The liberal New York Times has a story that the Public Unions have finally woken up to the changes due to Obamacare. Cities are warning the unions that if they can not figure out how to rein in health care costs now the Cadillac tax of Obamacare will cost the union jobs and or raises. The employers are using this as a great bargaining chip in the negotiations with the unions. If unions accept the lower price plans they will get fewer physicians and more co-pays. It is interesting that those public employees that will be hit the hardest are in the Democratic strongholds of Boston and New York City. Although the tax does not go into effect until 2018, the planning in union contracts must start now.
The administration has unilaterally delayed some caps for those insured by employers by one year. For 2014, these people will have two caps of $6300 each. One will be for prescriptions and one for major medical expenses. The employers have to January 1, 2015 to figure out how to have all under one $6300 cap on out of pocket expenses. There is no where in the law that lets the president change the law unilaterally. The exchange and individual caps will be the $6300 for all. This is akin to Obama's illegal recess appointments.
Ah yes. Remember when Pelosi said that Congress would abide by the same Obamacare rules as everyone else. She followed Obama and lied. The Congress and the aides were being confronted with higher costs for health insurance under Obamacare. The law requires them to get coverage via exchanges instead of the Federal Employees Health Benefits Program. Under this program the government (taxpayers) pays $5000 a year for individual coverage and $11,000 a year for family coverage. This was not going to happen with the exchanges and Congress. So the administration again unilaterally ordered the Office of Personnel Management to pay the same amount for those in Congress and their aides. Also when these people retire and are on the exchanges the money will continue but they will not be able to go back to the Federal program. This will turn out to be a major problem that will be raised in the 2014 elections.
Remember when Obama said no one would have to change physicians if Obamacare was passed? He lied. In San Diego alone California Healthline reports that 12,000 people will need to find new insurance which may or may not include their physician. This is because Aetna and United Health both pulled out of the individual market in California. The pull out affects 7% of the state's total individual market. See article below regarding insurers.
The Hill writes that Democrats are also lining up to fight against the IPAB. Howard Dean, former Democratic National Chair railed against the panel. Many congressional Dems and some Senate ones as well have also lined up against the panel. The board is supposed to start it's work when healthcare costs rise a certain percentage. However, no members have been selected for this panel.
Georgia is requesting an emergency delay on starting their health exchange. The reason is that the large insurers pulled out of the state. Those that wanted to remain wanted an average of 190% increase in premium over what is now being charged. The state can not make the insurers charge less since their actuary said the prices were within reason.
As all know the Pioneer Project for ACOs was generally a failure with nine switching to a different style ACO and two dropping out completely. There were so successes. The biggest one as reported in the San Francisco Business Times was the Brown Toland Medical Group of San Francisco. They saved Medicare $10 million, 12% of the total saved by all the ACOs. They used a hybrid Medicare HMO which is part fee for service and part HMO.
The Peoples Republic of Massachusetts has given out a study showing their medical plan is costing more and the people are getting less benefits. The problem in this Republic is that the people get their care from the major hospitals and physician groups which are high cost for the same thing done in community hospitals by community physicians. Top
The WSJ has an article regarding insurers paring their lists of physicians. This is presenting hardships on people with long term relationships with both their insurers and their physicians. If they like their physician and they are no longer in their plan they must pay out of network rates to see him/her. This is becoming especially true with the new HMO Obamacare arrangements. They are limiting the hospitals and the physicians that they will pay. Others are going back to the old HMO principles of getting authorizations to see specialists or prior to some procedures. In 13 states about 47% of the exchange plans are HMOs that do not pay for care outside of the network. This goes back to rationing to save money. The insurers are betting that people going to exchanges will go for cheap in exchange for flexibility. If there is a small physician network the insurer can negotiate a lower fee for captive patients. Very few insurers will include the teaching hospitals that are usually more expensive. Patients will become consumers and cost will be paramount. They may find that hospitals and physicians are not fungible. Again, remember when Obama said "you will not have to find a new doctor", he lied. Top
The AMA is closing it's AMA News print and online editions. They are not getting enough ads to cover the cost. They will continue with the JAMA for now. AM News will go out of business on September 9. It is interesting that publishing brings into the AMA about 20% of the revenue but dues only bring in 14%. Talk about a dying organization.
What to do about physicians who overprescribe controlled substances. Purdue Pharmaceuticals, the maker of Oxycontin, has a list of about 1800 physicians that they are investigating ov abusing their drug. Two California legislators have asked that Purdue turn over their list of California physicians to the Medical Board. Should they? Where does the DEA fit in? Should they be amassing their own database on all controlled substances and using it to go after the few bad apples? Top
It is 64 years late and not to the hospital that stole their cell line but Henrietta Lacks via her relatives have now given consent to the NIH for the use of her cervical cancer cells for experimentation. When Ms. Lacks went to Johns Hopkins for treatment for her terminal cervical cancer they found that her cancer cells would grow in-vitro and began the HE-LA cancer cell lines that are being used throughout the world for cancer experiments today. They took her cells without permission and never offered her nor her family any compensation. The deal with the NIH was prompted by the study and release of her genome. Again the Lacks were unaware of the studies. The NIH did what Johns Hopkins never did they agreed that the Lacks needed to be informed. Instead of the information being released the genome will be stored in the NIH and anyone who wishes to use it will apply to a committee that will include two members of the Lacks family. The family will receive no money for the use of the genome just as they had never been compensated by Johns Hopkins when they appropriated the cell line. Top
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