Category: Health care

Prevent Medicare Fraud

Prevent Medicare Fraud

Posted on by Jack

In discussing healthcare, the subject of Medicare fraud often comes up. The big thing that is often talked about is the billions of taxpayer dollars wasted because of fraudulent over-payments. There is another type of Medicare fraud where Medicare beneficiaries are targeted and the cost can be very personal.

I read an article from AARP today about a bill to reduce both types of fraud. Of course, it is near impossible to totally prevent attempts at fraud and Medicare is a very big target. So why not tighten things up a bit and make things a bit tougher for those committing the fraud and those who help wittingly or unwittingly.

The article is Pass the PRIME Act and it is from the AARP Bulletin. Read it over and see what you think. Seems reasonable to me.

Fixing the ACA or Obamacare makes more sense than repeal

Fixing the ACA or Obamacare makes more sense than repeal

Posted on by Jack

It seems that ever since the Affordable Care Act (aka ACA or Obamacare) was passed and then passed muster in court, nearly all Republicans have wanted it repealed. The latest efforts involve shutting down the government as we enter a new fiscal year and refusing to raise the debt ceiling so the government defaults on its debts.

Both efforts seem foolish and I have discussed them recently.

I live in Pennsylvania and get emails from Senator Toomey. He discussed his desire to compromise on the government shut-down stand-off by adding 3 amendments to the Senate bill. These amendments did not make it into the Senate bill. I do not think the debate on Obamacare should be part of the government shut-down or debt ceiling debates but these are good discussion points on the law.

The first would repeal the medical device tax that is costing Pennsylvania jobs; the second would provide relief from the infringement on religious liberty in Obamacare; the third would delay the individual mandate for one year.

I probably would back the repeal of the medical device tax. It seems to me the best way to do this would be a a separate bill but now seems a bit rushed. I don’t see much benefit to this tax since I would assume the tax would just be passed along as part of the cost of health care. So there is really no benefit since the users of heath care pay the tax and there well could be a job loss associated with this. But on the other hand with more people insured and using health care there may not be a job loss. I’d like to see more discussion on this point.

Regarding the second suggestion (infringement on religious liberty), I think this is inevitable as long as we insist on standards in health insurance. I think the employer mandate is problematic. The religious objection of an employer may or may not seem reasonable to others. One person may object to contraception and another may object to this or that aspect of health care. A public option would be much simpler here but I don’t think that is what the Senator had in mind.

As to the third point (a 1 year delay), there may be a problem. I assume the insurance companies took the widened risk-pool provided by the mandate into account when setting the rates for 2014. If this is not the case and we do not have additional delays such as a 1 year delay every year, it might be worth discussing this.

The ACA is a complex law with many parts. There are things I like and things I don’t. There seem to be things we could fix now and problems that would not be apparent until parts of the law are implemented. And we certainly could use a reasonable discussion of the pros and cons of parts of this law.

Rather than have a series of political stand-offs to attempt to repeal the law, maybe Congress could work to improve the law.

Fix Health Care, don’t just repeal the attempted reform

Fix Health Care, don’t just repeal the attempted reform

Posted on by Jack

A few days ago, I remarked on the apparent public disapproval Affordable Care Act (aka ACA or Obamacare) although there are many clear benefits some of which seem quite popular.

I like some provisions and dislike others. I like the idea of universal coverage. The ACA doesn’t get us to universal health care but sure gets us closer. There are certainly things I don’t know and perhaps are unknowable until we try.

So my vote is for fixing the parts of the law that don’t work or cause problems. I think a repeal is foolish. And it is certainly foolish to shut down the government to try to force a repeal.

And even more foolish to fail to increase the debt ceiling and have the United States default on its obligations in an attempt to force the will of some Republicans on the entire county.

The House Republicans have shown the ability to manufacture a crisis when there is no need. It is a shame they can’t direct their efforts at solving the problems of the country.

Are Americans really opposed to Obamacare ?

Are Americans really opposed to Obamacare ?

Posted on by Jack

It appears that there is considerable public opposition to the Affordable Care Act (aka Obamacare). House Speaker John Boehner cited this opposition to Obamacare in calling the House bill to to fund federal agencies past Sept. 30 and defund Obamacare.

I think saying a majority of Americans oppose Obamacare is an over simplification and wrote a bit about that.

I find it rather hard to believe that a majority wants to go back to a system where insurers can deny coverage because of pre-existing conditions (or they believe the applicant is likely to make too many claims). Or a system that allows insurers to place caps on benefits so if you develop a serious condition the policy just pays until a certain point and you are stuck with any bills after that point.

How can we conclude that a majority oppose the law when other surveys show many people just don’t know much about the law?

Trying a new way for medicaid expansion in Pennsylvania

Trying a new way for medicaid expansion in Pennsylvania

Posted on by Jack

I have previously written about the governmental see-saw on medicaid expansion in Pennsylvania. My understanding was the Feds paid 100% for 3 years, eventually falling to 90% (so the state is stuck with 10% in the long-term). But whether or not the state participates the residents still pay the tax for medicaid expansion in the other states.

As far as I could tell Gov. Corbett was against the Medicaid expansion in Pennsylvania but had not reached a final decision. The legislature went back and forth on it. It seemed to me the needy in Pennsylvania would be the losers. But things may be looking up!

Gov. Corbett would like to use these funds to provide private health coverage rather than add to the state’s Medicaid program. But this requires federal approval. Read the full article here. And more details are to follow.

It seems to me that it a good idea to try different methods of delivering services. If this works our well, it could be a model for other states to deliver medicaid services. So I’m eagerly awaiting more details and hearing the federal response.

Asking the wrong questions: polling and Obamacare

Asking the wrong questions: polling and Obamacare

Posted on by Jack

There has been quite a bit in the news lately about public opposition to the Affordable Care Act (aka ObamaCare). It seems that most recent polls indicate most are opposed (see http://www.realclearpolitics.com/).

But are the polls asking the right question? It seems to me you could oppose the law because you think it goes too far. Or you could oppose the law because it doesn’t go far enough.

Or you could generally agree with the aims law and disagree with parts. (And either support the law or not.)

You could want total repeal or perhaps just a modification of what you don’t like. You could want total repeal and replaced with no reform at all. Or you could want it repealed and replaced with a single payer system or another system.

This is really too complicated to just look at one number as a gauge of public opinion.

Another question would be does public opinion really reflect problems in the law or just how effective one side or the other is in presenting the case to the public.

Thanks for the fact checkers

Thanks for the fact checkers

Posted on by Jack

Years ago Daniel Patrick Moynihan said “Everyone is entitled to his own opinion, but not his own facts.”

But now people seem to be armed with their own facts. Supposed facts are claimed to support both sides of an argument. Unfortunately it is the claim that gets the attention and relatively few hear about the basis of the claimed fact later.

For example, I am sure many of us saw the claim that about 75% of small businesses will have to fire workers or cut their hours as a result of ObamaCare. This claim was based on a survey or more accurately what the survey was said to show. Of course, the survey showed no such thing but that part of the story was not very prominent in the news.

The Fact Checker of the Washington Post recently examined this claim and lays out the facts and demonstrates why this claim is far from fact. Lest anyone think this is a partisan criticism, I should point out that this article has links to previous articles by this fact checker criticizing President Obama and the NRA for misusing survey data.

Two other sites I like for checking the factual basis of claims are Politifact and FactCheck.org.

Don’t accept the “facts” presented by either side without some critical thinking and checking. Having fact checkers helps us do that. Thanks to the fact checkers.

Medicaid expansion in Pennsylvania

Medicaid expansion in Pennsylvania

Posted on by Jack

Bad news, then good news, and bad news again on medicaid expansion in Pennsylvania.

House Republicans followed through Monday on their threat to kill a provision written by the state Senate to require Gov. Tom Corbett to seek federal approval for an expansion of Medicaid eligibility to provide taxpayer-paid health care to hundreds of thousands of Pennsylvanians.

This from an article on the back and forth state of medicaid expansion in PA.

As part of health care reform (Obamacare), the federal government was going to pay to expand medicaid. But since this is a joint program between the federal and state governments, the states need to be willing participants. Seems an inexpensive way for the states to help their poorer residents. The federal government pays 100 percent for the first three years, starting next year, and 90 percent after that.

But 21 states governed by Republicans refused this deal. There are 6 states that haven’t decided yet and Pennsylvania is one of them.

I live in Pennsylvania so I’ve been paying attention to the see-saw here. First our Republican governor says NO. Then the state Senate says YES . Then the state House says No (see the quote above).

So I don’t know what will happen but I suspect the needy in Pennsylvania will be the losers.

Preventive services under the Affordable Care Act aka ObamaCare

Preventive services under the Affordable Care Act aka ObamaCare

Posted on by Jack

Much has been made of the many preventive services under the Affordable Care Act aka ObamaCare and there is a long list. But buyer beware.

Over 60 preventive services are covered but how it is covered may be up to the terms of the specific insurance policy that you purchase. For example, take BRCA and Breast Cancer.

Mutations (genetic changes) in the BRCA gene have been related to very high risks of Breast and Ovarian Cancer. Angelina Jolie tested positive for the BRCA gene and there has been pretty extensive new coverage about that.

So the health act does require that insurers pay for “BRCA counseling about genetic testing for women at higher risk” but says nothing about covering the actual test itself. I suppose that means the testing coverage is up to the insurance company.

Repeal ObamaCare, maybe 37th time is the charm

Repeal ObamaCare, maybe 37th time is the charm

Posted on by Jack

I read today that the House of Representatives is going to try to repeal ObamaCare for the 37th time.

I’m kind of on the edge of my seat here. Will it pass this time? Did it pass all 36 times before?

How long will it take House Republicans to realize that the Affordable Care Act or ObamaCare has been law for a few years and there is no chance of repeal unless the Republicans take over in the Senate and maybe the White House. Wouldn’t their time be better spend in trying to fix parts of the law they find especially objectionable? Or trying to be constructive?

What if repealing ObamaCare actually will increase the deficit as the Congressional Budget Office (CBO) predicted. Will the Republicans agree to raise taxes to make their plan deficit neutral? Or will they cut elsewhere?

Is Obamacare and employer-provided insurance pro-business or anti-business?

Is Obamacare and employer-provided insurance pro-business or anti-business?

Posted on by Jack

The Patient Protection and Affordable Care Act of 2010 (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare, is controversial. Republicans consider it anti-business; Democrats not so much. But is it really more pro-business or anti-business than our present system ?

Employer-provided health insurance began during World War II as a way of getting around wage controls on businesses. Currently most of the insured under 65 have employer-provided insurance. Obamacare is similarly dependent on employer-provided insurance. Sort of a doubling down on the idea by mandating that employers provide insurance or pay a penalty.

But is employer-provided insurance a good thing? Or would we be better off if the insurance was provided by another method ? And how do we pay for it ?

So many questions. Are there good answers? What do you think?

Low increase in employer health care: The good and bad

Low increase in employer health care: The good and bad

Posted on by Jack

The good news is 2012 saw the lowest increase in in health insurance costs for employers since 1997. That is certainly good news for employers. But the bad news is that this is largely the result of switching employees to lower cost plans. Almost certainly, bad news for employees. These finding are in a press release by Mercer , who conduct the National Survey of Employer-Sponsored Health Plans. More details are in the press release and even more in the detailed report.

Here are a few more articles on this I’ve run across:

Businessweek even suggests some employers may drop health-care coverage .

Since the trend among employers seems to be to lower costs and decrease benefits (or increase the employee’s share), I am wondering if our dependence on employer-provided health benefits as part of the Patient Protection and Affordable Care Act (ObamaCare) is such a good idea.

National Health Insurance plan in the US and business

National Health Insurance plan in the US and business

Posted on by Jack

A few days back I asked, “If we had a true National Health Insurance plan in the US, would it be pro-business or anti-business?

But still no answers or comments. It seems to me that compared to or present system, which is largely based employer-provided insurance, another system or systems could both increase coverage and allocated costs in a less harmful way to our economy.

Our present system directly adds a cost to the employer. I don’t recall where I saw it but a good example that sounds reasonable to me is that the cost of health insurance adds thousands of dollars to each car produced by American car makers. I would think this cost would put US companies at a large disadvantage in competing internationally. Also there would be competitive advantages and disadvantages within the US.

So a true National Health Insurance plan in the US would appear to have many advantages for our economy. If that is the case, other questions such as “How do we pay for it?” or “What does this plan look like?” follow.

But let’s not jump ahead but just consider one question at a time. Is National Health Insurance good for the economy?

What do you think?

Question on US National Health Insurance

Question on US National Health Insurance

Posted on by Jack

I have a question on US National Health Insurance:

If we had a true National Health Insurance plan in the US, would it be pro-business or anti-business? Currently we are basing things mainly on employer-provided insurance. I would think the cost of that would put companies at a disadvantage in competing internationally. Also there would be competitive advantages and disadvantages within the US.

Would a true National Health Insurance plan in the US put all companies on a level playing field with both other US companies and rivals in countries where there is National Health Insurance?

What do you think?

Sequester and Heath care reform (aka ObamaCare)

Sequester and Heath care reform (aka ObamaCare)

Posted on by Jack

Just 2 short notes today.

1. The Sequester is nearly upon us. The consequences have been much covered in the press. Long lines at airport security, cut-backs in air traffic control, military cuts, fewer food inspections, and many more. Additionally the cut-backs seem likely to hurt the economy which is only slowly recovering from the recession.

I see little movement toward a solution. In fact, both house of Congress took a week off last week, leaving only a few days to solve this.

2. Heath care reform (aka ObamaCare) is in place. Some find aspects they dislike or that they think will harm the economy. The only call I hear from these groups is “repeal” or “repeal and replace”. Since we have already passed health care reform and it has passed constitutional muster, why not work to fix those part that you disagree with?