November 15, 2013 Legislation

Due to a problem with the program used to publish this site and the amount of material over the past month, not all legislation will be included.






As all know Obama has spoken again to the American people and intimated that his promise that they could keep their insurance was real.  He did this as millions are receiving notices of cancellation of their policies and being shoe horned into policies that have benefits they do not want nor need at very high prices.  He also realized that this is one thing he could not do by executive fiat.  He is asking insurers and state insurance commissioners to allow their individual policy holders to keep their substandard policies.  Most insurers and states have said this is not wise nor feasible.  

In the ongoing Obamacare mess nine Democrat House Representatives have proposed a delay in the individual mandate penalties.  They are all up for re-election.  Eight of the nine are being targeted by the Republicans in their districts.  The majority of house Democrat freshmen and some Senators summoned White House representatives and Biden to a meeting to make sure they do more to help them in their re-election campaigns that may be in difficulty due to the screw-ups.

All know the website has been a disaster but what was not know was how the main contractor CGI, a Canadian company, was selected.  This started under Bush when 16 contractors were in 2007 named to do an umbrella contract for HHS.  This list was the only ones allowed to bid for the Obamacare website.  Out of the 16 only 4 actually bid and the lowest bid was CGI.  They are expected to gross about $630 million.  This is a very small amount of their expected $10.2 of revenue this year.

Obama finally realized that his staff were incapable of taking care of the problems of the Obamacare website.  He has asked and is getting help from the people in Silicon Valley that Tavener and Sebelius should have hired in the first place. 

After this lighting bolt of realization hit Obama and feeling the heat from all sides on the failed web site roll out, he called in a czar for overseeing the fix to be completed by December 1.  The goals of the site then changed.  The new goal for being able to declare success is for only 80% of the users to be able to enroll for insurance.  This is Obama's definition of the "vast majority" of users being able to use it as it was intended.  Good luck to the other 20%. 

As of now about 20% of visitors to have actually gotten insurance.  The reasons the other 80% did not get insurance were the policies were too expensive, they could not navigate the site due to problems with the site and/or they were still deciding on a plan.  Taking into account all the websites about 17% of all eligible Americans have visited a site.  

As always politics rule and those with the clout get to evade Obamacare.  The HHS has released guidelines that state self insured self administered plans will be able to not pay the Obamacare tax on insurances in 2015 and 2016.  Who has these type policies?  The unions do.  This is two months after Obama said he will not exempt the unions from the tax.  The tax is $65 per person insured in 2014 and $40 per person for 2015.  The tax is for insurance subsidy for those that have pre-existing conditions.

In another interesting ruling the HHS has stated that hospitals may help uninsured patients pay for private insurance via the exchanges.  The exchanges do not meet the definition of a federal health program.  I wonder what they are if not a federal health program and therefore are exempt from the Stark Law.  They subsidize people's premiums with taxpayer money.  Hospitals that attempt to help uninsured patient that come to the ER buy insurance so they will get paid may be in for a rude awakening since the insurance is not retroactive nor immediate.  This also means that pharmaceutical companies can give coupons for non-generic drugs for patients insured by the exchanges which they can not do for Medicare or Medicaid.  It will be interesting if and when someone challenges this in court.

It seems that small businesses around the country are quickly attempting to renew their current insurance policies so they will not have to pay the large increases of premiums under Obamacare.  After all the scurring Obama announced that those small businesses under the will not be able to buy insurance until next year.  This does not apply to those using state exchanges.  The small businesses (those under 50 employees) will need to use brokers to purchase the insurance and may still receive up to 50% tax credits.  They will not be able to use the website until October 2014.

Along with that delay is another one which is probably for political purposes.  Individuals will be given a whopping extra five days to sign up for Obamacare this year and could wait until December 31 to pay for it and an extra month next year start enrollment to November 15.  This pushes it to beyond the elections and means voters will not see the new premiums until after they vote.         Top 


It is that time of the year again.  If Congress does not get off their collective butts and do something the physicians are again threatened with a major cut of their Medicare payments starting January 1.  The figure is 24.4%.  This, as usual, will never happen.  Congress is planning on passing a real fix for the never used SGR.  It will freeze payments to physicians through 2023 and starting in 2017 providers will no longer be paid fee for service but the nebulous value based performance.  It would also get rid of the penalties on the physicians for not having EHR meaningful use, PQRS and Value Based Modifier at the end of 2016.  The law that made it through the Senate Committee states physicians can get a 5% bonus if they do much of their work via alternative payment models (APM) and consult the guidelines before ordering advanced imaging and electrocardiograms.

The American Board of Ob/GYN had to eat crow.  They originally decreed that physicians certified by them could not treat male patients for STDs or screen men for anal cancer.  After they received waves of protest they reversed their ill-thought out decision.

California has an initiative pending that if passed would require random drug screening for the state's medical providers.  That is merely a subterfuge for the small print of the initiative which would raise the non-economic damages in medical malpractice awards from $250,000 to now $1.2 million.  The price would then go up with inflation.

What is the requirement for the United States Surgeon General.  Do you remember when Dr. Koop was appointed and did real work.  Since that time the doctors have been only political hacks.  The latest is a continuation of that tradition.  His main claim to fame is being a backer of Obamacare.        Top


The Connecticut Attorney General is looking into the use of facility fees in physician offices that have been purchased by hospitals.  The AG is looking into the transparency of those fees.  It seems that hospitals do not clearly disclose these fees to patients prior to being seen by the physician.  The hospitals attempt to justify the fees by stating their costs are higher due to the practice now having a different set of standards to meet and the level of service increases.  

The California Business Journal wrote that California's Managed Care regulator has issued "cease and desist" orders to Health Net, Blue Cross and Blue Shield for their denying necessary speech and occupational therapy services.  Health Net was also fined $300,000 for repeatedly characterizing the requests for services as coverage rather than medical necessity.  

California's Insurance Commissioner has ordered Blue Shield to delay by three months the mandatory cancellations of individual policies that do not comply with Obamacare benefits.  The reason is the insurers not giving the required time notice for the cancellations.  After this was done, Blue Cross did the same thing for their cancelled individual policies.        Top


The Drug Quality and Security Act which helps control compounding pharmacies has passed both houses and awaits Obama's signature.  The law gives compounders the ability but does not require them to register with the FDA.  If they do they would be potentially able to get product liability insurance which would be helpful when they sell to large entities.  Those that do not register would be restricted to making drugs for individuals under a prescription and could make only limited batches of the drugs.  They would not be under any federal oversight.  The small compounders will still have to open their records to federal inspectors if they have a subpoena.        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.