cur-mud-geon: anyone who hates hypocrisy and pretense and has the temerity to say so; anyone with the habit of pointing out unpleasant facts in an engaging and humorous manner
Many of us have heard of the ‘Cadillac tax’, as it is called, that is part of Obamacare (the inappropriately named Affordable Care Act). That tax is designed to hit those with ‘rich’ health care benefit plans. It assesses a significant penalty tax to discourage employers from retaining the health plans that cover most ‘everything’ from first dollar forward. Those typically have been thought of as being the plans negotiated and/or sponsored by unions for their members, although some non-union employers use very generous health plans, also.
The International Classification of Diseases iteration 10 (ICD-10) is now in effect. It has increased the potential for reporting from a mere 13,000 +/- to some 68,000 +/- different items. This has caused some concern for providers as well as for payers given the increase in complexity. Given the lag in claim filing by providers, the results of the conversion to ICD-10 will not begin to be available for some time, but the level of detail, as shown by examples below, makes you wonder just who built this thing and if it was really necessary to go to this extreme.
I have blogged before about the thing called ICD-10, or the International Classification of Diseases-Version 10. We are now only a couple of weeks away from the implementation date of October 1, 2015.
We had occasion recently to experience Community Memorial Hospital as seekers of care. That exposure began in the ER and progressed from there. All is well now.
Take-aways from the first two Republican debates if you’re interested in my thoughts…
Planned Parenthood has likely had more publicity than it desires over the past several weeks after the seeming regular periodic release of damning video after damning video. This organization was created on October 16, 1916 as a 501(c)(3) entity. It is interesting, as an aside, that conservative organizations filing for approval under that designation can be politically harangued for their beliefs by the IRS.
Medicare and Medicaid were signed into law 50 years ago today by President Lyndon Baines Johnson who praised former President Truman for getting that ball rolling. Here we are five decades later observing the two programs that are an integral part of life in our country, and that are huge federal budget items.
Health care insurers have been in a merger frenzy; fearful apparently that they might either get taken over or get lost in the dance of elephants. The top five in size have now succeeded in making that group the top three presuming that all requisite governmental approvals are received. These three will control a significant majority of the total market.
The long awaited, or so it seems, decision on ObamaCare by the U.S. Supreme Court has been published and in a 6-3 decision the Supremes have upheld the language and say that the magic four words (established by the state) were ‘ambiguous’ but that all who enroll have access to the premium assistance given their view of the totality of the law.
The Los Angeles Times published a story today citing the statistics concerning Americans’ weight…actually Americans’ significant overweight issues as measured by the Body Mass Index which you can locate by clicking here. I could conclude that we are facing an epidemic of obesity.
Our treatment of our veterans is absolutely disgraceful. Those men and women were prepared to give their lives to defend us and our freedom and they did their job. Those who came home having been wounded or who lost limbs or who needed mental help were sent into the Veteran’s Administration system for those services.
The world of health care is changing more rapidly today than I can ever before recall. The advent of the Affordable Care Act (ACA) has played a significant role since it brought more patients into the mix and also directly and indirectly affects provider reimbursement.
The world of health care delivery has evolved rapidly. For the most part that is a good thing. The announcement today of Target and CVS making a deal for CVS to take over operation of the current Target-branded pharmacies is yet another step in that evolution. The retail pharmacy has become, in more and more cases, a walk-in clinic and underlying both is the vaunted pharmacy benefits manager (PBM) that dispenses or influences the delivery of drugs through mail operations and retail facility networks to many millions of people.
Given the possibility that the U.S. Supreme Court might disrupt the flow of the Affordable Care Act (ACA) depending upon how it rules in the next couple of weeks, Wisconsin’s Sen. Ron Johnson(R) has been working to put together a bipartisan bill that would solve the problem of premium subsidies while extracting some give-backs from President Obama.
There is an obvious ‘full court press’ underway with the Administration working diligently to basically, and blatantly, advise the Supreme Court what it should and shouldn’t do in the case it will soon publish a decision concerning. Of course, this all relates to the four words currently found in the Affordable Care Act (ACA) relating to purchasing exchanges which caused a case to be brought before the Court.
Many people are awaiting the U.S. Supreme Court’s ruling on tax credits to help offset premium cost in the Affordable Care Act (ACA) world. The Kaiser Foundation has created a state-by-state analysis to help people understand the potential impact if the Court rules that the tax credit is not available in states that rely on HealthCare.gov, the Federal exchange, as the vehicle for residents to select and enroll in plans. There are 34 states in that category, including Wisconsin.
Rate increase requests are flowing in now for ObamaCare health coverage in 2016 in various states. These increases are reflecting some of the issues of which many were wary, among them the cost of pent-up demand when there was no underwriting of risk possible.
A new report was just issued by a firm named Medscape that addresses the average compensation for physicians state-by-state. It sounds like the results should make us Wisconsinites happy at least for the fact that we should be an attractive place for doctors.
Assurant Health, basically the former Time Insurance Company that used to be headquartered in Milwaukee is being put on the block by its parent organization and the blame for that can be laid at the feet of the Affordable Care Act (ACA). Time Insurance made money on health insurance using smart underwriting of the risk. The use of health underwriting is forbidden by the ACA, something that people with prior health conditions and without insurance found to be great. Consequently, a formerly profitable health insurer is now losing big money due to adverse claims needing to be paid. It has other business that is largely comprised of life, dental and short-term and long-term disability policies which can still be underwritten but which is insufficient to keep the company alive in its present form.
Rep. Joe Courtney (D-Conn.) is slated to introduce, today, his “Middle Class Health Benefits Tax Repeal Act” and has 48 co-sponsors. Curiously, another ‘Cadillac tax’ repeal effort has been introduced by a Republican (Rep. Frank Guinta from New Hampshire).
The soon-to-become infamous Cadillac tax which is part of the Affordable Care Act is beginning to draw notice, especially from the labor leaders whose negotiated plans will likely come close to this penalty or enjoy the penalty from the outset.
The ongoing debacle called the VA Hospital in Tomah, WI was front and center again this week. The feds were conducting an open testimony committee hearing supposedly to get to the bottom of the “Candyland” and “Candy Man” issues that were identified by people on the inside and then effectively ignored by elected representatives.
Five years ago today we found ourselves with a new law that has been generally known as ObamaCare. It was passed in the dark of night and still is not fully understood even by those who theoretically knew what it was they were doing.
There are occasional stories that simply grip my senses to the point that I have difficulty in comprehending how I would feel if directly involved on one side or the other. One of those is the story on page one in the morning Journal Sentinel titled “Parents sue over screening delay”.
We spend a lot of time, many of us anyway, on trying to promote the candidate(s) of our choosing. Many spend a lot of money on that effort, as well. For some, this is an exercise of personal power as we see with the billionaires who throw tens of millions upon tens of millions of dollars into the fray. For the majority, this is an exercise in the use of freedoms guaranteed us by our Constitution. For whatever our reasons, many of us are thoroughly engaged in the outcome we favor. Sometimes we win and sometimes we lose. Some of those outcomes hang with us; I still remember the field of flowers suddenly being destroyed in the flash of an atomic bomb explosion that took Barry Goldwater to the loser’s position in the first election in which I became an active volunteer.
President Obama has taken a shot at Staples, Inc. because this company has had the audacity to try to find the best ways to work with the Affordable Care Act (ACA) while obeying the law and delivering good results for its stockholders. He has said they are “undercutting” his law and says further that large corporations should not use the health insurance issue as an excuse for cutting wages.
Those signed up for ObamaCare this year are averaging $268 per month in premium forgiveness. There are some 6.5 million people in that category. That totals nearly $21,000,000 annually in subsidies paid by the government to the health plans providing the coverage. It is easy to see why the major health insurance companies were so eager to jump onto the ObamaCare bandwagon. Their revenue streams have taken a significant jump and their profits have increased also.
The Wisdom of Solomon would be handy for our U.S. Supreme Court as it decides the issue raised concerning government subsidies to help pay for health coverage under the Affordable Care Act (ACA), or Obamacare. A look at the current information for Wisconsin gives some background:
If you see a guy walking or driving down the street with a white blob for a nose, that might just be me for a day or two yet. I had outpatient surgery yesterday for a malignant growth on my nose that was caught as a possible problem during my annual visit with my Dermatologist. He took a skin sample (from the nose where no one will see it J) and it tested positive, so I was referred to another member of the Dermatological team who handles such surgical procedures.
The Journal Sentinel front page this morning carries the header for the Dan Bice column No Quarter: “Baldwin ousts aide over VA controversy”. Bice details the following:
Just when you thought it was safe to go into the water…
Just when you thought it was safe to go into the water…
The Tomah, Wi Veteran’s Hospital has earned a nickname that is astounding. It is called “Candy Land” and that is not a sought-after euphemism. That name evolved from the heavy-handed distribution of narcotic drugs to veterans.
Republicans reportedly will test the waters on changes to the Affordable Care Act (ACA) by proposing to move the definition of full time from the current 30 hours per week back to the traditional 40 hours per week. They feel this is the slam dunk issue if one exists.
A largely unanticipated issue has apparently been recognized: medical debt appears to be a significant issue on credit reports. That is not too surprising except that it affects about 20% of the people in the country to one degree or another.
The December 9th Opinions page in our Milwaukee Journal Sentinel featured an article written by Stephen T. Parente titled “Obamacare spikes are coming”. It discusses the relatively hidden things in that law that will almost assure a major spike in the cost of health care coverage that will hit in 2017 and after. Mr. Parente is the director of the Medical Industry Leadership Institute at the University of Minnesota. He is also a professor of health finance at the U of M. With his credentials having been displayed, we can proceed to the expectations he sheds light on:
With the defeat (a/k/a dumping) of Sen. Mary Landrieu (D-LA), there are some amazing numbers floating around:
The Washington world is one of intrigue, broken promises and broken laws. That promises to be demonstrated more and more as we find ourselves watching the final two years of the Obama Presidency with a Republican-dominated Congress.
The several clips (at four so far) from MIT Economist Jonathon Gruber’s presentations where he discusses the creation of the Affordable Care Act, Obama Care as it is commonly known, have elicited the following quote from White House press secretary Josh Earnest:
Peggy Noonan has penned a blog that makes for an excellent read, in my opinion at least. She deals with ObamaCare and President Obama.
Our two Supreme Courts, one in Madison and one in Washington,D.C., are showing how important this third branch of government truly can be.
The U.S. Supreme Court enters its second day of hearings concerning PPACA (a/k/a ObamaCare) and will decide the various questions that have been raised. There are, as is usual in matters of this nature, many nuances that are often difficult to fathom. Among the issues is whether or not we can be compelled to take an action, buy health insurance coverage, and whether or not the fine for not doing so would be a tax or a penalty, and so on. Underlying much of this is the fact that the government intentionally eliminated the "severability clause" which is present in most contracts. That clause basically says that even if part of the contract is struck down, the rest survives.
We hear much about the Wisconsin Supreme Court and the prospect of one Justice or another recusing himself or herself...BUT...
Uncertainty is at the root of much of the disruption we face today in the various markets that exist in our economy. When that is coupled with energy costs, we have the makings of a tough summer and fall right when we will elect or re-elect a president.
There is little secret that this White House wants to control virtually everything about our lives. Health care, of course, has been the big target since PPACA (a/k/a ObamaCare) was passed in the dead of night.
I know it is probably a strange thing to do, but I read the obituaries every morning. In today's morning Journal Sentinel, I saw the obituary for William Lamers, Jr. who died at the age of 80 in his home in Malibu. The obituary stated that he was surrounded by family and friends.
The Federal agencies involved have just released the final regulations that govern how the simplified Summary of Benefits and Coverage (SBC) for PPACA must be written and displayed. This is a small part of the PPACA bill (aka ObamaCare) that covered some 2,100 pages without really saying anything in detail about that program. All the detail is now being formulated by the agencies, all of which are unelected and therefore beyond the public's reach so far as expressing displeasure.
President Obama announced this morning that he is backing away from the controversial birth control mandate for Catholic organizations. He is trying to make this go away and claims this isn't an accommodation. The practice of insurance companies eliminating contraception coverage for Catholic entities has been here for a long time. This isn't a new directive from the President much as he'd like us to think that is the case.
As I read the morning Journal Sentinel today, I was struck by the political inferences across the main section even though this publication claims to be unbiased. (1) Dan Bice continues on the 'expose Walker' bent that he has made standard fare of late. His "sources say" that charges will be issued in the coming days and that they likely will involve Walker operatives. He mentions that "at least eight" of Walker's "former aides and associates have hired criminal defense lawyers". "Insiders" have told Bice that the "next phase is focusing on the role of some of Walker's closest associates". (2) There is now an 'issue' over whether or not Wisconsin is in a deficit or not in a deficit. The gap of some $3.6 Billion that Walker encountered when he took office was closed by the Walker government but that was on a cash basis. So now we are exposed to the fact that under GAAP accounting there is still a deficit and that this fact was used recently in a petition to the federal government to gain its permission to cut some 50,000+ people from a state health plan if necessary. I don't recall the continuing series of articles during the former government's time in office that traced the ever-increasing budget deficit or that condemned the use of various 'funds' (transportation and patient compensation, for example) to make possible increased state spending. (3) A story on the national 'health care overhaul' from the Associated Press states that Wisconsin is among the states "lagging" in implementation of the wonderful new PPACA legislation that has yet to withstand U.S. Supreme Court scrutiny. This story mentions some 500,000 Wisconsinites who have no health insurance but does not indicate that this state is among those with the lowest uninsured population in the nation. Nor does it bother to mention that each of these 500,000 people have access to health care under federal laws that have been in force for years. Maybe this was simply accidental story selection. Maybe not.
Rick Perry left the field of Republican candidates this morning. He asked his supporters to back Newt Gingrich. Given Perry's showing, his tossing his support to Gingrich will do very little to help Gingrich. One of Newt's former wives, Marianne, will speak tonight on national television, and that won't help Newt either.
You may've read or heard reports of a shortage of drugs that has gotten worse this past year. This has largely been created through unintended consequences, I hope, of government's actions.