How to Protect Yourself From Obamacare

[Townsend]

http://www.tulsaworld.com/opinion/article.aspx?subjectid=61&articleid=20120106_61_A16_Frsael421567

Babies excluded from new insurance program

For state leaders who supposedly are staunchly pro-family, they have a funny way of showing it.

You'd think they'd be all for helping parents do the proper and responsible thing and acquire health insurance for their newborn babies. But instead, they "offered up newborn babies as a bargaining chip," an advocacy group charges, in order to strike a deal with insurers.

State Insurance Commissioner John Doak, with the approval of Gov. Mary Fallin, recently drafted an emergency rule that allows insurers in the state to exclude babies under 1 year of age from child-only coverage - a measure that could force some parents and caregivers into relying on taxpayers, other ratepayers or charity for infant health care.

According to Doak's office, insurers for more than a year have refused to provide "child-only" coverage in Oklahoma for children ages 19 and under because of a new federal regulation requiring coverage for pre-existing conditions. Oklahoma was one of 17 states where carriers withdrew entirely from the child-only market. (Doak noted that newborn coverage is still available through family plans and through Medicaid for those who qualify, and that child-only coverage already in effect was not canceled.)

The exit of insurers from the child-only market in those 17 states meant that parents who couldn't access coverage on their own - say, through an employer or Medicaid - ended up with few, if any, options for obtaining health coverage for their children.

Doak contends that allowing insurers to exclude babies under 1 year of age was the only way they would agree to re-enter the child-only market in Oklahoma.

It's interesting, though, that insurers continued offering child-only coverage in the other 33 states. And in some of the 17 states where all insurers pulled out of the child-only market, state leaders managed to find ways to compel insurers to re-enter that market.

The institute, which advocates on behalf of disadvantaged Oklahomans, called the Insurance Department rule a "downright Faustian bargain with insurers" and questioned why the department "chose to accept such a radical demand from the industry."

There are two high-risk pools available in Oklahoma for babies whose families meet certain guidelines. But some affected by the new rule won't qualify for those programs. So as it stands now, there are caregivers in Oklahoma who have nowhere to turn for coverage for the state's youngest new residents.

So much for the GOP mantras about the importance of personal responsibility, the excesses of big government and the evils of government-sponsored health care. 

Read more from this Tulsa World article at http://www.tulsaworld.com/opinion/article.aspx?subjectid=61&articleid=20120106_61_A16_Frsael421567

[Hoss]

They also weren't being squeezed from all sides with ridiculously high student loan balances, ridiculously high insurance costs, ridiculously high costs in accepting insurance, ridiculously high costs for medical equipment, and ridiculously low payments from insurance companies.

The way I see it, doctors both make too much and too little. They, in aggregate, make more than is sustainable for our society, yet they often make less than they need.

Alot of the blame is on the insurance companies.  I am a huge advocate of standardizing forms, but the insurance companies won't do it, for whatever reasons.  The costs then either get shuffled to the doctor, or the doctor has to drop which insurance he accepts.  Either way, the doctor loses money.

[Teatownclown]

Alot of the blame is on the insurance companies.  I am a huge advocate of standardizing forms, but the insurance companies won't do it, for whatever reasons.  The costs then either get shuffled to the doctor, or the doctor has to drop which insurance he accepts.  Either way, the doctor loses money.

No. Not the private hospital docs....and those 5013c units hide their share in the medicare reimbursement/write off column.

Single payer may take a while but it's coming....SOCIALIST MEDICINE IS THE ONLY SOLUTION!

Nice to see Tulsa World get it right....

[Gaspar]

No. Not the private hospital docs....and those 5013c units hide their share in the medicare reimbursement/write off column.

Single payer may take a while but it's coming....SOCIALIST MEDICINE IS THE ONLY SOLUTION!

Nice to see Tulsa World get it right....

I'm sure that will work.  All we have to do is combine the efficiency of the Postal Service with the compassion of the I.R.S., and the cost accounting of the Pentagon.

. . .Wait?

[nathanm]

I note you left out Medicare. Good call, actually, since their MLR is far beyond what most of the private insurers can do. Also, I dare say any organization that can move as much crap as the Postal Service as fast as they do and with as little getting lost as does is pretty efficient. It's OK, though. I know every time you attempt to internalize the fact they make an operating profit (pension prepayments are painful, though!) every year you wake up in the woods naked having cold sweats. We all have our weaknesses.

[Teatownclown]

[heironymouspasparagus]

Careful!  Reality isn't popular around here....

Anyone got a kid 19 to 26 years old who is still on their insurance?

[Teatownclown]

U.S. to Force Drug Firms to Report Money Paid to Doctors

http://www.nytimes.com/2012/01/17/health/policy/us-to-tell-drug-makers-to-disclose-payments-to-doctors.html?_r=1&nl=afternoonupdate&emc=aua2

By ROBERT PEAR
Published: January 16, 2012

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Federal officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.

The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.

The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.

Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”

The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”

The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.

“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.

Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.

“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.

Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.

As an example of inappropriate payments, the inspector general of the Department of Health and Human Services cited a case in which manufacturers of medical devices had provided financial incentives — in the form of consulting agreements, lavish trips and other perks — to induce doctors to use particular hip and knee replacement products. Under a civil settlement with the government, the companies agreed to new compliance procedures.

The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.

The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.

[Conan71]

Kudos to the Obama Administration.  Now whether or not that reporting will have a meaningful impact remains to be seen.

Good job!

[nathanm]

The talking points will arrive soon. I believe one has to do with the heavy burden of paperwork and red tape like this driving up the cost of health care.

[Townsend]

Per the Tulsa World FB

“This state Senate will stop at nothing to stop Obamacare from coming the state of Oklahoma,” said Sen. Dan Newberry, R-Tulsa.

OKLAHOMA CITY - A Senate committee approved a proposal Monday that would establish a state health care exchange without complying with the federal Affordable Care Act...

[Teatownclown]

Per the Tulsa World FB

“This state Senate will stop at nothing to stop Obamacare from coming the state of Oklahoma,” said Sen. Dan Newberry, R-Tulsa.

So, these "patriots" will set up a State health care exchange but without a mandate? They plan to fight the Federal guidelines? Who is this Newdingleberry? I bet the private hospitals, their doctors, and big pharma make his pay.

What will happen next?

This is just going to bring us Single Payer sooner....

Go righties!

[Gaspar]

Not that it's important, but the CBO has just doubled the cost of Obamacare.
http://campaign2012.washingtonexaminer.com/blogs/beltway-confidential/cbo-obamacare-cost-176-trillion-over-10-yrs/425831

I told you that you can take any CBO estimate and simply double it to get a more realistic figure.

The report also shows that 4 million fewer people will be covered under employee insurance plans as a result of companies eliminating health insurance as part of the standard employee package.
http://cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf

[Conan71]

Cue CBO spooners in 3, 2, 1....

I miss RWarn, he loved to justify everything via the CBO crooked calculator.

[Gaspar]

Cue CBO spooners in 3, 2, 1....

I miss RWarn, he loved to justify everything via the CBO crooked calculator.

A CBO estimate is a lot like the estimate provided by a contractor.  About half way through the job, it's discovered that the project will cost more and take twice as long.

In both cases I simply double the cost.