February 1, 2013 Legislation




The Democrats get an A for effort but flunk.  The House Democrats again proposed a law to have a public option in Obamacare.  This, of course, will go nowhere. 

The administration has proposed an increase in co-pays for Medicaid patients that live below the poverty line.  They want a flat $4 co-pay plus having the higher earning Medicaid patient pay more for non-emergency ambulance trips to the hospital.  They are finally understanding that their free care is not free.

As most states have decided not to join the feds folly of health care exchanges Sebelius has decided to give them more time to join even if the law says otherwise.

The Fiscal Cliff (slight slope) negotiations took funding away from Obamacare in the area of Consumer Operated and Oriented Plans.  This left those who had already started on the formation with debts.  The White House did not respond to questions as to why Biden allowed this to be in the negotiation.  

The OCR has made a common sense decision that patient privacy is overruled by potential threat to others such as in the Aurora shootings.  

HHS has released the new final version of HIPAA (over 500 pages) which will become law on 3/23/13 and will require all to redo their privacy practices notices and again give them to all patients.  The business associate agreements will also have to be amended.  Fines for large breaches of the rule are now raised to $1.5 million.  The business associates will now be directly responsible for problems and the breach will not revert to the covered entity.  The law goes on to state that insurance companies can not use genetic information in their underwriting.  Patients may now request their records either in writing or electronically.  

Obama is pushing Sebelius to write the mental health rules that she was charged with writing with the passage of Obamacare in 2010.  She thinks they will be ready by the end of 2013 which would be nice since that is when the law goes into effect.  

The Republicans won!  There are no more health exchanges either in the states or the fed.  In a PR attempt HHS hoped to bet buy in for the dreaded exchanges by now using the work marketplaces.  A horse by any other name is still a nag.  This is pure desperation since only a few states have agreed to the marketplaces.

A coalition of small business, providers and insures have requested the HHS to keep the mandates of Obamacare in line with what is already offered and not expand them so the costs will be prohibitively higher.

The Democrats have again proposed a bill to make all Corporation Sub S payments earnings and therefore subject to the Medicare tax.  In the past some were considered profits and therefore not subject to Medicare taxes.

The Republicans have introduced legislation to repeal the IPAB which is unpopular with both parties.  Last year it had over 200 co-sponsors from both parties.  This time it has 80 of the same sponsors and more are expected to join.

A bipartisan group of Senators are putting a bill on immigration in the hopper in order to take the issue away from the White House.  The bill will make a path toward naturalization easier for some illegals.  The bill does not allow those with probationary status to be eligible for Obamacare. 

In another DUH, the Senate has determined that there will be a shortage of about 16,000 primary care physicians when Obamacare starts.  This, they say with a straight face, will cause more ED visits and increase costs.  The problem starts with the physicians who make up the reimbursement board at CMS.  Since there are more specialists on the board than primary care physicians that is the reason specialists make more and more are not going into primary care.  The other problem is that medical school professors tend to steer their students to specialist care since it is more prestigious.  Of course, the Senate does not make any recommendations such as allowing more primary care spots in residency programs.  

For the second year the Senate has proposed a bill to force credit agencies to remove any medical debt from the bad credit within 45 days of the debt being paid.

In the vast majority of states that are not allowing Obamacare Medicaid expansions the HHS has issued a new "clarification".  The individual mandate or tax does not apply to those people who live in states that do not expand their Medicaid.  The mandate also does not apply to those individuals whose income change over the course of a year.  If you did not make enough in the beginning of the year to qualify for the mandate but your income rose during the year to eventually qualify, you are still exempt.  There will be many people exempt from the tax with these qualifications.  This will raise havoc with the cost of the program.  

Another problem with not reading something you pass and understanding it, are the "glitches" that come up later.  One that is bugging the liberals now is the glitch that states those families that cannot afford employer coverage offered can not get federal assistance to purchase private insurance.  They however are another class of people who will not face a penalty for not paying the individual tax. The only way this can be fixed is via legislation which will not occur with the Republicans holding the House.         Top  


An article in the Annuls of Internal Medicine told of behaviors by physicians that are not acceptable on line as well as those that the Federation of State Medical Boards might accept.  Those that are taboo are misinformation about the practice on their website, misleading information on outcomes, use of patient images without consent, misrepresenting ones credentials and inappropriate use of patient information such as using their data to "chat".  Gray areas include showing alcohol intoxication, using discriminatory speech and violating patient confidentiality.  Things that are OK are derogatory speech toward patients, showing alcohol use without intoxication and blogging without patient identification.

Wisconsin is a state that allows the practice of medicine with only one year of residency.  They are attempting to change that to require two years of residency in an American residency program.  Foreign Medical grads also need to take an oral exam to make sure their English is enough to practice.        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.