The FTC has again delayed the onset of Red Flag rules for all until June 1, 2010. This comes on the heels of a court decision stating that attorneys are exempt from the rules. Top
The physicians in the People's Republic of Massachusetts are fighting the legislature that wants to cut fee for service payments. They want a global fee defined as capitated and quality measured, whatever that is.
The US Senate failed to pass the repeal of the 21% projected decrease in physician Medicare payments starting 1/1/10. The rationale was there was no offset for the loss of the $200 Billion the bill would cost. It should be noted that when the CBO looks at the cost of healthcare reform they ignore physician costs. The CBO did state that the cost of the overhaul of the physician portion would be $210 Billion. This is cut back by not including physician administered drugs from the formula, which make for an inaccurate cost estimate.
Obama has again backed off another shoot from the hip statement. Originally he wanted 10% decrease in cardiology and oncology to pay for primary care. This is now being phased in over four years instead of at once. This is to help keep physicians seeing Medicare patients for a little longer. Of course with the 21% decrease scheduled many physicians will decrease the number of Medicare patients anyway.
The schizophrenic AMA has backed the House Health bill and at the same time wants the 21% cuts in physician pay to be stopped. They fail to realize that the problem with both is the cost. The country can not afford the House bill and without offsets the 21% reduction will not pass. This will lead to significant reduction to access to healthcare.
The American College of Surgeons has voiced six reasons not to support the Senate bill. They are the poor response of CMS to PQRI in not having adequate information and not paying the required monies, the bonus to primary care would come on the back of rural surgeons, the plan would reduce monies paid to surgeons with high utilization without regard to acuity, the Medicare Commission, CMS can not do a budget neutral value based payment modifier and physicians would have to pay a fee for a background check to be in Medicare. The ACS could not back an unsuccessful program. Top
CMS has cancelled its gag order against Medicare Advantage plans telling its consumers about possible cuts in their plans. The two faced administration now says there was never a gag order but a guideline. They are backpedaling as fast as possible. Top
In the six weeks since my last report there have been two and only two actual things done. The first was the passage of the Baucus bill out of committee in the Senate with one Republican vote, hardly bipartisan since Sen. Snowe stated that she would vote against it in the full Senate if a public option was added. The bill would cover about 29 million but leave out 25 million people of which about a third are illegal aliens. The other was the passage of the controversial House bill. This made it with one Republican vote and with 38 Democratic no votes. This bill would not have passed unless Pelosi prostituted herself even more by allowing an amendment not allowing abortion. Pelosi made another tactical error. She asked for a CBO review of the costs. The CBO pegged the Senate Baucus plan at $829 and cover 94% of Americans. She hopes that her idea of a millionaire tax will pay for the plan. Another tax would be on Cadillac medical plans but this may bite the Dems since many of these are union plans. The House moderates realize the folly of the idea. The Lewin Group states that over the first decade the tax would add $39 Billion to the deficit and after ten years there would be over $1 TRILLION in additional debt. House moderates are asking the CBO for 20 year projections instead of the usual ten. There were no monies in the bill for physicians. This was removed to make the bill seem cheaper and will be put into a separate bill later, another sleight of hand.
Several little known things in the House bill are employer contributions to gay companions would be tax free as it is for married couples. Chain restaurants and owners of more than 20 vending machines would need to post calorie content of each item. Home visitation for counseling of pregnant mothers by social workers or nurses would be insured. There would be priority given to construction of health clinics of Indian health clinics in Minnesota, Nevada and New Mexico. Health plans would have to pay about $2 per member a year to finance comparative effectiveness treatments.
The Wall Street Journal had two articles regarding little known tidbits hidden in the 2000 page House health bill. The first was in the payment for the policy. There is going to be a 5.4% surcharge on income taxes on people who make over $500,000 in adjusted gross income individually and twice that for couples. The problem is that means it applies for dividends and capital gains as well. This increases the capital gains by 26% in 2011. The last time this type of thing occurred there was a flurry of activity before it went into action and therefore no money was made by the raise of percentage. I predict the same will happen this time. It is interesting that when the capital gains tax went down a significant amount of money flowed into the treasury. Candidate Obama was against this type of tax but seems to be changing again toward the liberal bent.
The second tidbit was a buried tort problem. There is to be monies given to states to try new things as long as the states do not have caps on attorney fees or awards. There are many states that already have these and they are working fine. Will the states change their laws to get the money? The cost of defensive medicine is now pegged at $30 Billion annually. How much will it go up if the states change the rules.
The Washington Post had an article on Democratic "Fuzzy Math" used to drive the over $1TRILLION health care plan even higher and take away all suggestions that it will reduce the deficit. The Post article also states this was done by the Bush people as well when he had his war budget. It is well known by all that the payments to physicians were left off any CBO calculations. This alone saved almost $300 Billion from the bill.
The Senate Democrats are also wary of the cost of the Health Reform. The New York Times reported that some Democrats want significant changes in how hospitals and physicians are paid. They want the fee for service removed and paid by either a global service or a per patient (HMO) payment systems with quality controls. They also want the removal of workers and employers purchasing expensive health insurance that mask the true cost of health care. They want this quickly to reduce the cost of health care.
The House bill will raise the costs for insurance for younger people to help older ones pay. The House bill states that insurers can charge older insureds twice the cost of younger insureds. This will mean that the younger ones will be charged more so the insurers will be able to charge the older insured what is fiscally needed. The Senate bill is more realistic when it states the older can be charged three times what the younger insured is charged.
The AMA again voted as it did in June to back the House bill. This was after an eight hour debate with many wanting the AMA to reverse its June stand.
The NIH has decided that all that wait over 18 weeks for NIH treatment will be able to get free private healthcare. Also all cancer patients who are not seen by a specialist for over 2 weeks after being referred by their GP will also get private healthcare. These will be put into law by Parliament in the next few weeks says the Guardian. Top
The Governor has again vetoed the insurer rescission bill. He signed bills to mandate insurers cover cleft palate dental and orthodontic procedures, a bill to bar insurers from rescinding coverage after two years of coverage, prohibits different insurance rates based on gender and a requirement for clinicians to publicize any mammogram state violations by the Dept. of Health. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the