Impeding changes to our Health Care system

[Lamplighter]

Originally Posted by Ibram

...and there is nothing else in obamacare to hate. Is there?

Originally Posted by Undertoad

<snip>
We won't really know what to hate about the system until we are knee-deep in it and people are hustling it.

I found the following Timeline to be a relatively easy way to follow
what is in the PPACA (Obamacare) and, of course, when it is to be implemented.

Maybe this will be a way to identify those aspects that people
feel are so onerous they should be eliminated.

Cato Institute
Updated & Revised for 2011
Michael D Tanner
2011

Patient Protection and Affordable Care Act Timeline for Implementation

2010 (already in place)
Five percent tax imposed on tanning salons.

Seniors with prescription drug costs of at least $2,700 receive a check for $250.
If seniors reach the $2,700 ceiling later in the year, they will receive the check at the
end of the quarter in which they reach the ceiling.

$5 billion for temporary reinsurance program for employers who provide health
insurance coverage for retirees over age 55 who are not yet eligible for Medicare.
The program ends in 2014.
Insurers required to provide coverage for children regardless of preexisting condi-
tions. The prohibition on excluding preexisting conditions does not apply to adults
until 2014.

High-risk pools established to cover adults with preexisting conditions. Pools will
be eliminated after the ban on excluding preexisting conditions goes into effect in
2014.

Parents may keep children on their insurance plan until the child reaches age 26.

Lifetime caps on insurance benefits prohibited.

2011 ============
Medicare payroll tax increases from 1.45 percent to 2.35 percent for individuals
earning more than $200,000 and married filing jointly above $250,000.

A three-year phase-out of subsidies to Medicare Advantage begins. Some seniors
may be forced back into traditional Medicare.

States must expand Medicaid eligibility to all individuals with incomes below
133 percent of the poverty line. The federal government will cover the cost of this
expansion until 2017.

Businesses with fewer than 25 employees and average wages below $50,000 be-
come eligible for a tax credit to help offset the cost of providing insurance to their
workers. The credit applies to 2010 taxes filed in 2011.

Maximum contributions to flexible spending accounts (FSAs) reduced from
$5,000 to $2,500. FSAs and health savings accounts (HSAs) cannot be used to
purchase over-the-counter medications.

Workers begin contributing to the CLASS Act long-term care program, or may
opt out of the program.

$2.5 billion in new taxes are imposed on the pharmaceutical industry. The tax,
or assessment, rises to $4.2 billion by 2018, and is imposed on manufacturers
according to a formula based on the company’s aggregate revenue from branded
prescription drugs.

2012 ============
Businesses required to complete 1099 forms for every business-to-business trans-
action of $600 or more.

2013 ============
2.3 percent excise tax imposed on sale of medical devices.

Floor for deducting medical expenses from income taxes rises from 7.5 percent of
income to 10 percent.

The Employer Medicare Part D subsidy deduction for employers eliminated. Em-
ployers will lose the tax deduction for subsidizing prescription drug plans for
Medicare Part D–eligible retirees.

The 3.8 percent Medicare tax is applied to capital gains and interest and dividend
income if an individual’s total gross income exceeded $200,000 or a couple’s
income exceeds $250,000.

An $8 billion tax is imposed on insurers, based on market share. The tax rises to
$14.3 billion by 2018.

2014 Individual mandate imposed. With few exceptions, every American is required to
have a government-designed minimum insurance package. Failure to comply will
result in a fine equal to 1 percent of income. The penalty increases to 2 percent in
2015, and finally to 2.5 percent in 2016.

Employer mandate imposed. Companies with 50 or more employees must offer
coverage to employees or pay a $2,000 penalty per employee after their first 30
if at least one of their employees receives a tax credit. Employers who offer cov-
erage but whose employees receive tax credits will pay $3,000 for each worker
receiving a tax credit.

All insurance must meet federal minimum benefit requirements.

Prohibition on preexisting condition exclusions applies to adults.

Health plans prohibited from imposing annual limits on coverage.

Subsidies begin for individuals and families with incomes up to 400 percent of
the poverty line. Refundable tax credits limit the percent of income that must be
paid for either insurance premiums or out-of-pocket expenses.

Insurance exchanges become operational.

2015 ============
Independent Medical Advisory Commission (IMAC) established.

2016 ============
Individuals may begin collecting benefits from CLASS Act long-term care pro-
gram.

2017 ============
States have option to allow large employers to participate in exchanges.

States must begin covering part of the cost of Medicaid expansion.

2018 ============
“Cadillac” insurance tax imposed on high-cost, employer-provided health plans
with an actuarial value exceeding $27,500 for family coverage and $10,200 for individual coverage.

[Ibby]

Ibica? hm. I kinda like it actually.

[DanaC]

Originally Posted by Ibram

Ibica? hm. I kinda like it actually.

*smiles* good!

It keeps you as as the Ibs we know and love, but gives it a feminine tweak. And I think it suits you.

[Lamplighter]

So this is where ObamaCare is headed ?

Years ago, the Maternity Wing of Buffalo Children's Hospital served lobster every Friday.
This was well known through out the city, and generated a lot of business for the hospital.


NY Times
1/22/12
Chefs, Butlers, Marble Baths: Hospitals Vie for the Affluent

<snip>


It was Greenberg 14 South, the elite wing on the new penthouse floor
of NewYork-Presbyterian/Weill Cornell hospital.
Pampering and décor to rival a grand hotel, if not a Downton Abbey,
have long been the hallmark of such “amenities units,”
often hidden behind closed doors at New York’s premier hospitals.

But the phenomenon is escalating here and around the country, health care design specialists say,
part of an international competition for wealthy patients willing to pay extra,
even as the federal government cuts back hospital reimbursement
in pursuit of a more universal and affordable American medical system.

“It’s not just competing on medical grounds and specialties,
but competing for customers who can go just about anywhere,” said Helen K. Cohen,
a specialist in health facilities at the international architectural firm HOK,
which recently designed luxury hospital floors in Singapore and London
and renovated NewYork-Presbyterian’s elite offerings in the McKeen Pavilion in Washington Heights.
“These kinds of patients, they’re paying cash
— they’re the best kind of patient to have,” she added. “Theoretically, it trickles down.”
<snip>

At Mount Sinai Medical Center, where the aesthetic of the Eleven West wing
is antique mahogany rather than contemporary sleek, and the best room costs $1,600,
William Duffy, the hospital’s director of hospitality, said his favorite entree was Colorado rack of lamb,
adding, “We pride ourselves on getting anything the patient wants.
If they have a craving for lobster tails and we don’t have them on the menu, we’ll go out and get them.”

Oh, wait a minute. Don't the Republicans want to repeal ObamaCare ?

[ZenGum]

Roll a double six to start.

Collect MRSA each time you pass "go".

[Clodfobble]

I'm confused what it is you think this article has to do with Obamacare, one way or the other.

[Lamplighter]

Primarily just being facetious...

There are comments in the article about Medicare patients not being served,
and the coming standards for reimbursements, and physicians' practice
of accepting only private-pay (or private insurance) patients.

I do think that unless something is done to ultimately require physicians and hospitals
to accept Medicare reimbursements, this direction of seeking the wealthy patients
will only increase, so more and more patients will be turned away.

The smaller hospitals will probably see this as their way to go,
and so those ER's will only stabilize the patients and transport them
to larger "teaching" and "county" facilities that do accept Medicare.
.

[TheMercenary]

Originally Posted by Lamplighter

Primarily just being facetious...

There are comments in the article about Medicare patients not being served,
and the coming standards for reimbursements, and physicians' practice
of accepting only private-pay (or private insurance) patients.

I do think that unless something is done to ultimately require physicians and hospitals
to accept Medicare reimbursements, this direction of seeking the wealthy patients
will only increase, so more and more patients will be turned away.

The smaller hospitals will probably see this as their way to go,
and so those ER's will only stabilize the patients and transport them
to larger "teaching" and "county" facilities that do accept Medicare.
.

All of that has happened and is increasing. More people do not see Medicare anymore. The rural hospitals are passing on the sicker patients because they cost to much and sending them on to the larger hospitals further delaying much needed critical care. It has nothing to do with the capability of the hospital or the skills of the staff, it is now and always be about money. Medicine is a business, like it or not.

[SamIam]

I agree that medicine is a business, but disagree about the reason rural hospitals send patients to larger facilities. It IS about the skills of the staff and having access to the most up to date diagnostics and newer, more sophisticated treatments. A hospital in a town of 10,000 just can't afford the latest and greatest, and really good physicians do not gravitate to rural backwaters for obvious reasons.

[infinite monkey]

[classicman]

The smaller hospitals will probably see this as their way to go,
and so those ER's will only stabilize the patients and transport them
to larger "teaching" and "county" facilities that do accept Medicare.

What on earth makes you think this isn't already happening?
I can tell you for a fact that it sure as hell is here.

[Lamplighter]

Originally Posted by classicman

What on earth makes you think this isn't already happening?
I can tell you for a fact that it sure as hell is here.

Yes, and in the past it was based primarily on technical capability of the hospital and it's staff.
When it's the credit rating of the patients it takes on a completely [=MBAnoise]different motivation[/MBAnoise]

[classicman]

Originally Posted by Lamplighter

Yes, and in the past it was based primarily on technical capability of the hospital and it's staff.

Not here. Not even close.

[Sundae]

If'n I won the lottery, I would still be suspicious of a hospital tricked out as a hotel.
I want the money to go to research, pioneering treatments and the best medical care in the world.

Don't get me wrong, I'm happy for them to employ plenty of non-medical staff as Hospitality - making sure I have a cold drink, checking in on me, helping me to the toilet, picking up the book I've dropped. But lobster tails? I can do without those for a few days, thanks.

And no, I wouldn't use the NHS if I was mega-rich. At my salary level it's a hell of a lot better than nothing. Ditto the majority of the country. But it's overstretched, and if I was on the Times Rich List I'd see it as a moral obligation not to stretch it further. That and seeing how well Grandad was "cared" for when he was there.

[Lamplighter]

Another aspect of "ObamaCare" is coming on board...


Health Care Finance News
Kelsey Brimmer, Associate Editor
February 20, 2012 |

HHS ensures consumers get better value for their health insurance dollar

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius announced Thursday
that consumers will soon begin receiving unprecedented information on the value
of their health insurance coverage, and some will receive rebates from insurance companies
that spend less than 80 percent of their premium dollars on healthcare.

The Affordable Care Act requires that insurance companies begin notifying customers this year
about how much of their premiums they have spent on medical care and quality improvement.
Beginning in 2011, insurers were required to spend at least 80 percent
of total premium dollars they collect on medical care and quality improvement. <snip>

"Before the Affordable Care Act, insurance companies could spend your premium dollars
on administrative red tape and marketing," said Sebelius in a press release.
"With today's notice, we're taking a big step toward making insurers accountable to consumers.
Some of these insurance companies have already changed their behavior
by lowering premiums or spending more on medical care and quality improvement,
while the remainder will need to refund this money to their customers this year."<snip>

Consumers will receive these notifications after Aug. 1, 2012.
The regulation requires that insurance companies send these rebates by this date,
though consumers may receive them at different times.<snip>

HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule.
As a result of HHS’ decision to deny insurance companies the ability to spend
more premium dollars on administrative overhead costs rather than on medical claims,
consumers will receive up to $323 million in rebates this year compared to
what would have been owed if all state adjustment requests were fully granted,
according to data from state regulators and issuer reports.

.