June 15, 2013 Legislation






The WSJ has an editorial on the Obamacare "Bait and Switch".  This happened in California and Oregon where the states used erroneous figures to tell the population that Obamacare will only raise premiums slightly.  In fact, the article states, individual policies will raise for a typical 25 year old between 64% and 1117% over today's prices as listed in eHealthInsurance.  The price for a 40 year old will be between 46% and 146% higher.  After this was shown the left camp then said the higher premiums are for better benefits and pre-existing conditions so they are worth the money.  Remember, the original name of the law is the Affordable Care Act.  It isn't now and will never be.

Obama is coming to Sunnylands in Rancho Mirage to meet with the Chinese President.  As long as he's in California and so it will not be a wasted trip he will fund raise and give a speech on Obamacare.  California is one of the few states that doesn't need the speech as they were first to set up the exchanges and the pricing (see above).  

While Obama is in California Sebilius will continue to be attempting to defend her position in going after private money for public information on Obamacare.  

The LA Times has an article about Democratic members of the LA congressional delegation questioning the HHS about putting Medicaid and dual eligible patients into HMOs.  They say correctly that there are not enough physicians to care for them.  That is also true of all Obamacare patients.  

The Triad Business Journal states that only two or three carriers will participate in the North Carolina exchange.  Should be great for competition.

Obama has told Congress that they can not stop the sequestration problem that is causing a 28% drop in payments to outpatient cancer clinics who do chemotherapy.  This forces patients into hospitals for their care which is of poorer quality and much more expensive.

In one of the first of many expected law suits to be filed about Obamacare benefits, the National Women's Law Center has complained to the Justice Department about sex discrimination for lack of pregnancy coverage by some large employers.  The named companies were in Alabama, Indiana, Washington, Ohio and Pennsylvania.

According to an article in FierceHealthcare if the Republicans do not nominate anyone for the hated IPAB, the Sebilius will decrease Medicare spending on her own.  They state that this is in the Obamacare law and will be fast-tracked.  This means that it will become law if Congress does not make similar cuts elsewhere or the Senate does not override with a 2/3 vote.

CMS has decreed that they will now cover without prior authorization up to three PET scans for post cancer treatment follow-up. After three it will be up to each MAC to individually determine the need.

In another case of Boxer stupidity, the Senator has put up a bill that has no chance of ever becoming law. She wants illegal immigrants to be covered under the exchanges.  Even Pelosi is against this.    

The American Urological Assn. has issued new guidelines for PSA testing.  They recommend screen testing males between the ages of 55 and 69.  For those with family history screening should begin at 40.  They do not advise routine screening for those over 70 or with a life expectancy of less than 10 years.  I have no idea why there is an age cap on the screening as many men of this age are in great health and have much more than 10 years to live.  I agree that physicians owe a duty to their patients to discuss the test and the possible consequences if the result is abnormal. 

Some California politicians are dumber than others.  The Insurance Commissioner falls into that category.  He is frustrated that he has no power to deny insurance companies from raising rates so he has recommended that Blue Cross be banned from the Obamacare California exchange.  Since there are only three major insurers interested in the exchange deleting one would decrease competition and access. One of the other three is Kaiser which just announced huge increases for Obamacare.        Top


The California Senate has passed three bills that affect the Medical Board.  The Board has been under fire due to their "lax" attitude toward over prescribing physicians.  The bills are SB 304 which gives the Board investigators to the Attorney General instead of the Board, SB670 would allow the board to look at medical records of deceased patients without a court order or next of kin permission 62 would require coroners to tell the board of any deaths related to prescriptions and SB 809 would impose a 1.16 fee increase to give money for investigating physicians for over prescribing.  These bills all passed with overwhelming bi-partisan support.          Top 


The ACLU of Washington state is pushing the governor to put in a six-month moratorium in hospital mergers.  The reason is most mergers are with Catholic hospitals which may prohibit abortions and birth control. 

The Joint Commission has allowed Rawson-Neal Psychiatric Facility to retain it's accreditation.  This is the organization that gave its patients bus tickets to other states so Nevada would not have to pay for their care.

California seems to be the only state to fine hospitals for their screw-ups.  They just got another ten hospitals mainly for retained foreign bodies.  The hospitals are Simi Valley for leaving in a Babcock clamp, 2nd Penalty fine $50,000; CPMC for a retained sponge, Fourth penalty $100,000; Eureka St. Joseph for a retained FISH, 1st Penalty $50,000; St. Luke's Hospital for retained guide wire, 1st Penalty $50,000; UCLA for retained sponge, 1st Penalty $50,000; Tri-City Med Ctr. Pt. fall from Geri/bed without a retaining strap Pt. died.  3rd Penalty $75,000; Palomar Health Pt. fall resulting in death 3rd Penalty $100,000; Marin General gave wrong med that contributed to death, 3rd Penalty $75,000; LA Children's Physician ordered wrong dose and not caught by Pharmacy Pt died. 1st Penalty $50,000 and Fallbrook Hosp. Baby got med intended for mother wuith brain damage 1st Penalty $25,000.         Top


There has been another article this time in California HealthLine that warns physicians about a potential problem getting paid under Obamacare exchanges.  This is where a person in an exchange does not pay a quarterly premium to the insurer.  The insurer will not pay the physician after the first missed month.  The patient will have no responsibility to pay for the care and neither will the insurer.  The physician will eat the bill.  This may keep many physicians from joining the exchanges.  Think how much a round of chemo may cost the physician if no one pays for two months.  Maybe all exchange patients should have chemo at the hospital instead of the office.  Some small practices should be especially leery of taking exchange patients.  The only way to really solve the problem is via federal law which will not happen with the divided Congress.

The House Republicans have a plan to get rid of the dreaded SGR for good.  The way would be to keep fee for service and gradually incentives to other forms of payment.  A Democrat wants the new payment structure up front.  There is always something that will stop the SGR from going away.  Neither side has given a way to pay for removal of the SGR which of course is not logical since it has never been used since its inception.           

In the law of unintended consequences the People's Republic of Massachusetts has passed a law that in order to get a license in the Republic a physician must be proficient in EHR by passing the "meaningful use" test.   This means that only 1/3 of the Republic's physicians can be licensed.  This is another bill like Obamacare that was not read prior to passage.        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.