By Zachary A. Goldfarb and Sandhya Somashekhar, Published: in the Washington Post

The White House on Tuesday delayed for one year a requirement under the Affordable Care Act that businesses provide health insurance to employees, a fresh setback for President Obama’s landmark health-care overhaul as it enters a critical phase.

The provision, commonly known as the employer mandate, calls for businesses with 50 or more workers to provide affordable quality insurance to workers or pay a $2,000 fine per employee. Business groups had objected to the provision, which now will take effect in January 2015.

The decision comes as Obama is working to secure his domestic legacy, urging Congress to pass an overhaul of immigration laws and using his executive powers to combat climate change. With the prospects for immigration reform uncertain in the House — and new environmental regulations still more than a year way — implementation of the 2010 health-care law has singular importance.

The White House portrayed the delay as a common-sense step that would reduce financial and regulatory burdens on small businesses. Republicans, who are planning to target “Obamacare” in the 2014 midterm campaigns, said the delay is an acknowledgment that the health-care overhaul is flawed.

The decision will spare Obama what might have been a major distraction as officials begin to implement the centerpiece of the health-care law, which remains in place: a requirement, starting in 2014, that most Americans obtain insurance through their employer or through federally backed and state-backed marketplaces, known as exchanges.

The decision by Obama, who was on Air Force One returning from Africa on Tuesday when the announcement was made, to delay a controversial part of the law underscores his willingness to use the power of the executive branch to help to protect the legislation’s image at a defining moment.

“We believe we need to give employers more time to comply with the new rules,” Valerie Jarrett, a senior adviser to Obama, wrote in a blog post Tuesday evening. “This allows employers the time to . . . make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers.”

Republicans say they expect higher costs as a result of the law. House Speaker John A. Boehner (Ohio) said the decision “means even the Obama administration knows the ‘train wreck’ will only get worse.” He added, “This is a clear acknowledgment that the law is unworkable.”

Bob Kocher, a former top health-care aide to Obama, said he was disappointed by the delay because it will create uncertainty about what parts of the law will take effect. “It confuses people,” he said, adding that it “will undermine all the other rules because people will expect delay.”

The health-care law, which had been a source of confusion for years, is expected to have a bumpy rollout. The employer mandate would have added complexity.

Small businesses, many of which would have had to install systems to track and report which employees are receiving coverage, had been complaining about the difficulty of complying with the requirements, giving way to fears that companies might reduce their workforces to fall below the 50-worker threshold.

The decision comes as a result of years of bumps and setbacks for the overhaul, including legal challenges and political opposition that have hampered its implementation. Last summer, the Supreme Court upheld the law but struck down a mandatory expansion of Medicaid. State officials and businesses held off changing their policies through the 2012 presidential campaign because Obama’s GOP opponent, Mitt Romney, had promised to repeal the law.

Some populous states, including Florida and Texas, have decided not to set up exchanges, putting a far bigger burden on federal health officials to serve Americans. The exchanges are being designed to offer a variety of insurance plans; the federal insurance exchange is set to begin in less than three months.

One year ago today the Supreme Court found the Affordable Care Act constitutional. The new health care exchanges begin enrollment in 3 months but Obamacare is still confusing for most of us. Wonkblog’s Sarah Kliff explains what we can expect.

Although the overhaul was passed in 2010, federal officials continue to issue clarifications to its language. Many of the rules critical to employers were issued this year, or remain in draft form. As a result, businesses have been scrambling to understand their obligations, said Larry Levitt, senior vice president of the Kaiser Family Foundation, a nonpartisan health think tank.

“When I talk to large companies, even though they already offer coverage they are still scrambling to understand the rules so they can comply,” he said. “Employers were feeling like they had to make these decisions under some amount of pressure, and this gives them a year to be more deliberative about it.”

A senior White House official said the administration’s decision goes beyond delaying the employer mandate. Officials also are working to simplify the depth of information that businesses will have to provide to the government about the coverage they offer.

The launch of the exchanges is a landmark moment in the overhaul, and White House officials have been warning that there will be rough spots. The White House hasn’t received the funding it requested to implement the law, and officials have expressed concern that Americans eligible for coverage won’t know how to get it.

Earlier this year, the administration said businesses that buy health plans for their workers through health exchanges would not have access to the full range of options in 2014, promising to have them in place a year later.

The decision to postpone the employer mandate is not expected to have a major impact on employees. Those workers who would have received coverage from their employers as a result of the law will now be expected to use the exchanges. Employees who cannot afford coverage on their own are eligible for federal subsidies.

The vast majority of businesses — 96 percent, according to the White House — have fewer than 50 employees and therefore are exempt from the mandate. And nearly all firms of 200 or more workers offer their employees some sort of coverage, according to the Kaiser Family Foundation.

“We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark J. Mazur, an assistant Treasury secretary, wrote in a blog post. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.”

Mazur wrote that Treasury, which oversees part of the law, will issue more details about the delay within a week.

Several business groups praised the administration, saying the delay will give businesses time to adjust to the new requirements.

“This one year delay will provide employers and businesses more time to update their health care coverage without threat of arbitrary punishment,” Neil Trautwein, a top official with the National Retail Federation, said in a statement. “We appreciate the Administration’s recognition of employer concerns and hope it will allow for greater flexibility in the future.”

But others maintained that the provision will never be workable.

“Temporary relief is small consolation,” said Amanda Austin, director of federal public policy with the National Federation of Independent Business, which last year lost the landmark Supreme Court case challenging the law’s constitutionality.

As reported by Jeffrey Young Huffington Post 112012

 

Health insurance consumers won’t be discriminated against because of pre-existing conditions, can’t be charged more because of gender and will be guaranteed a basic set of benefits under historic new federal regulations published Tuesday.

Think of them as the Patients’ Bill of Rights that eluded former President Bill Clinton more than a decade ago. The regulations carry out the promises of President Barack Obama’s health care reform law, which will extend health insurance coverage to 30 million people over a decade and outlaw some of the industry’s most notorious practices.

Health insurance companies, state regulators and consumer advocates have eagerly awaited these rules since Obama enacted the health care overhaul in March 2010.

The details contained within the 331 pages of regulations are crucial for health insurance companies and states preparing for the new options that will be available to uninsured people and small businesses starting in 2014. The health insurance exchanges, online marketplaces where consumers can shop for plans and determine whether they qualify for tax credits to pay for private insurance coverage or Medicaid benefits, are slated to be open for business on Oct. 1, 2013.

“Americans in all 50 states will have access to an exchange and the benefits of the new law,” Health and Human Services Secretary Kathleen Sebelius said on a conference call with reporters Tuesday. “Beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage.”

The Department of Health and Human Services published three separate regulations Tuesday. Broadly, the rules restate the health insurance market reforms in Obama’s health care law. But health insurance companies and state officials that aren’t actively resisting the implementation of Obamacare need the details to ensure that health insurance exchanges are ready, and health plans available for sale on time.

One lays out the rules requiring health insurance companies to sell coverage to anyone who applies, prohibits charging women more than men, limits how much people must pay additionally based on age, where they live, family size and whether they use tobacco, and guarantees renewal of health coverage every year.

A second set of regulations spells out which benefits all health insurance plans sold on the exchanges must cover — 10 categories of medical care, including emergency services, hospital stays, maternity care, prescription drugs and preventive medicine. In addition, the rule explains how states must designate an insurance product already on the market as a “benchmark plan” to serve as a model for what the new insurance products will cover starting in 2014. This regulation also sets up how health insurance companies must prove their plans will cover at least 60 percent of a consumer’s average annual medical expenses.

The cost of health insurance on the exchanges will be subsidized using tax credits for people with incomes up to 400 percent of the federal poverty level, which is $44,680 this year. People who make up to 133 percent of poverty, $14,856 in 2012, will qualify for Medicaid in states that opt into an expansion of the health program for the poor.

The Obama administration published a third rule on “wellness” programs that employers include in workers’ health benefits, such as discounts to employees who quit smoking, lose weight or lower their cholesterol. The new regulations are designed, in part, to prevent companies from using the programs to set prices to discriminate against workers who don’t meet the wellness programs’ standards.

Publishing these regulations is just one small step toward 2014, however, and major obstacles remain. As of Monday, just 17 states and the District of Columbia had committed to creating a health insurance exchange themselves as the law sets out, according to a tally by the Henry J. Kaiser Family Foundation. The federal government will have to step in, and partially or completely establish these exchanges in the rest of the states, including those run by Republican governors like Rick Perry of Texas who have vowed continued opposition to the law.

“Now that the law is here to stay, I’m hopeful that states and other partners will continue to work with us to implement the law,” said Sebelius, who offered to meet with governors who have outstanding questions about states’ role in carrying out the health care reform law. Florida Gov. Rick Scott (R), an ardent opponent of Obamacare, last week wrote Sebelius requesting a sit-down.

The administration hasn’t yet detailed how it will handle the workload of establishing so many health insurance exchanges on its own but Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight, vowed that it would get  done. “Absolutely, we will be ready. There will be an exchange in every state open for business on Oct. 1 of next year,” he said on the conference call.

Eight states also already have declared they would not participate in the Medicaid expansion, which will curtail Obama’s goal of extending health coverage to the poorest people in those states. When the U.S. Supreme Court upheld the health care law in June, it also permitted states to refuse the Medicaid expansion, which the Congressional Budget Office says will result in 3 million fewer people gaining health coverage.

The benefits and consumer protections in the new regulations are in addition to other provisions of the health care reform law already in place, such as forbidding insurance companies from denying coverage to children with pre-existing conditions, and allowing young adults to remain on their parents’ health plans until they turn 27.

Just Thinking

October 5, 2012

My wife and I were watching TV

 

Last week

 

 

And she made a very

 

Astute observation

 

 

“How come all we hear about

 

 

 

In the Presidential election

 

 

 

Is the middle class

 

 

 

 

Did everyone stop talking…..

 

 

 

 

About the Poor?”

 

 

 

 

 

We hear about the top 2%

 

 

 

And

 

 

 

The middle class

 

 

 

What are we doing about the poor?

 

 

 

 

Are they now the middle class…

 

 

 

Want to hear some sobering facts?

 

 

 

There have been

 

48 murders…..

 

 

 

In Camden, NJ

 

 

So far this year

 

 

 

Camden has gained the title of….

 

 

 

America’s most dangerous city

 

 

 

Camden is about 7 miles

 

From where I am sitting

 

 

 

Let’s look at some of the facts:

 

  • 13 homicides in July – the most deadly month since a shooting spree in 1949
  • Murder rate was ten times New York City in 2011 — and on pace to be even higher this year
  • More than half of children live below the poverty line as the city is ravaged by drugs
  • Police department forced to cut one third of officers in 2011 and arrests dropped to less than half of what they were in 2009

 

 

 

I am using Camden

 

 

As an example

 

 

Because it is

 

 

Close to home

 

 

 

There are many families hurting

 

 

Not only in Camden….

 

 

 

But in all across…

 

 

The United States

 

 

 

In cities

 

 

And

 

 

 

In small towns

 

 

 

 

There are independent programs

 

 

Set up

 

 

To help these people…..

 

 

 

Mostly non profits

 

 

With Church affiliations

 

 

 

Providing food

 

 

Temporary Shelter

 

 

 

 

Working with youth

 

 

Helping them to

 

 

Believe in their abilities

 

 

 

 

Teaching them

 

 

You can make a difference

 

 

 

 

Aspire,

 

 

 

Don’t settle

 

 

 

 

But there is no grand effort

 

 

 

 

No coordinated

 

 

Vision

 

 

 

To make a difference

 

 

 

 

 

To lift these people up

 

 

 

 

Yes,

 

 

There is unemployment

 

 

Disability

 

 

Food Stamps

 

 

And

 

 

Other Government assistance programs

 

 

 

 

But what are we doing

 

 

As a whole….

 

 

 

To lift the poor in spirit

 

 

 

 

Give them the opportunity

 

 

To live

 

 

To Share

 

 

 

 

The American dream

 

 

 

 

Whatsoever you do

 

 

To the least of my brethren

 

 

 

That you do unto me

 

 

 

 

I think we are all familiar with that line

 

 

 

 

 

What are we doing to help…..

 

 

The poor?

 

 

 

 

We all take our lives for granted

 

 

 

 

What we fail to realize is that…..

 

 

 

Every Day is a Gift

 

 

 

 

 

I am a product of Catholic Schools

 

 

 

They taught the….

 

 

 

 

 

The 7 Corporal Works of Mercy

 

 

  • Feed the Hungry
  • Give drink to the thirsty
  • Cloth the naked
  • Shelter the homeless
  • Comfort the imprisoned
  • Visit the sick
  • Bury the dead

 

 

 

What have we been doing….

 

 

 

With the gifts that we have been given?

 

 

 

 

Many years ago

 

 

As man evolved

 

 

They realized

 

 

The only way

 

 

They could sustain

 

 

Continue to grow

 

 

And Survive

 

 

Would be by

 

 

Helping each other

 

 

 

There was no….

 

 

Bigger

 

 

Better

 

 

Stronger

 

 

 

 

They all worked together

 

 

They Realized that they….

 

 

 

All needed each other

 

 

 

 

The world calls us to be engaged

 

 

 

We are all one

 

 

 

 

“For I was hungry and you gave me food

 

 

I was thirsty and you gave me something to drink

 

 

I was a stranger and you welcomed me

 

 

I was naked and you gave me clothing

 

 

I was sick and you took care of me

 

 

I was in prison and you visited me.”

 

 

Mathew 25:34-36

The Huffington Post | By

 

Having to return to the hospital for another round of treatments for the same medical condition isn’t just emotionally draining, potentially dangerous and tough on a patient’s wallet, it also costs hospitals a ton of money, according to a report issued today.

A typical hospital with 200 to 300 beds wastes up to $3.8 million a year, or 9.6 percent of its total budget, on readmissions of patients who shouldn’t have had to come back, says Premier, a health care company that advises hospitals on improving efficiency and safety. The company analyzed the records of 5.8 million incidents in which a patient went back to a hospital to be re-treated and found they added $8.7 billion a year, or 15.7 percent, to the cost of caring for those people.

Cutting back on these readmissions would  be good news for patients. Even if the hospital has to eat the costs of additional treatments, patients are still subject to the risks of the procedures they undergo and the normal danger of contracting an infection while in the hospital. Patients being treated for heart attacks, respiratory problems like pneumonia and major joint problems are the most likely to wind up back in the hospital, according to Premier.

Wasteful spending in the U.S. health care system has been estimated to be as high as $850 billion each year, according to a 2009 Thomson Reuters report. Overall health care spending rose by a factor of 10 between 1980 and 2010, when it reached $2.6 trillion.

Hospitals are ground zero for health care cost-containment efforts because they are the biggest recipients of America’s health care spending, having taken in $814 billion in 2010, according to a federal government report. Rising costs and shrinking payments from government programs like Medicare and Medicaid and from private insurance companies have hospitals looking everywhere for ways to streamline their operations.

The health care reform law enacted two years ago expands on efforts begun three years ago to link how much Medicare pays hospitals to how well they reduce medical errors, readmissions, and other inefficiencies. Starting next year, hospitals will see their Medicare payments docked by 1 percent if they don’t cut back on these readmissions. The penalty increases to 3 percent in 2015.

Premier’s message to hospitals feeling squeezed: The money you need to save is already in the system. The company has identified 15 steps hospitals can take to improve the care they provide while also saving money, such as making sure patients are treated right the first time and don’t need to be “readmitted” for more care. By analyzing information culled from its hospital partners, Premier recommends other targets for savings, such as performing fewer blood transfusions and limiting costly tests.

Major physician groups also recently rolled out an initiative to reduce unnecessary medical tests. Combined with efforts such as those promoted by Premier, these ventures underscore how private sector health care entities are accelerating cost-containment programs with a push by the health care reform law.

 

As reported by Mike Sacks for the Huffington Post

WASHINGTON — After the Supreme Court oral arguments in the health care case Tuesday morning, the Obama administration better start preparing for the possibility of a future without the individual mandate.

From the very start, things did not go well for the government’s argument that the requirement under the Affordable Care Act that virtually all Americans have health insurance or pay a penalty is constitutional.

U.S. Solicitor General Donald Verrilli began his argument not with his usual calm and clear delivery, but rather with a case of coughs that seemed to take him off his game.

And just as he was starting to recover his composure, Justice Anthony Kennedy, a key swing vote, asked, “Can you create commerce in order to regulate it?” Kennedy’s question adopted the framing of the case put forward by those challenging the mandate.

From there, the barrage against Verrilli did not relent until he sat down nearly an hour later.

The conservative justices appeared particularly concerned that if they upheld the mandate, Congress would be loosed to regulate nearly anything else it deemed a national problem.

Verrilli argued that the health care market’s unique features allow Congress to require the uninsured to purchase health insurance.

“The health care market is characterized by the fact that, aside from the few groups that Congress chose to exempt from the minimum coverage requirement, … virtually everybody else is either in that market or will be in that market,” Verrilli said. Plus, he said, “people cannot generally control when they enter that market.”

Chief Justice John Roberts responded, “The same, it seems to me, would be true, say, for the market in emergency services: police, fire, ambulance, roadside assistance, whatever.”

When Verrilli said those services do not constitute markets, Justice Samuel Alito asked what would keep the government from applying to burial services — which Verrilli conceded do constitute a market — the same rationale about preventing cost-shifting that it used for health care.

Verrilli never quite answered that question, pointing instead to the “billions of dollars of uncompensated costs” that distort the health insurance market.

Alito then flipped the tables, saying that the mandate will require young, healthy people to pay more per year for insurance than they would pay for health care out-of-pocket, thus forcing them “to subsidize services that will be received by somebody else.”

“If you’re going to have insurance, that’s how insurance works,” Justice Ruth Bader Ginsburg argued back, in the first of the four-justice liberal bloc’s attempts to shore up the government’s case.

She and Justices Stephen Breyer and Sonia Sotomayor would all leap in to make the government’s case themselves after Justice Antonin Scalia invoked the prospect of a broccoli mandate.

Verrilli could not gain traction with his alternative arguments that the mandate falls within Congress’ ability to pass laws “necessary and proper” to effectuate its constitutionally enumerated power to regulate commerce. Scalia, who relied on this clause in 2005 to uphold a federal ban on cultivating marijuana for personal consumption, said the individual mandate may be necessary to carry out the Affordable Care Act, but it is not proper “because it violated the sovereignty of the States.”

“If the government can do this, what, what else can it not do?” Scalia asked.

After a brief halftime, Paul Clement, a former U.S. solicitor general, began his argument on behalf of the 26 states challenging the mandate.

If Verrilli struggled, Clement shined. The conservative justices remained largely silent as he skated through the liberals’ heavy questioning.

“The mandate represents an unprecedented effort by Congress to compel individuals to enter commerce in order to better regulate commerce,” he began, employing the same terms Kennedy used to describe the mandate throughout the government’s argument.

When Breyer rolled out a multi-part question seemingly designed to be his tour de force on the mandate’s obvious constitutionality, Clement cut the legs out from under it, noting that Breyer was talking about the wrong constitutional provision.

Roberts then asked Clement to address the government’s contention that “everybody is in this market, so that makes it very different than the market for cars.” But it was hard to view this question as anything but diplomatic after Roberts’ own clear antagonism to the same contention during Verrilli’s hour.

Instead, Roberts appeared to favor the challengers’ belief that the mandate regulates the insurance market, not the health care market, and the consumption of insurance, unlike health care, is not an inevitable fact of life.

“We don’t get insurance so that we can stare at our insurance certificate,” Justice Elena Kagan responded when Clement offered her that argument. “We get it so that we can go and access health care.”

Clement parried that remark and concluded his time before the justices apparently unscathed by the liberals’ attacks.

Michael Carvin, representing the National Federation of Independent Business and several individuals, used his half hour as a sort of end-zone dance for the seeming defeat of the mandate, going so far as to chuckle at questions from Breyer and Sotomayor.

When Verrilli returned for his rebuttal, all he could do was remind the justices of their “solemn obligation to respect the judgments of the democratically accountable branches of government.”

Whether one or more of the Supreme Court’s conservatives will ultimately come to that conclusion, and thereby defy the expectations they set on Tuesday morning, is anyone’s guess.

As reported by ReimagineAmerica

Congratulations to the FBI for their “take-down” of a $100M Medicare fraud ring on October 13,2010.  According to the NY Times October 14 morning addition, the “band of Armenian-American gangsters” billed Medicare for more than “$100M by inventing 118 bogus health clinics in 25 states”.  According to the paper, the gangsters made off with $35M in cash that cannot be recovered.  You will find a link to the NY Times news story at the end of this blog.

How did this happen?  It happened because Medicare is a wholly automated payment system that is notoriously porous.  If the SSN number of both patient and doctor are validated electronically, and the treatment code is separately validated electronically, an electronic payment is generated.  Only after the payment is any audit performed.   Often, but not always, the audit happens only when a recipient reviewing their own Medicare statement reports activity they know to be fraudulent, according to the CBS 60 Minutes exposé filmed in Florida, earlier this year,   I suppose that Medicare subscriber doctors, also,  report fraud when the IRS accuses them of under reporting their income?

The 2010 Health Care Reform legislation did include funding for Medicare fraud detection.  But focusing on investigation after the fraud occurs and on TV warnings to Medicare recipients urging them to “guard the card” will not solve a problem estimated to be at least $50B – billion with a B – dollars a year!  In fact, the legislation expects these efforts to save only $2B a year – 4% of the estimated reduction in benefit payments mandated by the Act.   Wow we need to do 96% better or cut seniors’ benefits, according to Congressional Budget Office estimates!

Last week Fox Business News reported, and an IBM spokesman confirmed,  that Sam Palmisano, CEO of IBM,  told Barack Obama that IBM had carefully studied the Medicare fraud issue and estimated the actual 10 year problem to be closer to $900B – that’s billion with a B — over ten years.  Mr. Palmisano believes so strongly in both IBM’s numbers and IBM’s potential solution that he offered to “build” the  solution for “free”.  Fox reported that Barack Obama turned down this offer.   Can you imagine, an American CEO of an American corporation offers a solution that could, potentially, save 90% of the projected health care reform deficit and the President of the United States turned down the offer?

I was astounded – so astounded that I knew I needed to verify the story before I gave full vent to my frustration.  So I Googled “IBM Medicare fraud”.    Turns out that it’s true!  IBM confirmed it. 

There is no mystery here.  Health care is a great business opportunity for IBM.  IBM Health Care Practice works with partners every day in both the United States and Europe to improve the use of technology to simultaneously reduce the cost of delivering health care and improve health care outcomes.  

It is important to examine my Palmisano’s language carefully.   He offered to “build” the solution for free to “prove” it worked.  He never said, IBM didn’t want to be paid if it worked.  He was willing to “share the risk”.    That has been a standard practice in business for years!  Time that we adopted these money saving practices in the government as well. 

Why would the President turned down such an offer?  Certainly he knows that all major technology initiatives in federal government are done by private contract vendors?   So what’s up?

  1. Most benignly, he does not want to appear to promote one federal vendor over others?  That can easily be dealt with in the contracting process – requiring IBM to partner with other major software and hardware vendors to develop an “open source” solution. 
  2. Can it be the President, who has no business experience,  does not understand the concept “investing in a new business opportunity”?    Mr. Palmisano is not an altruist.  Successfully ending Medicare fraud would further strengthen IBM’s “qualifications” as a global health care solutions provider.  This would be worth billions in new profits to IBM and its partners.
  3. Can it be possible that the President really has such a deep-seated distrust of business and business executives that he cannot imagine a CEO can be a patriot at the same time that he is responsible for producing share holder value? 
  4. Could the President fear that accepting this offer might be seen as a public rebuke of the team at Medicare, who are all SEIU or AFGE members?  Could he be concerned that such a perception would have political ramifications as he looks to government union support in his 2012 Presidential election?

Based on CBS and the New York Times reporting, I can think of a half dozen “quick hit” changes to the existing Medicare payment process that would produce billions in potential Medicare fraud savings.   So,  its easy for me to believe that the full force of IBM, IBM partners,  the Medicare staff, and the FBI could eliminate $900B in Medicare fraud over the next decade.

Personally, I believe that Mr. Palmisano is acting both as a patriot and a good CEO.   Mr. Obama, what do you have to lose?