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Your private health information is being stolen by the government

For any of this new healthcare to work, the government needs your personal health information. Read the requirements below for physicians and their EHR systems. Eventually in year 2 (next year) your data will be AUTOMATICALLY transferred to the government WITHOUT YOUR CONSENT.

In the first year of the new ACO program announced by CMS ACOs will use a new ACO GPRO tool based on the data collection tool currently used in the PQRS. In subsequent program years through additional rulemaking, we would expect to refine and expand the ACO measures to enhance our ability to assess the quality of care furnished by ACOs participating in the Shared Savings Program and expand measures reporting mechanisms to include those that are directly EHR-based. The tool would allow ACOs to submit clinical information from EHRs, registries, and administrative data sources required for measurement reporting. One very interesting section of the proposed rule on ACOs is:

In July 2010, HHS published final rules for the EHR Incentive Programs. Included within the final regulations were certain clinical quality measures for which eligible professionals and eligible hospitals are responsible. We have noted in Table 1, the proposed Shared Savings Program quality measures currently included in the EHR Incentive Programs and will continue to further align the measures between the two programs. Given that we have proposed in Section II.E.6 that at least 50 percent of an ACO’s PCPs are “meaningful EHR users” as that term is defined in 42 CFR 495.4 by the start of the second Shared Savings Program performance year in order to continue participation in the Shared Savings Program, our intent is to develop the capability of the GPRO web-based tool to interface with EHR technology, such that EHR data could directly populate the ACO GPRO tool with the required quality data. As we intend to further align both the Shared Savings Program and EHR incentive program through subsequent rulemaking, we anticipate that certified EHR technology (including certified EHR modules capable of reporting clinical quality measures) will be an additional measures reporting mechanism used by ACOs under the Shared Savings Program for future program years.

Obviously, there will continue to be alignment, not only between the reporting requirements for ACOs and the EHR Incentive Program requirements for meaningful use, but also the Standards and Certifications Criteria for EHRs in the succeeding phases of the program. I imagine that the interface between the EHR and the ACO GPRO tool will become a very important part of healthcare innovation for the future…

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New Taxes for You – Courtesy of Obama Care

As a reminder, there are twenty taxes in PPACA.

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new “community health assessment needs,” “financial assistance,” and “billing and collection” rules set by HHS. Bill: PPACA; Page: 1,961-1,971

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion).  This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113

3. “Black liquor” tax hike (Tax hike of $23.6 billion).  This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959

Tax that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013):  Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single).  This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93

  Capital Gains Dividends Other*
2012 15% 15% 35%
2013+ 23.8% 43.4% 43.4%

 

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations.  It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income.  It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans.  The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

  First $200,000
($250,000 Married)
Employer/Employee
All Remaining Wages
Employer/Employee
Current Law 1.45%/1.45%
2.9% self-employed
1.45%/1.45%
2.9% self-employed
Obamacare Tax Hike 1.45%/1.45%
2.9% self-employed
1.45%/2.35%
3.8% self-employed

 

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax.  Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise “Haircut” for Medical Itemized Deduction from 7.5% to 10% of AGI ($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI).  The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited).  Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children.  There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education.  Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs educationBill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

  1 Adult 2 Adults 3+ Adults
2014 1% AGI/$95 1% AGI/$190 1% AGI/$285
2015 2% AGI/$325 2% AGI/$650 2% AGI/$975
2016 + 2.5% AGI/$695 2.5% AGI/$1390 2.5% AGI/$2085

 

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS). Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014):  If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees.  Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer). Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year.  Phases in gradually until 2018.  Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family).  Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions.  CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

Do not ask for whom the Tax Man tolls. He tolls for thee.

 

http://www.atr.org/tax-hikes-obamacare-scotus-rule-a6996#ixzz1z7PbBevK

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CCHF Asserts: State Health Exchanges Simply a Ruse to Mandate Federal Registration of All Americans

Statewide “Marketplaces” Feed Directly to National Portal; Force Americans to Register with Federal Government

Key Facts:

  • •           Under the Obama Administration’s Affordable Care Act, states must implement state-run “American Health Benefit Exchanges,” otherwise known as state health exchanges, which comply with a host of federal regulations.
  • •           States refusing to implement a health exchange will have a federally established exchange imposed upon them.
  • •           State exchanges are simply a façade that provides the federal government access, through oversight and control measures included in the Affordable Care Act, to individuals’ private data and forces individuals to register with the government for either insurance or exemption status.

 

ST. PAUL, M.N. – As states begin to process and plan for the implementation of “American Health Benefit Exchanges,” otherwise known as state health exchanges, the reality of the end of personal health privacy is being realized by individual citizens. The Citizens’ Council for Health Freedom has produced a detailed diagram that shows exactly how each individual state exchange is connected back to the federal government, creating a federal registration system that involves every American.

Through the Affordable Care Act, exchanges are federally mandated to handle and manage not only private health data, but they can forward coverage data to the IRS for purposes of determining tax penalties based on coverage level. Other government agencies, like the Department of Justice, Department of Homeland Security, and the Social Security Administration also have access to citizen’s private data, as the Affordable Care Act mandates that the Department of Health and Human Services has the authority to require “any measure or procedure” be undertaken by the exchange.

As currently written, HHS has the authority to require or deny coverage of procedures as they deem fit based on the data available through an individual’s health record. The federal government can also track citizens from the time of birth and mandate registration with the state health exchange within a defined amount of time.

“President Obama’s state portals for national registration of citizen insurance status and IRS enforcement of the individual mandate requiring all Americans to purchase insurance is a major intrusion into the privacy of citizens and a hindrance to the doctor – patient relationship,” said Twila Brase, President for the Citizens’ Council for Health Freedom. “Not only do state health exchanges require registration of every American citizen – whether they purchase insurance or not – they enable access to a multitude of very private data and authorize five government agencies, including DOJ, IRS, SSA and DHS, to have access to that data.”

The Citizens’ Council for Health Freedom is urging state legislators to refuse implementation of the state health exchange to prevent federal intrusion into the lives of their citizens.

“In the short term, refusal to implement a state exchange for as long as possible to prevent the intrusion into citizens’ privacy, as well as to prevent the incredible cost is the best strategy,” said Brase. “Of course, our hope is that the election in November will result in the ultimate repeal of Obamacare so that state exchanges will no longer be an issue, but in the meantime, refusal to implement them is the best option to prevent the overwhelmingly negative consequences of implementation.”

Twila Brase, a public health nurse and health care freedom advocate, informs listeners of crucial health issues, such as the intrusive wellness and prevention initiatives in Obamacare, patient privacy and the need for informed consent requirements, the dangers of “evidence-based medicine” and the implications of state and federal health care reform.

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State Health Insurance Exchanges Compromise Patient Privacy, Provide Federal Agencies Broad Control over Health Care

Key Facts:

  • •           After the Supreme Court Ruling on the Patient Protection and Affordable Care Act (PPACA) components of the law – like healthcare exchanges – are on the fast track to be implemented.
  • •           State healthcare exchanges are website portals that feed into the national exchange and allowing broad access of private health data by five government agencies.
  • •           The Citizens’ Council for Health Freedom (CCHF) continues to urge states to refuse implementation of health insurance exchanges to prohibit the implementation of the PPACA, prevent privacy intrusions and limit the detrimental financial consequences of the PPACA.

 

ST. PAUL, Minn. – Now that the Supreme Court of the United States has ruled the Patient Protection and Affordable Care Act (PPACA) mainly constitutional, primary components such as health insurance exchanges are being pushed at the state level. But implementation of these exchanges creates new and lasting challenges, adding $340 billion to the nation’s deficit and creating $17 trillion in long-term, unfunded liabilities that will burden the already floundering economy. Perhaps even more disturbing is the intrusion into patient privacy that these exchanges allow.

“Many Americans do not recognize the governmental overreach of power that implementation of the state and national healthcare exchanges creates,” said Twila Brase, President of the Citizens’ Council for Health Freedom. “But once these web portals to the federal government are created and implemented, they will be very hard to dismantle, and the control they exert over insurance and medical delivery, and the access they allow to individual data is disturbing.

These portals provide five major government agencies access to personal information. They are not the one-stop-shopping “marketplaces” that they have been described to be.”

Many Americans don’t understand the flow of information allowed through the state healthcare exchanges. According to the CCHF, the exchange is a web portal that enables data transfers, financial transactions, and bureaucratic functions for the purpose of implementing the federal controls of the PPACA.

Brase continues to urge state legislators to refuse to implement these exchanges in their states and prevent the exchange system from moving forward.

“I’ve spoken to a number of legislators in the months leading up to the Supreme Court decision,” Brase concluded. “Many now understand and agree that the states are the only barrier to full implementation of the Patient Protection and Affordable Care Act. They can and must refuse to implement these exchanges in their states to protect their fiscal health and the privacy and choices of all citizens. This is the clearest way to prevent the implementation of this onerous legislation until the Congress can vote to repeal it.”

Twila Brase shares health care-related news with the American public in her daily, 60-second radio feature, Health Freedom Minute. Health Freedom Minute airs on the entire American Family Radio Network, with more than 150 stations nationwide, in addition to Bott Radio Network with over 80 stations nationwide. During the daily features, listeners can learn more about the agenda behind proposed health care initiatives and policies and what they can do to protect their health care choices, rights and privacy.

Brase, a public health nurse and health care freedom advocate, informs listeners of crucial health issues, such as the intrusive wellness and prevention initiatives in Obamacare, patient privacy and the need for informed consent requirements, the dangers of “evidence-based medicine” and the implications of state and federal health care reform.

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You CAN’T Keep Your Insurance – Obama’s Radical Restructuring

And he said we could…..

 

A Radical Restructuring of Health Insurance

Millions to lose the health coverage they have now

By Grace-Marie Turner • December 2011

One of the most fervent promises President Obama made to the American people before passage of the health overhaul law was “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”1

 

But, even before the law fully takes effect, millions of people are losing “the coverage they have now,” and tens of millions more surely will follow.

 

A major survey of employer plans provides evidence. McKinsey & Company surveyed 1,300 employers across industries, geographies, and employer sizes, and concluded that the Patient Protection and Affordable Care Act (PPACA) will lead to a “radical restructuring” of job-based health coverage.2 McKinsey found that 45 to 50 percent of employers say they will definitely or probably pursue alternatives to employer-sponsored health insurance in the years after it takes effect in 2014. One-third of employers say they “will definitely or probably drop coverage after 2014.” Among employers who knew most about the new health law, half said they were likely to drop coverage.

 

Since an estimated 156 million non-elderly Americans get health insurance at work, according to the Employee Benefit Research Institute,3 that means as many as 78 million people could be forced to find other sources of coverage.

So clearly President Obama’s key promise will be broken after the law fully takes effect. But the deterioration in coverage already has begun as many people already are losing the coverage they have now as health insurers are dropping out of markets in many states. Some of the carriers are exiting because of onerous state regulations, others are victims of a faltering economy, but the cascade has been accelerated by the rules that already have taken effect and the many more that are to come as a result of PPACA.

 

In this paper, we provide:

 

an overview of carriers leaving the private    • health insurance market

the impact of Obama administration rules                 • on the child-only health insurance market

the disruptions caused by rules governing                • health premium payouts and “grandfathering,” and

the threats to the Medicare Advantage market.•

 

Some health plans are already leaving markets

The American Enterprise Group announced in October 2011 that it would stop offering non-group health insurance in more than 20 states.4 As a result, 35,000 people will lose the health coverage they have now. The company cited regulatory burdens, including the “medical loss ratio” (MLR) requirements (see page 4 for more), in explaining its decision to leave the markets. This means there will be less competition in these 20 states, resulting in higher prices for consumers in many cases.

In New York, Empire BlueCross BlueShield said it will drop in the spring of 2012 health insurance plans covering about 20,000 businesses in the state. Mark Wagar, president and CEO of Empire, said that the company will eliminate seven of the 13 group plans it currently offers to businesses which have two to 50 employees. The move is expected to have a great and potentially “catastrophic” impact on small businesses in New York, according to James L. Newhouse, president of Newhouse Financial and Insurance Brokers in Rye Brook, NY. 5 This loss of competition inevitably will lead to higher prices and fewer choices for businesses and their employees.

In Colorado, World Insurance Company/American Republic Insurance Company announced in October 2011 that it is leaving the individual market, citing the company’s inability to comply with insurance regulations.6

In Indiana, nearly 10 percent of the state’s health insurance carriers have withdrawn from the market because they are unable to comply with the federal medical loss ratio requirement. Indiana was hoping to bring the companies back by asking the Department of Health and Human Services (HHS) for a waiver from the rule, but Washington refused in late November 2011 to grant the waiver. “Once again, the Obama administration took a position in favor of higher health care costs and against personal freedom,” said Indiana Governor Mitch Daniels after receiving the letter notifying him of Washington’s decision. “Today’s letter is further proof that the PPACA is a catastrophe for America and must be repealed.”7 The MLR rules are particularly difficult to meet for plans such as Health Savings Accounts which offer high-deductible coverage, and Indiana has a particularly high concentration of the popular cost-saving plans. Indiana had proposed an alternative approach to phase in the MLR triggers, but it was denied by HHS.

 

These are the latest in a series of announcements that health insurers are leaving the market as a result of ObamaCare’s edicts. But there are many more.

 

The exodus continues

Citizens in states around the country have learned that carriers are leaving markets, largely as a consequence of the combined effect of the health law and state regulations that make it particularly difficult to offer coverage in the small group market.

Principal Financial Group, based in Iowa, announced in 2010 that it would stop selling health insurance, impacting 840,000 people who receive their insurance through employers served by the company. The company assessed its ability to compete in the new environment created by PPACA and concluded its best course was to stop selling health insurance policies.8

Another 42,000 employees of small and midsize employers learned in January 2011 they were losing their health coverage with Guardian Life Insurance Co.of America. The company announced it was leaving the group medical insurance market (it had reached an agreement

with UnitedHealthcare to renew coverage for Guardian clients).9 Guardian began withdrawing from the medical insurance market in specific states more than a decade ago, and says it would be leaving the market with or without PPACA.

Cigna announced that it is no longer offering health insurance coverage to small businesses in 16 states and the District of Columbia: California, Connecticut, Florida, Georgia, Hawaii, Illinois, Kansas, Missouri, New Hampshire, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Texas, Virginia, and Washington, D.C.10

In Colorado, Aetna will stop selling new health insurance to small groups in the state and is moving existing clients off its plans this year, affecting 1,200 companies and 5,200 employees and their dependents. 11 Aetna also has pulled out of Colorado’s individual market because of concerns about its ability to compete there, dropping 22,000 members.12 Aetna also has dropped out of the small-group market in Michigan and several other states.

 

Since June of 2010, 13 plans have left the health insurance market in Iowa, citing regulatory concerns.13

 

In New Mexico, four insurers — National Health Insurance, Aetna, John Alden, and Principle — are no longer offering insurance to individuals or to small businesses — drying up the market and driving out competition.14

 

In Utah, Humana is ending its participation in the Utah Health Exchange, leaving only three carriers participating in the exchange.15

 

In Virginia, UniCare has eliminated its individual market coverage for about 3,000 policyholders.16 And shortly after the health law was enacted in 2010, a new Virginia-based company, nHealth, announced it was closing its doors, saying that the regulatory burdens posed by the health law made it impossible to gain investor support to continue operating.17

 

These announcements that carriers are exiting markets accelerates a trend that the American Medical Association says leaves four out of five metropolitan areas in the United States without a competitive health insurance market.18 The report found that in about half of the metropolitan markets, at least one health insurer had a commercial market share of 50 percent or more. In 24 states, the two largest health insurers had a combined commercial market share of 70 percent or more.

 

This is a negative and destructive trend, leaving fewer carriers to serve these markets and giving small businesses and the insurance agents who serve them less leverage to negotiate better benefits and lower rates among competing companies.

 

Children-only policies

One of the provisions of the health law that the Obama administration touts most enthusiastically is the requirement that employers who offer dependent coverage allow employees to add their 26 year old “children” to their policies. It is highly ironic, then, that another provision is causing huge losses of coverage among children whose parents or guardians were buying health insurance policies for them on their own.

 

One of the earliest indications of lost coverage came in June 2010 when Health and Human Services Secretary Kathleen Sebelius told health insurers that they must write policies for children under 19, including those with pre-existing conditions, no matter when their parents and guardians apply. This creates an incentive for parents to wait to buy the coverage until the children have a significant medical condition. This in turn creates a substantial risk of “adverse selection,” which makes it financially unsustainable for health plans to continue to offer these policies. Rather than wait for this to happen, many carriers have decided to leave this market altogether.

 

Sen. Michael Enzi, ranking Republican on the Health, Education, Labor, and Pensions Committee, asked his staff to survey the states to find out how many were offering child-only policies.19 Of the 50 states that responded to the HELP Committee survey, 17 states said there are no carriers currently selling these plans to new enrollees. One of the largest insurance markets in the country, Texas, has seen all of its carriers drop child-only health insurance. Other states that no longer have carriers selling child-only plans include Alaska, Arizona, Connecticut, Delaware, Florida, Georgia, Idaho, Minnesota, Nebraska, Nevada, North Dakota, Oklahoma, South Carolina, Tennessee, West Virginia, and Wyoming. The HELP Committee updated its survey of the child-only market and released a paper in August 2011 with a detailed summary of the states impacted.20

Grandfathering rules

Other factors are contributing to disruptions of coverage, including regulations to implement PPACA. The Obama administration’s own estimates show that seven out of 10 Americans with employer-based coverage could lose the health plans they have now as a result of the law and will not be able to keep the promised “grandfathered” status. This was the commitment to employers that if they offered coverage now, it would be “grandfathered in” and they could avoid most of the new coverage rules in the health overhaul law. While most companies initially hoped they would be able to preserve much of their existing group health plans under the new grandfather provisions, a survey by Aon Hewitt Consulting found almost will not.21 The rules developed by the Obama administration to define what grandfathered status entails were so onerous that few companies will be able to comply.

 

The Obama administration expects that by 2013, between one-third and two-thirds of the 133 million people with coverage through large employers will lose their grandfathered status. Up to 80 percent of the 43 million people in small employer plans will lose their grandfathered protection. Up to 70 percent of those with coverage in the individual market would be forced to comply with expensive new federal rules within a year. 22 Few of them are likely to lose coverage in the short term, but most will lose the coverage they have now.

 

The grandfathering rules back employers into a corner. They cannot make changes, other than minor modifications, to their health plans to keep costs down without being forced to comply with expensive PPACA regulations that increase their health costs.

 

ObamaCare regulations cause havoc in the insurance market

Another provision in the health overhaul law, the “minimum medical loss ratio” (MLR) requirement, mandates that health insurance carriers spend most of the money they collect from premiums on direct medical care. The MLR is another contributor to lost coverage.

 

Sec. Sebelius refused to listen to the carriers when they asked her to use her authorized discretion to delay for at least a year the MLR requirement. The MLR rules require insurance companies to spend at least 80 percent of premiums received in the individual and small-group markets and 85 percent in the large-group market on medical claims. These rules are designed to limit supposedly wasteful spending on administration and profits. But insurers are hardly careless with premium dollars. According to Fortune magazine, health insurance is among the least profitable industry sector in America. Kaiser Health News concludes, “With the nation’s health care spending estimated at $2.5 trillion this year, even the elimination of insurers’ profits and executive compensation would lower health care spending by just 0.5 percent.”23

 

Many states have applied to Washington to give them flexibility because they say it’s impossible for some carriers to comply with the MLR rule. Thirteen states that have applied to the federal government for temporary “adjustments” in MLR rules have been granted waivers. But the Obama administration has turned down requests from Indiana, Louisiana, North Dakota, and Delaware that they be granted waivers from the health law’s strict directives.

 

The stakes are high. Beginning this year, insurance plans must provide rebates to plan enrollees if they can’t meet the standards. Overall, Aetna warns it may hemorrhage up to $100 million thanks to MLRs this year.24 Many others face the same predicament.

 

Companies that sell policies to individuals have higher marketing costs and higher customer service expenses, and it is especially difficult for them to meet the MLR tests because their administrative costs are necessarily higher. In addition, high-deductible policies provide customers protection against large medical expenses, but carriers may not pay out the required percentage of premiums every year in medical claims, making it very difficult for them to meet the MLR test. Many health insurance companies have slashed the number of employees, cut agent commissions, and taken other harsh steps to reduce overhead, but this is also slashing customer services.

Indiana argued that some carriers would be forced to stop selling policies in the state if they were not given relief from the rules. This would lead to less competition and higher prices for consumers. Indiana asked HHS to lower the threshold MLR percentage companies would have to meet, provide a permanent waiver for high-deductible plans, and provide a waiver for new entrants into the individual market until 2014. Louisiana asked HHS to lower the MLR percentages to 70 percent for 2011 and 75 percent for 2012.

 

Health and Human Services officials said in letters on November 27, 2011, to the insurance commissioners in Indiana and Louisiana that the government is denying their requests.25

 

In addition, North Dakota warned that if the government denied its request for a waiver that “consumers would be left without coverage” and many would have trouble finding new coverage, especially if they have a health condition. Washington denied its request as well.

 

This Washington-knows-best attitude that is guiding the creation of more than 10,000 pages of rules and regulations to implement the health law will continue to cause a cascade of lost coverage because it is ignoring market forces in favor of Washington rule-making.

 

ObamaCare spending cuts threaten Medicare Advantage

While seniors are guaranteed coverage in Medicare, early changes impacting Medicare Advantage (MA) plans already are leaving some seniors with few choices of health plans.

 

For example, about 7,600 seniors in several counties in New Hampshire received notice in November 2011 that their Medicare Advantage coverage is being discontinued. New Hampshire has one of the highest percentages of Medicare Advantage enrollees in New England.

 

“The private fee-for-service plans are going away and we’re left with one HMO in Rockingham, Carroll, and Hillsborough Counties,” said Michelle Magarian, Medicare coordinator for Hillsborough County ServiceLink, as quoted in an article in the Union Leader.26

 

A Government Accountability Office (GAO) report found that the number of MA plans offered through April of 2011 had declined from 2,307 to 1,964.27 Most of the drop reflected a decline in private fee-for-service plans.

 

Nonetheless, the Obama administration touted the report and said that enrollment in the popular Medicare Advantage program had continued to increase, reaching nearly 12 million by April 2011. That means that more than one-fourth of seniors have voluntarily decided to enroll in private health plans through Medicare Advantage.

 

The administration says that the Government Accountability Office study shows the health law had little or no effect on Medicare Advantage enrollment in the first year after enactment of ObamaCare. But less than one percent of the health law’s cuts to MA actually went into effect in 2011, according to the Congressional Budget Office.28

 

The health law mandates that $136 billion be taken out of the program over the decade to help pay for new health insurance subsidies. In an effort to delay the loss of Medicare Advantage coverage that will result from PPACA cuts, HHS notified carriers in its annual “call letter” earlier this year of the surprising news that per-capita Medicare Advantage payments will increase by 1.6 percent for 2012. The temporary reprieve from the mandated cuts in Medicare Advantage spending will surely mean much deeper cuts — and coverage dislocations — to come.

 

The Associated Press previously reported that the MA estimates for 2012 are likely to be skewed due to bonuses paid out from a temporary, multi-billion dollar demonstration/waiver program — one that even Democrats admitted was implemented because Medicare “could not tolerate dislocation, given the political climate.”29

The Congressional Budget Office has predicted that the cuts mandated in PPACA would decrease enrollment by about 35 percent through 2019.30 The Office of the Actuary at the Centers for Medicare and Medicaid Services has found that the reduction in MA payments would eventually lead to those plans offering “less generous benefits packages” for seniors and that the coverage will cost them more. They estimate that seniors’ costs will go up by as much as $923 by 2017.31 Another report also demonstrated how MA enrollment will decrease.32 The study found that Medicare Advantage enrollment will be cut in half by 2017 as a result of cuts mandated in the health overhaul law, and that the choices of health plans will be reduced by two-thirds, with an average of almost 18 fewer MA plans being offered in each county.

 

Obama administration actuaries have predicted that the health law will force 7.4 million seniors to lose or be denied access to a Medicare Advantage plan. As described earlier, HHS Secretary Kathleen Sebelius has tried to push off this inevitable loss of coverage with a temporary boost in payments to the plans, but this only means bigger cuts to come in subsequent years.

 

A new study by the American Action Forum found that PPACA “will dramatically reduce the number and variety of healthcare plan choices available to seniors and reduce benefits and enrollment.”33 The study found that nearly all seniors in Medicare Advantage plans will find that the plan they have chosen is either no longer available or will have reduced benefits, higher out-of-pocket costs, or both within five years. By 2017, nearly 15 million seniors “will either lose their access to MA plans entirely or drop out due to reduced benefits. And, by 2017, the average person who was enrolled prior to PPACA would lose $3,700 in health care services per year,” the authors found. “When the new formula is fully phased in, there will be 66 percent fewer choices available in each county in the U.S. on average, with at least 152 U.S. counties losing all access to MA plans.”

 

 

Conclusion

Long before the law fully takes effect, PPACA is harming workers, employers, and seniors as they face fewer choices for health insurance.

 

Clearly, millions of people are having their coverage disrupted, violating the promise that President Obama — and virtually all of those in Congress who voted for the law — made to the American people. As the cascade continues, support will grow for an alternative approach to PPACA.

 

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on free-market ideas for health reform. The views expressed in this paper are hers and do not necessarily reflect the views of the Galen Institute or its directors. She can be reached at P.O. Box 320010, Alexandria, VA, 22320 or galen@galen.org. This paper updates an earlier Galen Institute paper on this topic, “Negative Consequences of Health Law Force Health Insurers to Withdraw from Markets Across the Country.”34

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A Single Federal Health Exchange – the ONLY way it will work

I been saying this since its inception – individual state exchanges are a waste of time and money – only a federally funded & maintained data ware house will ever work.

The Health Insurance Exchange under Obamacare is not 50 “state” exchanges and one federal exchange to be imposed on recalcitrant states. Instead, this is a National Exchange with 50 State portals (websites) and one Federal portal into the National Exchange. All exchanges (portals) must comply with the Obamacare law and regulations. The first set of regulations uses the word “require” 811 times. The National Exchange is an IT infrastructure that includes data sharing with at least five federal agencies, money transfers (subsidies/premiums), and federal monitoring, enforcement and regulatory controls. A National Exchange was supported by President Obama and had been explicit in the U.S. House’s version of the legislation.
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17 Fact about Medicare

  1. Medicare is essentially compulsory. People who refuse to join Medicare Part A are not allowed to receive their earned Social Security benefits. Brian Hall, et al. v. Kathleen Sebelius, et al, was filed October 9, 2008 and appealed in July 2011. On June 30, 2011, U.S. Sen. Jim DeMint and 12 GOP colleagues introduced the Retirement Freedom Act to decouple Medicare from Social Security.
  2. Medicare patients cannot pay cash for care. A 1997 law (Balanced Budget Act, section 4507) forbids private contracts between patients and doctors. With few exceptions, Medicare recipients cannot pay cash for a Medicare-covered service that Medicare denies until the doctor has opted out of Medicare. Most physicians cannot afford to opt out, so the law essentially prohibits private contracting between elderly patients and their doctors. Obamacare cut $500 billion from Medicare and enacted two administrative panels that are expected to advance rationing: the Independent Payment Advisory Board (IPAB) and the Patient-Centered Outcomes Research Institute (PCORI).
  3. Initial refusal to enroll in Medicare Part B leads to costly penalties. Seniors are automatically enrolled in Medicare Part B. Those who refuse and later change their minds will pay a premium for the rest of their lives that is 10 percent higher for EACH year they were not enrolled.
  4. Citizens do not have a right to their Medicare contributions (payroll taxes). There is no binding contract between the government and citizens for future payment of Medicare benefits. Congress can alter or eliminate Medicare benefits at their discretion.
  5. Medicare comes in four parts. Medicare Part A (hospitalization insurance) is funded through payroll taxes. Obamacare increased the payroll tax for individuals earning more than $200,000 and couples earning more than $250,000. In 2006, Medicare Part B (supplemental medical insurance for physician services, diagnostic tests, and other services) was funded approximately 76 percent by federal income taxes and 21 percent by Medicare recipients. Under Medicare Part C, the Medicare Advantage HMO managed care plan, insurers receive approximately $800 per month per Medicare enrollee. Medicare Part D allows senior citizens to receive subsidized drug coverage.
  6. Medicare dependency is growing. In 2003, there were 40 million Medicare recipients. In 2010, there were 47.5 million recipients. In 2011, the first of 77 million baby boomers began entering Medicare.
  7. Medicare faces insufficient funding. In 1965, 4.6 workers/taxpayers supported each Medicare recipient. In 2003, around 4 workers supported each recipient. In 2010, there were less than three workers per retiree. In 2030, only 2.3 workers/taxpayer are estimated per Medicare recipient. Medicare is expected to grow from 3.6% to 6.2% of GDP.
  8. Medicare is heading toward bankruptcy. According to the Medicare Trustees 2011 report, Medicare will be insolvent by 2024-five years earlier than estimated in 2010. Each new Medicare beneficiary is expected to cost $7,700 per year and “the total cost of the program to expand to $929 billion in 2010-an 80% increase over 10 years.” (American Health Line blog, 12/30/2010)
  9. Medicare is not health insurance. Medicare does not pay for hospitalization longer than 150 days, and there is no cap on out-of-pocket expenses. “Medigap” insurance is often purchased to protect against huge medical bills not covered by Medicare.
  10. Medicare does not cover the cost of long-term care and nursing home care – unless it is related to a hospitalization or other urgent medical care.
  11. Medicare pays only about half of all health care costs of seniors. In 1997, 39,840 seniors paid an average of $22,124, either in out of pocket costs or through supplemental insurance.
  12. Medicare frequently denies payment. In 2001, 3.7 million appeals were filed for denial of payment by Medicare Part B. Despite a 2000 law requiring swift processing of appeals, a 2003 report by the General Accounting Office found significant delays in appeals processing.
  13. Medicare has not significantly decreased out of pocket payments for seniors. In 2000, a study by the American Association of Retired Persons (AARP) found seniors paying an average of $2,510 per year-about 19 percent of their income-on out-of-pocket costs. This does not include home care or nursing home care. In 1964, a year before Medicare passed, seniors were paying 20 percent of their income on health care.
  14. Medicare wastes taxpayer money. Almost $107 billion in improper payments were paid between 1997 and 2003. In 2002, $13.3 billion was lost to improper payment. In 2010, $47.9 billion was improperly paid (HealthLeaders, 7/29/11). CCHF calculates the 2010 loss at $131 million per day.
  15. Doctors, hospitals and others who accept Medicare patients are at enormous risk. There are over 130,000 pages of Medicare regulations that must be meticulously followed. In 1996, Congress made health care fraud a federal crime-a felony. Even minor billing errors can be considered fraud and extrapolated across the practice. Obamacare increased fines per violation from $10,000 to $50,000.
  16. Medicare threatens patient privacy. The federal government requires home health agencies to regularly send private data on Medicare recipients. This is called the Outcomes Assessment Information System (OASIS). Obamacare requires extensive reporting by doctors and hospital on patient treatments and outcomes. And, doctors and hospitals that make inadvertent errors in billing can be forced to hand over the patient’s entire medical record for investigation of fraud.
  17. Medicare dollars used beyond patient care. Medicare dollars fund medical education, and a research institute (PCORI) created under Obamacare, leaving fewer dollars for treating the tsunami of Medicare recipients. In 2008, Medicare paid $9.0 billion to train doctors.

Information taken liberally from Medicare’s Midlife Crisis (Sue Blevins, Institute for Health Freedom, published by Cato Institute); GAO REPORT: “Medicare Appeals: Disparity between Requirements and Responsible Agencies’ Capabilities” (September 2003); The Medicare Program as a Capstone to the Great Society-Recent Revelations in the LBJ White House Tapes (Larry DeWitt, May 2003); Kaiser Family Foundation documents; testimony to Congress (House Budget Committee) from the Office of Inspector General (July 9, 2003); Americans for Tax Reform; the 2010 Affordable Care Act; “Economic Report of the President” (St. Louis Federal Reserve, 2007), and other sources.

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Obama Care Requires Your Employer to Report you to The Government!

Health Insurance Exchanges:
National Registration of Individual and Employer
Compliance with Insurance Mandate
Legal Requirements Under the Affordable Care Act (ACA)
Title I, Subtitle C:
PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION
THROUGH HEALTH BENEFIT EXCHANGES
SEC. 1311. AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS.
(a) ASSISTANCE TO STATES TO ESTABLISH AMERICAN HEALTH BENEFIT
EXCHANGES.—
[…]
(4) FUNCTIONS.—An Exchange shall, at a minimum—
[…]
(I) transfer to the Secretary of the Treasury—
(i) a list of the individuals who are issued a certification under subparagraph (H), including the name and
taxpayer identification number of each individual;
(ii) the name and taxpayer identification number of each individual who was an employee of an
employer but who was determined to be eligible for the premium tax credit under section 36B of the
Internal Revenue Code of 1986 because— (I) the employer did not provide minimum essential coverage; or
(II) the employer provided such minimum essential coverage but it was determined under section
36B(c)(2)(C) of such Code to either be unaffordable to the employee or not provide the required minimum
actuarial value; and
(iii) the name and taxpayer identification number of each individual who notifies the Exchange under
section 1411(b)(4) that they have changed employers and of each individual who ceases coverage under a
qualified health plan during a plan year (and the effec- tive date of such cessation); (J) provide to each
employer the name of each employee of the employer described in subparagraph (I)(ii) who ceases
coverage under a qualified health plan during a plan year (and the effective date of such cessation)
Title I, Subtitle E, Part I, Subpart A:
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND
COST-SHARING REDUCTIONS.
(a) IN GENERAL.—The Secretary, in consultation with the Secretary of the Treasury, shall establish a
program under which—
(1) upon request of an Exchange, advance determinations are made under section 1411 with respect to the
income eligibility of individuals enrolling in a qualified health plan in the individual market through the
2
Exchange for the premium tax credit allowable under section 36B of the Internal Revenue Code of 1986
and the cost-sharing reductions under section 1402;
(2) the Secretary notifies— (A) the Exchange and the Secretary of the Treasury of the advance
determinations; and (B) the Secretary of the Treasury of the name and employer identification number
of each employer with respect to whom 1 or more employee of the employer were determined to be
eligible for the premium tax credit under section 36B of the Internal Revenue Code of 1986 and the costsharing
reductions under section 1402 because—
(i) the employer did not provide minimum essential coverage; or
(ii) the employer provided such minimum essential coverage but it was determined under section
36B(c)(2)(C) of such Code to either be unaffordable to the employee or not provide the required minimum
actuarial value; and
(3) the Secretary of the Treasury makes advance payments of such credit or reductions to the issuers of the
qualified health plans in order to reduce the premiums payable by individuals eligible for such credit.
Title I, Subtitle F, Part I:
SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—Part III of subchapter A of chapter 61 of the Internal Revenue Code of 1986 is
amended by inserting after subpart C the following new subpart:
‘‘Subpart D—Information Regarding Health Insurance Coverage
‘‘Sec. 6055. Reporting of health insurance coverage.
‘SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.
‘‘(a) IN GENERAL.—Every person who provides minimum essential coverage to an individual during a
calendar year shall, at such time as the Secretary may prescribe, make a return described in subsection (b).
‘‘(b) FORM AND MANNER OF RETURN.—
‘‘(1) IN GENERAL.—A return is described in this subsection if such return—
(A) is in such form as the Secretary may prescribe,
‘‘(B) contains— ‘‘(i) the name, address and TIN [taxpayer identification number] of the primary insured
and the name and TIN of each other individual obtaining coverage under the policy,
‘‘(ii) the dates during which such individual was covered under minimum essential coverage during the
calendar year,
‘‘(iii) in the case of minimum essential coverage which consists of health insurance coverage, informa- tion
concerning—
‘‘(I) whether or not the coverage is a qualified health plan offered through an Exchange estab- lished under
section 1311 of the Patient Protection and Affordable Care Act, and
‘‘(II) in the case of a qualified health plan, the amount (if any) of any advance payment under section 1412
of the Patient Protection and Afford- able Care Act of any cost-sharing reduction under section 1402 of
such Act or of any premium tax credit under section 36B with respect to such cov- erage, and ‘‘(iv) such
other information as the Secretary may require. ‘
‘(2) INFORMATION RELATING TO EMPLOYER-PROVIDED COVERAGE.—If minimum essential
coverage provided to an indi- vidual under subsection (a) consists of health insurance cov- erage of a health
insurance issuer provided through a group health plan of an employer, a return described in this subsection
shall include—
‘‘(A) the name, address, and employer identification number of the employer maintaining the plan,
‘‘(B) the portion of the premium (if any) required to be paid by the employer, and
‘‘(C) if the health insurance coverage is a qualified health plan in the small group market offered through
an Exchange, such other information as the Secretary may require for administration of the credit under
section 45R (relating to credit for employee health insurance expenses of small employers).
3
Title I, Subtitle F, Part II:
SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—Subpart D of part III of subchapter A of chapter 61 of the Internal Revenue Code of
1986, as added by section 1502, is amended by inserting after section 6055 the following new section:
‘‘SEC. 6056. CERTAIN EMPLOYERS REQUIRED TO REPORT ON HEALTH INSURANCE
COVERAGE.
‘‘(a) IN GENERAL.— Every applicable large employer required to meet the requirements of section
4980H with respect to its full-time employees during a calendar year and every offering employer shall, at
such time as the Secretary may prescribe, make a return described in subsection (b).
‘‘(b) FORM AND MANNER OF RETURN.—A return is described in this subsection if such return—
‘‘(1) is in such form as the Secretary may prescribe, and
‘‘(2) contains—
‘‘(A) the name, date, and employer identification number of the employer,
‘‘(B) a certification as to whether the 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)),
‘‘(C) if the employer certifies that the employer did offer to its full-time employees (and their dependents)
the opportunity to so enroll—
‘‘(i) in the case of an applicable large employer, the length of any waiting period (as defined in section
2701(b)(4) of the Public Health Service Act) with respect to such coverage,
‘‘(ii) the months during the calendar year for which coverage under the plan was available,
‘‘(iii) the monthly premium for the lowest cost option in each of the enrollment categories under the plan,
‘‘(iv) the employer’s share of the total allowed costs of benefits provided under the plan, and
‘‘(v) in the case of an offering employer, the option for which the employer pays the largest portion of the
cost of the plan and the portion of the cost paid by the employer in each of the enrollment categories under
such option,
‘‘(D) the number of full-time employees for each month during the calendar year,
‘‘(E) the name, address, and TIN of each full-time employee during the calendar year and the months (if
any) during which such employee (and any dependents) were covered under any such health benefits
plans, and
‘‘(F) such other information as the Secretary may require.
The Secretary shall have the authority to review the accuracy of the information provided under this
subsection, including the applicable large employer’s share under paragraph (2)(C)(iv).

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The falacy of the Medical Crisis

You hear it all the time – “we are in a medical crisis – costs are our of control!”, we need more money, we need better health – its going to explode now!!!!!!!!!

Realty check:
There is no crisis – its all made up.

All this information is public knowledge – search for it and read it – medicare/medicaid – government programs (go figure why they are in trouble) simply pay to much.

Our government pays companies based upon contracts a certain amount per “member” aka patient per month for care – this is in the tune of $1500 – $2000 per month – NO MATTER WHAT THE CARE.

These organizations receiving this money, then pay the doctors at most $90 per member (patient per month) the rest – is profit for the company.

It never trickles down to the doctor.

Hence the ACO thought process – give more back to the doctor

In a nutshell:
Our government is overpaying companies – then declaring we are in a crisis because of over payments.

Medicare wastes taxpayer money. Almost $107 billion in improper payments were paid between 1997 and 2003. In 2002, $13.3 billion was lost to improper payment. In 2010, $47.9 billion was improperly paid (HealthLeaders, 7/29/11). CCHF calculates the 2010 loss at $131 million per day.