September 1, 2009 Legislation





Even with all the reading I do on this Obamacare project, every once in a while I really get fooled.  I thought that the bill did not include illegal aliens and indeed it is in the House version.  I was wrong.  According to CNN there is no citizenship verification in the bill so there is nothing to stop the illegals from getting their healthcare paid by our funds.  Current estimates is that there are approximately 10 million to 12 million illegals now in the country and getting their care in the EDs.  It is possible that the illegals may be required to purchase insurance if they are here for over a certain length of time.

Yet another detail is the prescription benefits.  Medicare enrollees will pay more for Part D than they do now.  There will hopefully be some negotiation to cut back some prices that enrollees pay for meds.  Pharma has stated that it will put up $80 Billion to reduce the cost of the drugs in the doughnut hole.  This will save the enrollee with alot of prescription some money but will save no money for those who take few prescriptions or for the government.  The House measure also hopes by some as yet unknown way to decrease the size of the doughnut hole.

Another item in the House Bill that I just found out about from an article in the Detroit Free Press gives $10 Billion to the labor unions.  It would pay "temporarily" 80% of all claims between $15,000 to $90,000 by non working union members between the ages of 55-64.  The unions have not put away enough money to pay for the healthcare of their early retirees so need their friendly Democrats to bail them out.  This, according to the newspaper, is payback for their help in getting Obama elected.

Speaking of help getting Obama elected the media had alot to do with the outcome.  ABC, after the election, gave considerable time to Obama to discuss his healthcare agenda.  Now ABC will not accept an ad that is anti-healthcare reform because it is partisan.  That sounds slightly hypocritical.  NBC will run the ad nationally if some of the statements made are either changed or proved.  The locals are free to run the ad which is a neurosurgeon explaining how "your" healthcare will change with "reform". 

Several weeks ago John Mackey, the CEO of Whole Foods, gave his version of Whole Foods HSA plan as a possibility for healthcare in the country.  There is now a call from the unions to boycott the store because of the opinion of the CEO.  The company itself is very progressive in pay and benefits as well as the quality of its food.  This is another example of either my way or the highway by the unions and anyone who disagrees with any policy.  It truly shows the smallness of those protesting.

First you say you do and then you say you don't.  The Obama two step is in full sway.  A month ago he stated that any bill he signs on healthcare would have a public option.  That may have been a ploy to eventually get Republican votes if he got rid of the public option.  That is now not possible since now he states this is not a central point of the plan. After Sebelius stated that it was negotiable, the White House announced it was still part of the plan.  Nobody can make a decision.

The Dems are starting the dirty play.  Waxman has sent out 52 letters to health insurance companies for information regarding all who are paid over $500,000 and other company financial information.  Most of the information is already public and the Congress knows it.  They will use the refusal to send or the information sent against the health insurers. This actually sounds like a Pelosi trick.  After sending the request and before receiving any answers the Dems have "invited" the CEOs of several of the insurers to Washington to openly discuss why they charge what they do.  Remember that the insurers originally were for Obama's healthcare before he added the public option.

Hospitals via the AHA also supported the healthcare reform but now it comes out why.  The AHA conservatively estimates that nationally hospitals will receive an additional $171 Billion over the next ten years due to reimbursement for the newly covered uninsured.  This is set off over the promised $155 Billion in cuts over the same period of time.  Remember those cuts were incremental and may not add up to the whole amount. The cuts would start immediately and the new patients would not become a positive on the balance sheet until 2013.  Congress has stated that they are not bound by any deal cut by the White House and any third party.

The White House is trying to restart the healthcare push by sending emails to 3000 of over 150,000 physicians promoting their "reform".  I wonder where they got the names of the 3000.

It is beginning to sound like cooler heads are talking in the Senate.  Several Democratic, Republican and Independent Senators are starting to think that the most, if anything, that should be done this year is a baby step due to the significant recession.  The same is true with the Blue Dogs in the House. New figures from both the White House and the CBO show that the deficit will raise to about $9 TRILLION over the next ten years with 10% unemployment without any healthcare "reform".  Obama believes that "reform" will lower the federal deficit even though independent government surveys say the opposite if the true payments to physicians are left in the projections.

Liberal Democratic Senator Feingold agrees that it is unlikely that any major healthcare reform bill will be passed this year due to the deep divisions in the nation.   

Liberal and stupid Senator Pete Stark is taking a page from the stupid book of Pelosi.  He opened his mouth and out came a blast at his fellow Democrats that do not agree with him on healthcare.  He called the Blue Dogs brain dead.  

The Democratic head Howard Dean in an open forum in Virginia stated when asked the question, "Why is lawsuit reform not in the bill?" that "it is because the bills already have enough enemies and we don't want to tick off the Trial Lawyers."  That at least is a truthful answer.  The Trial Lawyers according to the Washington Times give 95% of a great deal of money every election to the Democrats.

In a new Kaiser Foundation poll, people were asked about how to pay providers (physicians).  Most (44%) stated they should continue to be paid fee for service. The poll also showed the continuing slippage of Obamacare.  The vast majority opposed reducing payment to physicians as a way to pay for healthcare reform. 

As part of Obamacare there will be more money paid to primary care physicians and correspondently less to specialists.  This is going to play havoc with Medicare as cardiologists start taking less Medicare patients and oncologists send patients to the hospital for chemo instead of doing it in their offices.  CMS may still back down on the reductions to specialists if they want to keep enough in the program.      Top


The Health IT Policy Committee has adopted several recommendations for meaningful uses. In order to get their blood money the providers MUST have full CPOE in 2010 to get paid in 2011.  Also the required reporting to CMS is the percentage of diabetics with their A1c under control, the percentage of hypertensives with under control blood pressures and percentage of asthmatics offered smoking cessation programs.  Currently there is only one certifying body but others may be certified provided they conform to the same standards as the CCHIT.  The wonks are doing the same as Obamacare working at full speed without time to consider the consequences, intended or not.  

HHS has added to the HIPAA regs by stating that as of September 23, 2009 the following must be in place.  A policy to notify patients or their next of kin of any breach of their information within 60 days at the latest and sooner if possible. The business associates must tell the covered entities when they discover any breach.  If more than 500 patients are involved the media and the secretary of HHS must be notified.        Top


The OIG has issued a report to CMS stating that for the beginning of 2007 unlicensed and untrained people performed a significant amount of services on Medicare patients.  These were billed as incident to services.  The billing is legitimate and account for physicians billing more than 24 hours of work in a day.  The kicker is that the physician must be in the office, not the room where the service is being performed, and the person performing the service must be qualified to do so.  CMS agreed that licensed to services must be performed by either another licensed physician or by a properly licensed and qualified non-physician.  CMS did not agree that there needed to be a modifier when incident to services were provided.        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.