December 15, 2010 Legislation




A federal judge in Virginia has declared the individual mandate of the Obamacare to be unconstitutional as it violates the commerce clause. This is the first judge to rule this way and sets up a potential problem in the Circuit Courts and depending on the Florida case may scuttle the plan or at least send it to the Supremes without it going to the Circuit Courts.  The Florida judge will hear arguments tomorrow and will issue an opinion probably in January. 

The AMA is calling for legislation to allow physician led ACOs under the Stark and other laws.  They want this done so that physicians do not have to go under a hospital tent.  They want the feds to permit ACOs to have no more than the minimum now required beneficiaries of 5000.  This would enable small physician practices to be part of the ACO program.  

The administration has announced broad eligibility rules for small business to get tax credits for paying health benefits.  All but the self employed can benefit.  They will get credit for 35% of their healthcare costs.  They must have under 25 employees, pay annual wages below $50,000 and pay for most of the employee health coverage.

In one of many pages of the Obamacare bill that was not read by anyone, is an opt out provision starting in 2017.  The kicker is that a state that opts out must devise a coverage program that is at least as comprehensive and affordable as the health reform law as judged by HHS.  There is now a move to move that up to 2014 by Democrat Ron Wyden of Oregon and Republican Brown of Massachusetts.   

The start of the State revolt of the Medicaid tightening under Obamacare has begun.  Arizona has decided that they can no longer pay for transplants for those on Medicaid. The state has stopped liver transplants for hepatitis C, lung transplants, and some bone marrow and pancreas transplants.  Transplants are considered optional services under the federal law. Almost all states have cut Medicaid benefits but this is the first one to cut transplants. 

An apparent deal has been reached for a year delay in the dreaded Medicare SGR implementation.  The Dems want it done now so that the Republicans can not tie it to a healthcare repeal.  The money would be paid by people who have eligibility changed during the year.  If they got a subsidy early in the year due to unemployment and then received employment, they would have to pay back money to the government for any healthcare subsidies.  This would be about equal to the $19 Billion needed for the SGR one year fix.  It passed the Senate and House the next day.

The House and Senate have passed the repeal of the Red Flag rules for attorneys and medical/dental offices.  They finally realized after being sued how dumb the rule was.

The English NHS is planning reforms for "value based pricing".  The pharmaceutical houses have stated that they will not participate if they have to participate in the pricing and have to negotiate with each GP who now will be in charge of the drugs instead of NICE.   

NICE is not finished.  They have rejected Avastin for breast cancer.  They did not find that the drug was good for quality of life nor for prolonging life, taking into account the cost of the drug.  They had previously not approved the drug for renal or colo-rectal cancer that has spread.    Top


Stockton, California's St. Joseph's Surgery Center is no longer able to take Medicare or Medicaid patients due to deficiencies.  They flunked two inspections.  The Center states they have not been told of the restrictions which is hard to say with a straight face.  They can appeal within 60 days but can not apply for reinstatement for 90 days.  Over 50% of their population would be affected.  

To some surprise the Feds have stopped their termination of the above Surgery Center.  They have given them another month to come into compliance.      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 information presented.