HHS Requests Comments on the National Health Care Quality Strategy & Plan

The Department of Health and Human Services (HHS) is seeking public input in the development of a National Health Care Quality Strategy & Plan. The Patient Protection & Affordable Care Act (the Affordable Care Act) calls on HHS to establish a National Quality Strategy, including a comprehensive strategic plan and the identification of priorities to improve the delivery of health care services, patient health outcomes, and population health.


To provide feedback, HHS's requests that you provide comments on the webpage (link below). Alternatively, you may submit comments electronically to national_quality_strategy@hhs.gov . Written comments may also be submitted and should be addressed to the Agency for Healthcare Research and Quality, Attention: Nancy Wilson - Room 3216, 540 Gaither Road, Rockville, MD 20850 or faxed to the Agency for Healthcare Research and Quality, Attention: Nancy Wilson at (301) 427-1210.

All comments should be received no later than 5 p.m. on October 15, 2010.

Read the complete HHS report at: http://www.hhs.gov/news/reports/quality/nhcqsap.html .

Insurance Fraud Mushrooms

As was predicted here in April, insurance fraud is now mushrooming, with new schemes popping up to scam the American consumer in 24 states. Section 1322 of the Patient Protection and Affordable Care Act mandated that states create co-ops. Under this legislation, private insurers or related entities in existence before July 16, 2009, cannot qualify as health insurance issuers in co-ops. The co-op provision in HR 3590 necessitates that a number of new nonprofit companies will pop up and apply for startup loans and grants from the federal government.

Who exactly will these new nonprofits be? After paying their premium dollars, will customers get the services they expect? Apparently not, according to a Reuters article published on Tuesday:

“The Federal Trade Commission said on Wednesday it is working with 24 states to crack down on sellers of medical discount plans that market them as health insurance that covers doctors, hospitals and other services. Such scams have increased in the wake of the health care reform law…, said David Vladeck, director of the FTC's Bureau of Consumer Protection…"The uncertainty about the benefits that will be available under the new federal insurance program and the fact that the budget doesn't kick in until 2014 is going to give scammers very fertile ground for this," Vladeck told reporters in a conference call. "They're going to try to capitalize on uncertainty."


…"Health discount plans are not insurance. They don't pay your medical bills," said Minnesota Attorney General Lori Swanson, who has filed three lawsuits. She added that continued job losses are fueling the scams since most Americans who have insurance get it through their employer. The companies targeted by the FTC and states are mostly privately owned. They include Health Care One, Consumer Health Benefits Association, and United States Benefits. So far, 54 lawsuits and other civil enforcement actions have been taken by the FTC and the states, officials said. New York's insurance superintendent, James Wrynn, said some of the discount plans do offer some limited payments for some healthcare expenses such as medical tests or short hospital stays, "but when you find out the extent of the coverage, there is for all intents and purposes, no coverage."

Expect even more fraud in the next few years. Given the state budget deficits most states are facing and ever deepening economic recession/depression, there will be even less resources available to combat it in the future.

As always - let the buyer beware!

House Passes Sentate Health Bill

Last evening the House passed the Senate's health bill, H.R. 3590, the Patient Protection and Affordable Care Act. Over 38 states are now stating they are in process and will file suit regarding the procedures and processes, as well as substance and constitutionality issues once the bill is signed into law. This law, along with H.R. 4872, the Health Care and Education Affordability Reconciliation Act which follows, will greatly expand Medicaid. Unlike Medicare, Medicaid requires states to chip in a percentage of the costs as well as administer the program. As mentioned in the January 4th posting, 43 states are facing financial deficits. Not every state was fortunate enough to get the nearly $600 million each in supplemental Medicaid deals to which Vermont and Massachusetts were privy, let alone the cornhusker kickback that Nebraska did which covered the state's required Medicaid contributions in perpetuity. (This provision for Nebraska will supposedly be eliminated in the yet to be passed by the Senate reconciliation bill.)

Last Thursday, Arizona's new budget signed by the governor dropped coverage for childless adults and the child health insurance program (CHIP) instate, leaving 357,000 Arizonans without coverage. The governor stated the "budget is a vivid reflection of how the fiscal crisis affecting state governments is cutting deeply into healthcare."

Politicians may choose to ignore the will of the people and pass legislation, but ultimately someone must pay for it. Given the present economic crisis, tax revenues are falling for both state and federal governments. It seems Washington has forgotten the fiscal realities of those outside of the Beltway. If the checks and balances built into our Constitution do not cause this legislation to be rethought, the financial realities will.

CBO Report Released Today on Cost of ObamaCare is Incomplete

The CBO Report is out on ObamaCare [H.R. 4872, the Reconciliation Act of 2010 combined with H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as passed by the Senate], stating that it will cost $940 billion over 10 years. Whether this forecast is realistic is for another day’s discussion. Never mind that it uses 10 years of premiums to pay for 6 years of claims.

What is not included is “the doctor fix” for Medicare, which is estimated to be $247 billion. This means that the present health bill is NOT budget neutral, but ADDS to the deficit.

Last evening on Special Report, Bret Baier interviewed the President [transcript]:

“BAIER: And you call this deficit neutral, but you also set aside the doctor fix, more than $200 billion. People look at this and say, how can it be deficit neutral?

OBAMA: But the — as you well know, the doctors problem, as you mentioned, the "doctors fix," is one that has been there for years now. That wasn't of our making, and that has nothing to do with my health care bill. If I was not proposing a health care bill, right — let's assume that I had never proposed health care.

BAIER: But you wanted to change Washington, Mr. President. And now you're doing it the same way.

OBAMA: Bret, let me finish my — my answers here. Now, if suddenly, you've got, over the last decade, a problem that's been built up. And the suggestion is somehow that, because that's not fixed within this bill, that that's a reason to vote against the bill, that doesn't make any sense. That's a problem that I inherited. That was a problem that should have been solved a long time ago. It's a problem that needs to be solved, but it's not created by my bill. And I don't think you would dispute that.”

This bill was to be a comprehensive bill. We were told it could not be done piecemeal. We had to have one bill. Suddenly, paying doctors for their services is somehow irrelevant to providing care for our elderly citizens.

Ignoring the facts, failing address the real access to care issues and failing to add up ALL the costs of in one bill because it isn’t convenient seems more than a little disingenuous, doesn’t it?

Senator Reid makes the Doctors Pay for Medicare under Senate Bill 3590

The politicians are claiming that Senator Reid's bill will save the country money according to the latest CBO report. Physicians were scheduled to have a 21% pay cut caring for Medicare patients as of January 1, 2010. However, under Section 3101, this bill provides for .5% increase for physicians in 2010 but assumes no further increases or change to the Medicare Sustainable Growth Rate formula which is used to compute physician payment rates. It is known to be a flawed formula requiring an act of Congress to "fix" each year. Politicians have always provided some nominal increase in physician payments, even if it has not kept pace with inflation. According to the Alliance of Specialty Medicine, "If the SGR formula is not fixed, physicians will receive negative updates of approximately five percent each year from 2006 until 2013 and rates will not return to their 2002 level until well after 2013. In other words, physicians will receive less reimbursement in 2013 than they did in 2002 for the exact same procedure, regardless of inflation and increases in practice costs." This unrealistically assumes doctors will bear the cost burden for the Medicare population. More likely physicians will have to stop Medicare participation (stop caring for Medicare patients) under these conditions. It seems disingenuous to claim "savings," when not all the costs have been realistically accounted for in this bill. This bill will surely go over the CBO estimates if real world historical political behavior of annual "fixes" are assumed as opposed to the static assumptions of the CBO.

On Sunday, under Cloak of Darkness, in the Wee Hours of the Night and in a Snow Storm, the Senate Voted on Health Reform

I am reminded of a phrase my grandmother used to say, “Fra dire e fare, ch’é un mare” - Between saying and doing there is an ocean in between. For all the talk about openness and transparency, it seems things could not be more the opposite given the government was shut down yesterday (Monday) due to the snow. Most all of what has been negotiated has been behind closed doors, with only the ruling party invited to participate. All the rhetoric about “If anyone out there has any good ideas, we want to hear them,” appears to be just hot air. Only one party actually got to bring any of their ideas to the floor for a vote. Despite the fact that Rasmussen has polled the public on healthcare reform and 57% do not want the government to do anything at this point, Congress seems determined to ignore the will of the people. Many have called their elected representatives to find no one answers the phone, email is answered by form letter that usually is not even relevant to what the person wrote. Local offices of elected officials are not taking calls from what my colleagues are reporting to me. Americans are frustrated because their voices are being flatly ignored.

It seems our elected officials do not realize healthcare is not like any other issue. People go back to work for healthcare coverage. The definition of a good job is that it has good benefits, especially health benefits. For most people this is a giant security blanket. They will take a lesser paying job in order to get coverage.

What is most disturbing is the fact that Congress fails to appreciate that the uninsured are not a static group of people. According to a 2004 CBO report, “About 30 percent of Americans under age 65 who become uninsured in a given year remain so for more than 12 months, while nearly half obtain coverage within four months.” Given that most are only transiently uninsured, one must ask. “What is the purpose of remaking 1/6 of the economy and financing it with high taxes to build a system that is not scheduled for implementation for four years, for people who will not likely need coverage by then?”

Politicians, beware passing any of the currently proposed healthcare bills. Failure to recognize that this unlike any other matter before Congress, will surely mean peril in next fall’s election and beyond.