Health Care Reform Bill Passes - Now What?

by BizzyBee 118 Replies latest jw friends

• 

  leavingwt

  Insurance Rate Regulation Dropped from the Latest Bill

  . . .

  However, the Democratic plan to send the fix-up bill first to the House and then to the Senate depends on using "reconciliation" rules to get it past a Republican filibuster in the Senate.

  A White House aide said Thursday that the Senate parliamentarian had ruled that the new insurance-rate regulation proposal didn't qualify to be included in that bill under rules for reconciliation.

  In particular, the parliamentarian ruled that the proposal ran afoul of the Byrd Rule, named for Sen. Robert Byrd, D-W.Va., which requires that anything passed under reconciliation - and therefore exempt from the threat of filibuster - be limited to budget measures.

  Obama plans to try again later, the aide said.

  "We will continue to push for legislation to give the HHS secretary the authority to help prevent unfair rate hikes," said the aide, who spoke only on the condition of anonymity in order to discuss legislative strategy. "However, the health insurance reform legislation that Congress is about to pass contains several important measures that will make insurance companies more accountable for how they are spending your premium dollars."

  http://www.miamiherald.com/2010/03/18/1536309/insurance-rate-regulation-dropped.html
• 

  skeeter1

  It didn't take long for the sh*t to hit the fan. More providers are going to pull out of Medicare and Medicaid.

  ***********************************************************************************************

  Walgreens says no to new WA Medicaid customers

  posted at 1:36 pm on March 18, 2010 by Ed Morrissey
  Share on Facebook | printer-friendly

  Medicaid customers in the state of Washington will no longer be able to get prescriptions filled at Walgreens, one of the nation’s most ubiquitous pharmacies, unless they already have accounts there. Due to parsimonious reimbursements from the state’s Medicaid system, Walgreens has decided to stop accepting new Medicaid customers. The decision takes 121 locations off the list for Washington’s Medicaid program:

  In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a “continued reduction in reimbursement” under the state’s Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

  Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.

  The reimbursement policy comes from an impulse to control costs by controlling prices. This shows the inevitable result of such policies. When price controls get used, they do nothing to reduce actual costs for providers. The drugs cost Walgreens the same amount to buy for Medicaid patients as they do for everyone else. Instead of lowering the actual cost, it pushes Walgreens to either hike prices for everyone else or to remove themselves from the marketplace, causing scarcities in the provider chain. Either Walgreens and Bartell have to make their other customers subsidize their losses, or they have to stop conducting money-losing business.

  This same dynamic exists elsewhere in the health-care industry. As I wrote in an AIP column last June when the public option was still on the table, you’re almost certainly subsidizing Medicare services through higher charges to your own wallet or that of your private insurer:

  And that in itself is remarkable, considering the second dirty little secret of a public plan. While Sebelius and the White House disdain and completely misunderstand the private market, the private market in fact subsidizes the already-existing public plans of Medicare and Medicaid. A correspondent from within a major insurer explained to me exactly how that works:

  At a recent leadership meeting, our CEO mentioned that the providers are very nervous about the government program expanding. Currently, the government dictates to a provider how much they will be reimbursed for a given procedure. That reimbursement does not cover the actual cost, which leaves the provider to spread the remaining portion of the cost to the rest of the people who have insurance.

  If the government program were to expand, the number of privately insured people to absorb that extra cost would shrink, driving up the cost of insurance for everybody else. Eventually, two things would happen…. First, nobody could afford the non-government program, and secondly (and this is what the providers are truly afraid of), providers would not be able to cover their costs. This would drive them to bankruptcy. We would then either be in a position where there are no health care providers, or the government would have to nationalize them as well.

  Many providers now refuse to take new Medicare/Medicaid patients because the plans don’t cover their costs to provide services. Those who do wind up charging their other patients more to cover their losses. The private insurers bear the brunt of that business practice now, which is bad enough. If the private insurers disappear, though, providers will not recoup the losses at all, and will go out of business altogether.

  Instead of having a robust health-care system that rewards providers and insurers for their work, the public plan and its inevitable market-killing characteristics will create an artificial shortage of health-care providers. Everyone will have coverage, but it may take months or years to get treatments, if at all. That is not a worst-case, hypothetical scenario, either; single-payer systems around the world share this commonplace result.

  The Medicaid program in Washington says that the loss of Walgreens and Bartell, with their combined 178 outlets, won’t present a problem for Medicaid patients. However, it won’t be long before other pharmacies conclude that they don’t want to lose money on their sales — and before customers at those locations start demanding to know whether they’re subsidizing those sales with their own purchases as well as with their tax dollars.
• 

  Yizuman

  That's in the State of Washington (and not Washington D.C. see your Atlas) and it had nothing to do with the Health Care Bill passed yesterday. This is a seperate issue. State of Washington made some changes with Medicade that Phamas is having issues with.

  Yiz
• 

  BizzyBee

  Skeeter, you're trying to connect dots with the health care bill, but you're a a few dots short. (Per Yiz above.)
• 

  skeeter1

  Yiz,

  I know that this is the State of Washington and pharmacies. You are not telling me what the separate issue that pharma is having with Washington. Please enlighten me. I look forward to learning more, and I don't mind if you cut & paste. I couldn't find the "behind the scenes" reasons in what I read.

  I also know that pharma and Obama had some "not so open" meetings to protect the pharma interests. So, perhaps these payments were enough to seal that big pharma gets a good deal.

  One of my first jobs was working for Eckerds, a pharmacy and competitor of Walgreens. There were some drugs, namely birth control, that was always sold at a loss. Say, we sold a pack for $20.00. The pack cost Eckerd's $25.00. (In Central America, you can buy the same pack for $2.00, but I digress). Why would Eckerds take this $5.00 loss? There was two reasons. First, it was a great way to get women into the store each month to buy other items. These extra purchases were supposed to make up for the loss. Plus, getting them used to coming into the store meant that they would visit during the month too.

  Second, our pharmacy computer system had a "kiss" key on it that added 50 cents to other customer's charges whenever I pressed the special key on the keyboard. So, a mean, nasty customer always got a "kiss"...as did customers who didn't call ahead to check the price on a prescription that day. I was routinely told by the pharmacist to, "give a kiss." Even if it was the 1980s, we redistributed wealth.

  The importance of the above Walgreens article is that businesses will drop the government payor if it is slow to pay or does not pay a reasonable amount. This is what is happening with doctors. They are dropping patients becuase Medicare does not pay enough or is too slow. Here's another "cut and paste" so you can check my sources...from the Wall Street Journal.

  ************************************************************

  When Doctors Opt Out

  We already know what government-run health care looks like.

  • By MARC SIEGEL

  Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

  Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

  More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

  The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

  The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

  Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

  Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

  I wouldn't want to be a patient when that happens.

  Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center, is a Fox News medical contributor.

  What's important is that we have government not
• 

  shamus100
• 

  leavingwt

  Ross Douthat says, 'let's see what happens'.

  Show Time for Health Care

  . . .

  We’ve been arguing about the health care bill, in all its many iterations, for more than a year. Along the way, liberals have made a lot of predictions about what its passage will mean for America — for our health care system and our health, our economy and our long-term solvency.It will be interesting, to put it mildly, to see if they end up coming true.

  For instance, if liberals are right, health care reform will save tens of thousands of lives every year. Not some lives, on the margins, in hard-to-measure ways that may or may not justify the bill’s price tag. Tens of thousands every year.

  Some estimates bear those optimistic figures out; others emphatically do not. But if the bill passes, we won’t have to rely on projections. American life expectancy will either leap upward, vindicating the bill’s supporters, or it won’t.

  Likewise, liberals are convinced that reform will cut the deficit, rather than increase it. This conviction depends on two big assumptions: that Congress will actually slash Medicare payments, no matter the howls of outrage that ensue, and that the “Cadillac tax” on high-value plans, currently postponed till 2018, won’t end up being put off again, again and again into eternity.

  Right now, these assumptions are hotly contested between left and right. But if the bill passes, by 2018 we’ll find out who’s right.

  By then, we’ll also be able to assess the oft-heard liberal claim that the legislation will actually save even more money than current estimates suggest. The Congressional Budget Office scores, they argue, don’t account for the bill’s investments in comparative effectiveness research and delivery system reform, or the impact of a federal board charged with weeding out unnecessary Medicare payments.

  Evaluating these predictions is like groping in the dark. But passing the bill will shed some light on them.

  It will shed light, as well, on all other promises that piled up as the health care vote drew near — that the bill, its implicit abortion subsidies notwithstanding, will actually reduce the abortion rate, as T.R. Reid argued last week in the Washington Post; that it will create 400,000 new jobs “almost immediately,” as Pelosi recently claimed; that it will become more popular once implemented, as every Democrat insists; and so on through an array of happy possibilities.

  The same goes for all the things that liberals are sure won’t happen. We’ll find out if the bill makes premiums skyrocket. We’ll find out if it creates doctor shortages. We’ll find out if the array of new taxes destroys more jobs than the new spending creates. We’ll find out if the fiscally essential firewall between the new, heavily subsidized exchanges and the old, less-subsidized employer-based system holds up. And in the (only slightly) longer run, we’ll find out if tacking an entitlement to comprehensive health insurance atop a groaning system speeds America’s rendezvous with a bankrupt, Californian future.

  . . .

  http://www.nytimes.com/2010/03/22/opinion/22douthat.html?hp
• 

  skeeter1

  Shamus100,

  While your smiley face is cute, it doesn't offer substance to my understanding of your stance to the US healthcare law or our economy. Please enlighten me with detailed facts. I am always open to learning.

  LeavingWT,

  Yes, we shall see. I am waiting for the 400,000 new jobs. I think 15,000 will be IRS agents alone! That's exciting, isn't it?
• 

  skeeter1

  Billions have "9" zeros behind it. Trillions have "12" zeros behind it.

  1) Cost of Wars in Iraq & Afghanistan to date. $974 billion. We can't afford this war either. We can't be the defender of the world, folks.

  http://costofwar.com/ - $974,000,000,000

  2) Real Cost of 6 years healthcare (benefits don't start until 2014)= $1,640,000,000,000. (1.64 Trillion...that's about 1.5 times the cost of the wars)

  or ($940,000,000,000 + $463,000,000,000 + $53,000,000,000 + $70,000,000,000 + $114,000,000,000)

  First, the act relies on $463 billion in cuts from Medicare. This includes the so-called "Doctor's fix" which is supposed to cut fees to doctors and has been in the law for a long time. But Congress rescinds the cuts every year. Are they suddenly going to stop doing that? And if they do, what will be the effect on Medicare recipients? Perhaps there is really enough waste, fraud, and abuse in the Medicare system to cover the rest of the cut, but if so, why are we only now acting to fix that? Moreover, Medicare is already insolvent over the near future. This is money that cannot now be used to try to fix the Medicare system. The CBO estimates that this healthcare reform will push Medicare into the red.

  Second, the bill counts on $53 billion in higher Social Security taxes, anticipated because some employers will pay higher wages in lieu of healthcare benefits. Assuming that's what employers do, won't that money be needed for future Social Security benefits? In case you hadn't noticed, Social Security just went into the red.

  Third, there are a considerable number of costs that aren't counted in the bill at all. $70 billion is raised in premiums in the first ten years, for benefits that would begin later. Another $114 billion in additional spending is required by the bill but not included in the tally. Holtz-Eakin estimates $562 billion added to the deficits over ten years.

  3) Our National Debt

  The problem is, now a lot more Americans do know. A year of debate has brought a lot of these things out into harsh daylight. There is also the bigger monster in the room, about which a lot of Americans are suddenly aware.

  As documented in another recent budget office analysis, the federal deficit is already expected to exceed at least $700 billion every year over the next decade, doubling the national debt to more than $20 trillion. By 2020, the federal deficit — the amount the government must borrow to meet its expenses — is projected to be $1.2 trillion, $900 billion of which represents interest on previous debt.

  Bear in mind: that is what the Obama Administration is planning on. In ten years time, the interest on the national debt will be almost as large as Democrats say the healthcare bill will cost.

  What does "$20 trillion" look like? About 21 Iraq/Afghan wars or 73 years of this new healthcare bill.

  $20,000,000,000,000
• 

  skeeter1

  All this talk about "stimulus packages" and "bailouts"...
  
  A billion dollars...
  
  A hundred billion dollars...
  
  Eight hundred billion dollars...
  
  One TRILLION dollars...
  
  What does that look like? I mean, these various numbers are tossed around like so many doggie treats, so I thought I'd take Google SketchupGoogle Sketchup out for a test drive and try to get a sense of what exactly a trillion dollars looks like.
  
  We'll start with a $100 dollar bill. Currently the largest U.S. denomination in general circulation. Most everyone has seen them, slightly fewer have owned them. Guaranteed to make friends wherever they go.
  
  $100
  
  
  A packet of one hundred $100 bills is less than 1/2" thick and contains $10,000. Fits in your pocket easily and is more than enough for week or two of shamefully decadent fun.
  
  $10,000
  
  
  Believe it or not, this next little pile is $1 million dollars (100 packets of $10,000). You could stuff that into a grocery bag and walk around with it.
  
  $1,000,000 (one million dollars)
  
  
  While a measly $1 million looked a little unimpressive, $100 million is a little more respectable. It fits neatly on a standard pallet...
  
  $100,000,000 (one hundred million dollars)
  
  
  And $1 BILLION dollars... now we're really getting somewhere...
  
  $1,000,000,000 (one billion dollars)
  
  
  Next we'll look at ONE TRILLION dollars. This is that number we've been hearing so much about. What is a trillion dollars? Well, it's a million million. It's a thousand billion. It's a one followed by 12 zeros.
  
  You ready for this?
  
  It's pretty surprising.
  
  Go ahead...
  
  Scroll down....
  
  Ladies and gentlemen... I give you $1 trillion dollars...
  
  $1,000,000,000,000 (one trillion dollars)
  
  
  (And notice those pallets are double stacked.)
  
  So the next time you hear someone toss around the phrase "trillion dollars"... that's what they're talking about.