The Data Agenda

Friday, December 20, 2013

ACA Transactions Not Completing

The next obvious shoe to drop in the series of bombshells the Affordable Care Act is leaving on the American health insurance market is round two of the you-really-can't-keep-your-insurance reality: small group policies.

Press coverage of this issue should be abundant in 2014 as the line between "do you or don't you have coverage" is both clear and potentially widespread, and maybe much wider than the individual market.

Less obvious are the data integrity problems on the back-end that could render supposedly active policies useless.  That is, even if you are told you have "coverage," acting on that could be problematic.

Monday, December 16, 2013

ACA's ban on health insurance

For those 30 and older (counting from "the beginning of the plan year"), catastrophic health insurance is not an option under the Affordable Care Act. For those under 30, catastrophic plans are still allowed.

From the text of Public Law 111-148 (emphasis added):

SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.

(e) Catastrophic Plan-

Friday, November 8, 2013

Six-Figure Poverty

On the floor of the House of Representatives in May, Ms. Jackson Lee explained that "the Affordable Care Act is to lift your boat" and is for those in "poverty" in which she included those who are "poor," "low-income," and "working middle class."

The Affordable Care Act provides subsidies for Americans with incomes at or below 400 percent of poverty ($94,200 for a family of four). The middle class would include those with incomes from one to four times the federal poverty level (FPL). A look at US Household income or a distribution chart shows that this includes at least 75 percent of Americans.

Do the American people really believe that three quarters of the country are in some form of poverty now?

Saturday, October 26, 2013

An Affordable Care Act takeover in view

The Affordable Care Act mandates mental health benefits in insurance coverage, and the 2008 mental health parity law, which requires private and public insurers to cover mental health needs just as they do medical conditions by charging similar co-pays, for example.

“It’s a big change for us,” said Barbara Griswold, a marriage and family therapist in San Jose, Calif. “I spent all of my life setting up this practice where I choose my clients, I choose my hours.”

In just the last few months, Griswold has weighed a new contract with a giant health insurer, warned other therapists to watch what they’re signing in payment negotiations and considered the extinction of her own solo practice. “The idea of me moving into an interdisciplinary practice where somebody else is taking care of my billing, and someone is choosing my clients for me—there is a loss of autonomy that a lot of therapists are frightened about,” Griswold said.

Saturday, September 28, 2013

The Tools of ACA for Lowering Costs

ABC News ran an article on the Affordable Care Act that made little mention of the effect of various "free" services on costs. Upon pointing this out, another reader commented that those services "will lower costs because treatable illnesses will be caught early before they are very expensive to treat and irreparable damage has been done."

The assumption in "treatable illnesses" lowering costs is that only those with illnesses are getting that "free" treatment.

Thursday, September 26, 2013

The Individual Mandate's Impossible Mission

Healthwatch is carrying the water for the Administration. Upon a West Virginia Democrat departing the ACA reservation, it concludes its reporting by noting:
Delaying the individual mandate would deal a severe blow to the healthcare law and could make it altogether unworkable.

The unpopular provision was included in the healthcare law to help prevent massive premium increases.
One has to ask the question, How did the health insurance industry ever exist before the individual mandate of the Affordable Care Act?

Medical Devices: Not necessarily about electronics

A variety of medical devices commonly used in hospital surgical procedures experienced a significant dip in prices over the past six years, according to the Advanced Medical Technology Association. These devices include:

  • drug-eluting stents (34 percent price decline)
  • pacemakers (26 percent price dip)
  • artificial hips (23 percent price decrease)
  • artificial knees (17 percent price drop)

Read more: Hospitals driving down price of medical devices

The Purpose of EMRs

EMRs are not designed for patient care because our medical system is no longer designed for patient care. Our medical system is being redesigned to provide health services to consumers, and EMRs are morphing into superb tools for a service industry.
  • EMRs are designed to collect increasingly detailed customer information.
  • EMRs are designed to facilitate market research.
  • EMRs are designed to standardize and automate transactional complexity.
  • EMRs are designed to smooth handoffs across the supply chain.
  • EMRs are designed to orchestrate and monitor production lines.
  • EMRs are designed to minimize production costs and maximize revenues.
  • EMRs are designed to provide quality assurance based on exact specifications.
  • EMRs are designed to prevent and quickly detect malfunction and non-compliance with specifications.
Read more: Why Doctors Will Never Ever Like EMRs

Thursday, September 12, 2013

ACA fees and taxes raising costs for employers

From CNNMoney

Transitional reinsurance fee: This fee will be imposed on employers for the next three years and will go towards helping the state-based insurance exchanges, where individuals can find coverage, pay for large claims. The fee will be $63 per insured member in 2014, but is expected to decrease in the latter two years. Delta said this fee will cost it more than $10 million next year.
Patient Centered Outcomes Research Institute fee: This charge will go to pay for a new agency tasked with giving patients a better understanding of the prevention, treatment and care options available, and the science that supports those options. Employers will be charged $1 per insured person this year, $2 in 2014 and then increases with inflation in health care spending for the next five years.
Health insurer fee: This annual fee is aimed at helping pay for the implementation of ACA. It will be about 2.5% of total premiums in 2014 and is expected to go up to 4% by 2017. Beyond that, it will rise with the growth in premiums. Insurers are expected to pass this fee through to employers.
'Cadillac' tax: Starting in 2018, employers who offer rich benefit plans -- where the total premium will cost more than $10,200 for an individual plan or $27,500 for family coverage -- will have to pay the so-called Cadillac tax, a 40% tax on the amount over the threshold. This tax is prompting companies to shift more medical expenses onto employees, which not only brings down the price of the premiums, but also pushes employees and their spouses to consider other options available to them, said Sandy Ageloff, senior consultant with Towers Watson, a professional services firm.
Individual mandate: Also adding to employer costs is the Obamacare requirement that Americans obtain insurance or face a penalty starting in 2014. That will prompt many employees who had opted out of their company's coverage to sign up. Delta, for instance, estimates this will add $14 million to its costs annually.

Tuesday, September 10, 2013

Options for replacing the Affordable Care Act

From Forbes:
Comprehensive Republican health reform plans introduced in Congress
Let’s start with 5 comprehensive health reform proposals that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) voted on what eventually became Obamacare.

Friday, July 12, 2013

How ACA requires employers to "share responsibility"

SEC. 1513. SHARED RESPONSIBILITY FOR EMPLOYERS.

    (a) In General- Chapter 43 of the Internal Revenue Code of 1986 is amended by adding at the end the following:

`SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH COVERAGE.

[...]
    `(c) Large Employers Offering Coverage With Employees Who Qualify for Premium Tax Credits or Cost-sharing Reductions-
      `(1) IN GENERAL- If--
      `(A) an applicable large employer offers to its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) for any month, and
      `(B) 1 or more full-time employees of the applicable large employer has been certified to the employer under section 1411 of the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee, then there is hereby imposed on the employer an assessable payment equal to the product of the number of full-time employees of the applicable large employer described in subparagraph (B) for such month and 400 percent of the applicable payment amount.
      `(2) OVERALL LIMITATION- The aggregate amount of tax determined under paragraph (1) with respect to all employees of an applicable large employer for any month shall not exceed the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month.
From the text of Public Law 111-148, the Patient Protection and Affordable Care Act.

Emphasis added on key phrase.

In other words, if even just one employee gets a "premium tax credit or cost-sharing reduction," for getting insurance from the exchange outside the employer, then the employer is penalized as if all full-time employees got a tax credit.

Employers are also discovering the "low-benefit" coverage ACA requires does not require they cover what most insurance covers today: hospitalization.

If even just one employee finds his coverage is insufficient and purchases his own coverage through the exchange to cover hospitalization, that employer is penalized as if all full-time (30 or more hours per week) employees did that as well.

Thus, even if employers only need to spend "$40 to $100 a month per employee" for a low-benefit plan, they may not even provide that if they still end up with the "$2,000-per-employee penalty for providing no insurance" for all their full-time employees.

If those developing the federal exchange systems are planning on only a relatively tiny fraction of Americans enrolling, they may be in for an even more overwhelming surprise during the "largest ever" open enrollment season this fall.

Wednesday, May 15, 2013

When a temporary staffing agency is not a temporary staffing agency

D. Temporary Staffing Agencies
Page 230: 3. Anti-Abuse Rules

The Treasury Department and the IRS are aware of various structures being considered under which employers might use temporary staffing agencies (or other staffing agencies) purporting to be the common law employer to evade application of section 4980H.

Friday, May 10, 2013

How to take over medical academia: call it research

Are you ready to become a data point?
Under Obamacare program, doctor visits would become data points
By Sarah Kliff, Published: April 23, 2013 at 12:45 pm

A new nonprofit is putting millions of Obamacare dollars towards an effort to turn routine doctor visits into a treasure trove of data on what medical treatments work best.
And by "doctor visits," we are, just to be clear, talking about your actual visit to your doctor. Supposedly it's been "deidentified," but that will be put to the test.

The Affordable Care Act created the Patient Centered Research Outcomes Institute (PCORI) to support comparative effectiveness research, studies that identify the most effective treatments when a whole array of options might be available.
PCORI and "comparative effectiveness research" would, respectively, be better known as a rationing board and the reasons why certain treatments won't be funded.

Pelosi: Democrats are "very pleased" and "pretty excited" about ACA implementation

Pelosi Press Conference Today
May 9, 2013
Contact: Drew Hammill, 202-226-7616

Washington, D.C. – Democratic Leader Nancy Pelosi held her weekly press conference today in the Capitol Visitor Center. From her transcript of the press conference:

Q: Next week, it sounds like they are going to vote once again to repeal Obamacare. I wonder what you think about the wisdom of that and also the fact that apparently this is such a popular subject for the new class of Republicans that they have been clamoring for the leadership finally to do.

Friday, March 15, 2013

Top 10 Things to Know about Certified EHRs

Advocates claim federally certified electronic health records (EHRs) are poised to transform the delivery of health care in America. There are some things to know.

Citizens' Council for Health Freedom in Minnesota has released a one-page briefing on these EHRs. Below is expanded information on each of these points.

Wednesday, February 20, 2013

Open Meetings vs. Privacy

NIH recently posted a series of notices of meetings.
* Closed to the public.

Of those meetings closed to the public, seven of them include this notice:

    The meeting will be closed to the public in accordance with the 
provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 
U.S.C., as amended. The grant applications and the discussions could 
disclose confidential trade secrets or commercial property such as 
patentable material, and personal information concerning individuals 
associated with the grant applications, the disclosure of which would 
constitute a clearly unwarranted invasion of personal privacy.

While this notice clearly identifies "individuals associated with ... grant applications," as electronic health records, and all the personal information they contain, become ever more pervasive in healthcare, what would stop an agency from simply closing a meeting involving health IT because of a "clearly unwarranted invasion of personal privacy"?

Tuesday, February 5, 2013

Will You Be Forced into Medicaid?

Government "insurance" exchanges (or "marketplaces") are going to force many people into Medicaid, the government subsidy program for the poor.

As Brandon Clark from the consulting firm FrogueClark told CBS Charlotte, "A lot of middle class individuals are going to apply for a state exchanges... thinking they're going to get a Blue Cross Blue Shield plan or a United Plan, like they had before... But they will find out they're not on private health insurance, but rather, a state Medicaid program."

Tuesday, January 29, 2013

ACA Protection of 2nd Amendment Gun Rights

`SEC. 2716. PROHIBITION ON DISCRIMINATION IN FAVOR OF HIGHLY COMPENSATED INDIVIDUALS.

`(c) Protection of Second Amendment Gun Rights-

`(1) WELLNESS AND PREVENTION PROGRAMS- A wellness and health promotion activity implemented under subsection (a)(1)(D) may not require the disclosure or collection of any information relating to--
`(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or
`(B) the lawful use, possession, or storage of a firearm or ammunition by an individual.
`(2) LIMITATION ON DATA COLLECTION- None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used for the collection of any information relating to--
`(A) the lawful ownership or possession of a firearm or ammunition;
`(B) the lawful use of a firearm or ammunition; or
`(C) the lawful storage of a firearm or ammunition.

Tuesday, January 22, 2013

House Passes H.R. 307

Today the House voted 395-29 to move toward national and international biosurveillance. Previous vote: 383-16

Yes votes increased from 383 to 395.
No votes increased from 16 to 29.

Saturday, January 19, 2013

Tuesday House Suspension Vote - International Biosurveillance

Tuesday the House is scheduled to vote on H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013.

Included in this bill is Section 204 on "Enhancing Situation Awareness and Biosurveillance" which requires the National Biodefense Science Board to "provide expert advice and guidance, including recommendations, regarding the measurable steps the Secretary should take" to "achieve a national biosurveillance system for human health, with international connectivity, where appropriate, that is predicated on State, regional, and community level capabilities and creates a networked system to allow for two-way information flow between and among Federal, State, and local government public health authorities and clinical health care providers."  (Full text of the section is below.)

If the purpose of this is to "achieve early warning and identification of such health threats," then an emergency is not required for implementing biosurveillance, and is, in fact, required when there is no public health emergency.