    *
    *
    The State’s Healthcare Insurance Coverage
    *
    A breakdown of current individual healthcare coverage in Louisiana includes 1.7 million with commercial health insurance, 1.2 million rely on Medicaid, 653,000 rely on Medicare, and 813,000 have no insurance coverage. *43% of Louisiana hospital revenue is generated from Medicare and 21% from Medicaid. *Statewide, Medicaid reimbursement accounts for 70% of hospital services in urban hospitals, 8% of hospital services in rural hospitals, and 22% of hospital services in state hospitals.
    *
    Under the Affordable Care Act, Medicaid enrollment eligibility in Louisiana will increase by 36%, or 467,000 Louisiana residents. *Almost 260,000 will be newly eligible individuals that were previously uninsured. *More than 20,000 will be individuals currently eligible but not enrolled. *Nearly 187,000 new enrollees will come from private insurance rolls. *The burden of 467,000 new Medicaid enrollees while experiencing the state budget challenges, and noting that the federal share for Medicaid funding has decreased by almost 20% since December 31, 2010, is driving state legislators to “fix” Louisiana Medicaid.
    *
    *
    The State’s Healthcare “Fix”
    *
    While all areas of healthcare are “on the table,” including significant cuts to Medicare reimbursement, cuts to Uncompensated Care reimbursement, and several other funding sources for physicians and hospitals in Louisiana, the primary focus of the Louisiana Department of Health and Hospitals (DHH) to address much of the financial shortfall in healthcare is on the Medicaid program delivery system. *DHH will implement its managed Medicaid program, promoted as Coordinated Care Networks (CCNs), on February 1, 2012 in the New Orleans area. *The rest of South Louisiana will begin implementation on April 1, 2012, and North Louisiana implementation will commence on June 1, 2012. *You can read about Coordinated Care Networks by visiting the Louisiana Department of Health and Hospitals website at www.dhh.louisiana.gov.
    *
    While DHH promotes the benefits of implementing CCNs including improved patient outcomes, improved quality, reducing the financial strain of the Medicaid program on the state budget, and reducing Medicaid expenditures wasted on fraud and abuse, the concerns of healthcare professionals do not lie in the reasoning, but in the implementation itself. *The implementation timeline for CCNs being undertaken by DHH is unprecedented in its rapidity. *Dozens of questions posed to DHH concerning issues such as program infrastructure, administration, organization, governing documents, patient requirements, and provider requirements all remain unanswered.
    *
    Most Louisiana physicians remain uneducated on CCNs, and many are completely unfamiliar with the term “Coordinated Care Networks,” yet are expected to play a key role in the delivery of care. *Rural hospitals continue to express concerns, still unaddressed by DHH, regarding discrepancies in fee comparisons between urban and rural hospitals and the implied risk of CCNs to direct patients away from rural hospitals and to urban facilities. *If the CCN program initially fails, Medicaid reimbursement would be expected to cease until corrective action can be taken.
    *
    Any reduction in funding though reimbursement cuts, shifts in patient volumes, or shifts in payer mix, will likely result in the inability of many Louisiana rural hospitals and physician practices with high Medicaid volumes to sustain positive cash flow. *A one to six month cease in Medicaid reimbursement will be devastating to numerous healthcare providers across the state. *The obvious results will be closures. *While this certainly is a pessimistic view of the CCN initiative, it is the view shared by most healthcare professionals in the state, as DHH has done nothing to instill confidence in the implementation procedures or outcomes of this delivery system overhaul.
    *
    *
    Healthcare Reform
    *
    Healthcare reform consists of two separate pieces of legislation: *The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Affordability Reconciliation Act of 2010. *In summarizing what the more than 2,400 pages of these two bills mean to physicians and hospitals, healthcare providers are going to be required to provide more access, for more people, while increasing quality, for lower cost. *To understand the magnitude of how strategically disruptive this legislation is, comparisons are being made to the Hill Burton Act of 1946 which stimulated growth and expansion of hospitals across the country, the implementation of Medicare in 1964, the implementation of Medicaid in 1965, and the Tax Equity and Fiscal Responsibility Act of 1982 which introduced prospective reimbursement.
    *
    The major elements of Health Reform Legislation include coverage expansion, redesigned Medicare and Medicaid payment policies, Medicare and Medicaid delivery system reforms, multiple healthcare provider issues, and Health Insurance Market reforms. *While most informed healthcare experts agree that many provisions in the legislation are positive, the fundamental problem in healthcare is worsened. *That fundamental problem is the fiscal sustainability of Medicare and Medicaid which is being addressed by the expansion of coverage, requiring physicians and hospitals to service larger quantities of patients, while improving quality, and being reimbursed less. *As physicians become incentivized to retire early, opt out of Medicare and Medicaid, move to alternative models such as “cash only,” students choose to not pursue careers in medicine, and hospitals across the country become unsustainable, a supply and demand issue that exists in many states today, including Louisiana, would be exacerbated. *As pent up demand is released through the expansion of coverage, even the current supply of physicians will be insufficient. *Expectations are that utilization of Emergency Departments will increase.
    *
    In addition to coverage expansion, provisions of Health Reform Legislation include: *creation of a high risk pool, dependent coverage for young adults up to 26 years old, provisions for children with pre-existing medical conditions, the establishment of state-based health insurance exchanges, subsidies for health insurance coverage, Medicare Part D coverage “donut hole,” an employer mandate, and an individual mandate that requires all American citizens not covered by an employer-based or governmental plan to purchase health insurance. *The key provision being challenged in the legal system is the constitutionality of an individual mandate.
    *
    Included with the overhaul of the healthcare delivery system, the healthcare provider reimbursement system is also getting an overhaul in the form of cuts. *Compounding this change is the federal budget deficit, the Federal Debt Ceiling Agreement, and our state’s budget challenges. *A long laundry list of cuts to healthcare service providers, some included in Health Reform Legislation and some under consideration, have the potential to deliver a devastating blow to healthcare in Louisiana. *According to the most recent estimates, the potential impact of reimbursement cuts on Louisiana hospitals alone could reach as high as $153,182,100 over the next year and $2,072,355,900 over the next ten years.
    *
    *
    A Breakdown of Health Reform
    *
    Provision:​​Insurance required for all citizens. *Significant changes to help individuals obtain insurance.
    • Medicaid eligibility expanded to all non-elderly individuals below 133 percent of the FPL
    • Individuals not eligible for Medicaid but below 400 percent of the FPL will receive credits to offset the cost of premiums
    • Companies with 50 or more employees required to provide health insurance or pay a penalty
    • States set up exchanges to help individuals and small employers obtain insurance
    *
    Effect on Utilization:​Increase
    *
    Explanation:​Of all the reforms, this will have the largest impact on utilization. *By insuring the previously uninsured, it reduces the out-of-pocket cost of healthcare to those individuals and increases their utilization. *For the majority of individuals already with insurance, there should be little impact.
    *
    *
    Provision:​​New plans must provide coverage for preventive services without co-pays.
    *
    Effect on Utilization:​Increase
    *
    Explanation:​Includes only select procedures. *Will increase preventive procedures with the largest co-pays. *As a secondary effect, additional screening will identify more patients needing follow-up services.
    *
    *
    Provision:​​Increased Medicaid payments to PCPs (2013 and 2014).
    *
    Effect on Utilization:​Increase
    *
    Explanation:​May entice more PCPs to accept Medicaid patients.
    *
    *
    Provision:​​Medicaid medical homes for patients with multiple conditions.
    *
    Effect on Utilization:​Increase
    *
    Explanation:​Will call for additional care management, care coordination, and health promotion services for these patients.
    *
    *
    Provision:​​Additional funding for community health centers and other community clinics.
    *
    Effect on Utilization:​Increase
    *
    Explanation:​$11 billion is currently budgeted.
    *
    *
    Provision:​​High-risk pools for uninsured denied insurance.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​Only 200,000 people are expected to join the high risk pools.
    *
    *
    Provision:​35% tax credit to businesses with fewer than 50 employees who offer health insurance, increasing to 50% by 2014
    *
    Effect on Utilization:​Small Increase
    *
    Explanation:​May entice some small businesses to start offering insurance, but some with new employer-provided insurance will be shifting out of individual plans.
    *
    *
    Provision:​Free annual checkups for Medicare enrollees.
    *
    Effect on Utilization:​Small Increase
    *
    Explanation:​In addition to their initial impact, checkups will lead to the discovery of more health issues, leading to more follow-up tests, visits, etc.
    *
    *
    Provision:​Coverage for dependents up to age 26.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​This is a generally healthy population.
    *
    *
    Provision:​No exclusions for children with pre-existing conditions.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​Impacts a limited number of children. *A third of all children are covered by Medicaid or state children's health insurance programs, and 10% have no insurance.
    *
    *
    Provision:​No lifetime limits.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​An important issue for some cancer patients and the long-term chronically ill, but there are relatively few of them.
    *
    *
    Provision:​Minimum coverage for all plans.
    *
    Effect on Utilization:​Increase
    *
    Explanation:​Effects depend on what the new minimum coverage will be.
    *
    *
    Provision:​Reduce Medicare and Medicaid Disproportionate Share hospital payments 75% but increase based on percent of population uninsured and amount of uncompensated care.
    *
    Effect on Utilization:​Unsure
    *
    Explanation:​Effects could vary by individual hospital.
    *
    *
    Provision:​Tax on “Cadillac” insurance plans.
    *
    Effect on Utilization:​Minimal Decrease
    *
    Explanation:​There will probably be few “Cadillac” plans remaining by 2018.
    *
    *
    Provision:​Insurers can’t charge higher rates or refuse coverage because of health status, sex, or pre-existing conditions.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​Doesn’t impact anyone with employer-provided insurance. *Will reduce the premiums for unhealthy individuals with individual insurance and allow them to spend more on co-pays.
    *
    *
    Provision:​No annual limits on coverage.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​few patients currently affected.
    *
    *
    Provision:​Limited deductibles in small group insurance market.
    *
    Effect on Utilization:​Some Increase
    *
    Explanation:​Effect limited to patients who would have waited more than 90 days and also needed care.
    *
    *
    Provision:​Limited insurance waiting period to 90 days.
    *
    Effect on Utilization:​Small Increase
    *
    Explanation:​Effect limited to patients who would have waited more than 90 days and also needed care.
    *
    *
    Provision:​Income based out-of-pocket limits for up to 400% of the FPL.
    *
    Effect on Utilization:​Modest Increase
    *
    Explanation:​Impact limited to individuals below 400% of the FPL who already have insurance and are approaching their out-of-pocket limits.
    *
    *
    Provision:​10% Medicare bonus to primary care providers and general surgeons in health professional shortage areas.
    *
    Effect on Utilization:​Limited Increase
    *
    Explanation:​Limited to some physicians in HPSAs.
    *
    *
    Provision:​Medicare payments to qualifying hospitals in counties in lowest quartile Medicare spending (2011 and 2012).
    *
    Effect on Utilization:​Small Increase
    *
    Explanation:​Limited to hospitals in 20% of the country’s counties. *No direct effect on physician remuneration.
    *
    *
    Provision:​Reduction in annual Medicare market basket payment updates.
    *
    Effect on Utilization:​Decrease
    *
    Explanation:​May reduce the number of providers accepting Medicare patients.
    *
    *
    Provision:​Medicare Accountable care Organizations (ACOs) established.
    *
    Effect on Utilization:​Decrease
    *
    Explanation:​The goal of ACOs is to reward efficient providers of quality coordinated medical care.
    *
    *
    Provision:​Reduce Medicare payments for preventable hospital readmissions.
    *
    Effect on Utilization:​Decrease
    *
    Explanation:​Impact will vary by hospital.
    *
    *
    Provision:​Establishment of a hospital value-based purchasing program that links hospital payments to outcomes.
    *
    Effect on Utilization:​Decrease
    *
    Explanation:​Depending on the final program design, the impact could be large for selected hospitals.
    *
    *
    Provision:​Limit flexible Spending Account (FSA) contributions to $2,500.
    *
    Effect on Utilization:​Small Decrease
    *
    Explanation:​Will limit the tax savings for patients who spend more than $2,500 a year out-of-pocket.
    *
    *
    *
    Conclusions
    *
    Changes in Medicare and Medicaid payment and delivery systems will have the most direct impact on providers. * There will be increased pressure on operating margins due to payment reductions, resulting in increased difficulty to generate and access capital. *Physician alignment with larger entities will become increasingly important. *The formation of networks of providers into ACOs will likely accelerate to align payment systems with reduced patient volumes resulting from disease management initiatives. *Quality will drive reimbursement levels and will become the differentiator in the market, as traditional fee for service payment will cease.
    *
    Ultimately, independent hospitals will struggle financially as they become pressured for operational efficiencies and human and capital resources. *Clinical integration will create advantages for systems of care including value-based purchasing, a focus on re-admission rates and preventable re-admissions, and bundled payments. *The future of healthcare comes down to affordability. *Is it affordable to continue providing increased access and quality to a larger customer base for lower cost? *At the moment, healthcare experts believe the math doesn’t work. *For the equation to balance, a reduction in access through closures of physician offices and hospitals, a reduction of quality through rationing, or a decrease in consumer benefits will be required. *The next eight months are likely to change healthcare for decades.
    *
    *
    *
    *
    PSA: Please realise the impotence of proof reading before you post.

  7. #22
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    Re: ObamaCare: A false Promise

    If I get some time tonight, I may outline an alternative to healthcare as you know it, that works under Obamacare but more outside the system than in it...perfectly legal, gets back at "the system," is much cheaper for you the consumer, and we are developing right now. I'd be interested in everyone's feedback, while not terribly worried about anyone stealing it. I'll try to get it done later.
    PSA: Please realise the impotence of proof reading before you post.

  8. #23
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    Re: ObamaCare: A false Promise

    Interesting....thanks RD.

  9. #24
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    Re: ObamaCare: A false Promise

    Wow! Thats looks like a lot of work RhythmDawg. Thanks!

  10. #25
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    Re: ObamaCare: A false Promise

    Yes, unlike washington i did read the bill. 3 versions. I don't recommend it.
    PSA: Please realise the impotence of proof reading before you post.

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    Re: ObamaCare: A false Promise

    Quote Originally Posted by RhythmDawg View Post
    Yes, unlike washington i did read the bill. 3 versions. I don't recommend it.

    Thank you for the time it took to condense all of that down to language I can understand. I tried to sit down and read 1 version of the bill, but didn't have the 3 bottles of strattera it would have taken to get through it.

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    Re: ObamaCare: A false Promise


  13. #28
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    Re: ObamaCare: A false Promise

    Quote Originally Posted by RhythmDawg View Post
    If I get some time tonight, I may outline an alternative to healthcare as you know it, that works under Obamacare but more outside the system than in it...perfectly legal, gets back at "the system," is much cheaper for you the consumer, and we are developing right now. I'd be interested in everyone's feedback, while not terribly worried about anyone stealing it. I'll try to get it done later.
    Wow, can you just give me the executive summary to the dissertation?

  14. #29
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    Re: ObamaCare: A false Promise

    Quote Originally Posted by glm47 View Post
    Wow, can you just give me the executive summary to the dissertation?
    Yes. Full access to basic primary care services, a second tier piece that I will leave undisclosed for intermediate care (specialists, x-rays, lab work, etc.), and a third undisclosed piece that covers major medical and meets the requirements to sit on Obama's heatlh exchange and allow you to avoid the penalty for the personal mandate. All for the low low price of between 30%-60% less than what it costs you, or you and your employer together depending on if you share the cost, through the current health insurance system. How is that possible, you ask? Sorry. I'll let you know just after we beat everyone else to the market.


    ...all coming to a town near you, with the beta starting in Ruston hopefully within the year.
    PSA: Please realise the impotence of proof reading before you post.

  15. #30
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    Re: ObamaCare: A false Promise

    Quote Originally Posted by RhythmDawg View Post
    Yes. Full access to basic primary care services, a second tier piece that I will leave undisclosed for intermediate care (specialists, x-rays, lab work, etc.), and a third undisclosed piece that covers major medical and meets the requirements to sit on Obama's heatlh exchange and allow you to avoid the penalty for the personal mandate. All for the low low price of between 30%-60% less than what it costs you, or you and your employer together depending on if you share the cost, through the current health insurance system. How is that possible, you ask? Sorry. I'll let you know just after we beat everyone else to the market.

    ...all coming to a town near you, with the beta starting in Ruston hopefully within the year.
    All for the low, low price of an insolvent nation, death panels and few/poor doctors to see for that low, low price. Any other representation is a lie.

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