May 1, 2013 Legislation



If anyone thought Obamacare would be self-sustaining they were wrong.  CQ reports that HHS will raid the prevention fund to pay to enroll people in exchanges.  This withdrawal was just the first of many.

The feds have announced the new rules on those providers that self report fraud violations.  The self reporters will probably only have to pay 1 1/2 times the amount involved as opposed to the non-self reporters who will need to pay up to treble damages and have a CiA.  

HHS OIG reports that Medicare could save $111 per year if they stopped paying drug companies prior to the companies paying their bills and the companies get to keep the float.  CMS disagrees since they believe this would lead to the pharmaceutical companies raising their prices.  

In the same vein, the Dems want Medicare to reduce the amount of money they pay the pharmaceutical companies for dual eligible patients.  Apparently they pay Medicare rates when they should be paying Medicaid rates.

Obamacare has a tax on the insurers to help fund the program.  The problem is this also includes the Medicaid private (HMO) companies that some states have for their Medicaid patients.  The states will have to pay this tax which will cost the states about $15 Billion over the next decade.  

Senator Tom Harkin, the Democrat from Iowa, blasted Sebelius in committee for raiding the preventative health fund for other uses.  Sebelius has illegally used this fund to pay for advertising of Obamacare and to set up the federal exchanges.  She attempted to spin the use of the funds for advertising by stating she was telling people about preventative measures.  A lie.  Even Obama has in his budget cut the slush fund.  Harkin has blocked the nomination of Tavenner until the White House backs off the raid.

Several days later Democratic Senators met at the White House to tell of their concerns regarding the rollout of Obamacare did not go well.  These Senators are up for re-election and will be roasted if Obamacare does not go as planned.

SURPRISE!!! The federal lawmakers want they and their aides to be exempt from Obamacare.  This is on both sides of the aisle. They don't like being put in the exchanges that they foisted on the rest of the country.  Senator Reid put the kabosh on the idea of not being in the exchanges.  There was then a bill introduced to make sure the President and the Cabinet were also in the exchanges.

Maryland's Blues, the primary state insurer, will raise rates for individuals 25% to get ready for Obamacare.  This may make exchanges too expensive to purchase. The raise for small group plans will be smaller and all insurers will follow suit.

The Commonwealth Fund has a survey that shows that more young adults are insured than before due to the ability to stay on the parent's plan until age 26.  However, the survey also showed that other adults of under 65 are less insured than in the past.  This is due to the rising costs of insurance and the high unemployment rate.

The sequester has started to hit the cancer patients.  Several major cancer centers are shifting the chemotherapy to the hospital instead of doing it in their offices due to the decrease in payments.  
They are losing more money on each patient both on the drugs and the infusions and can not make it up on volume.  This increases the costs to the healthcare system since it is much more expensive to do the infusions at the hospital.  Under Obama's budget, which has fortunately no chance of passage, the cuts would be even more draconian and all patients would go to the hospital with office chemo being a thing of the past.  We have already begun to see this in cardiology where the decrease in payments for testing to the office has started a boon for the hospital bottom line.  This also has increased government spending on healthcare.  Another in the long line of unintended circumstances.

Senator Barbara Boxer, the shill for the unions that helped get her  re-elected last go around, is now pushing for national nurse patient ratios.  This is the payback that she owes the nursing unions.  She tried this last year with failure and should get the same result this year.

As all know the states have the right to cover or not cover the expanded Medicaid patients.  However, even if they agree they may still have to pay part of the money if not enough physicians sign up to take a significant amount of Medicaid patients.  The physicians have to sign attestation cards to agree to the taking of the patients.  Can you see California physicians who just received a 10% pay cut to sign an agreement even though they will get a 2% increase for the primary care physician for a whole two years.

Stop the presses.  The VA has announced that they will start to process the oldest disability claims first.  What a concept!

The VA truly is becoming almost like a real agency.  They are going to not only do the above but also will raise the threshold for non service related long term care higher and tie it to the Medicaid threshold.

San Francisco  and LA are opening an investigation that a Nevada state psychiatric facility for the past five years has shipped by bus about 1500 indigent mentally ill patients to various locales throughout the country including San Francisco. 

CMS has entered the fray regarding the busing of patients from Nevada to other states.  They have given the state run Rawson-Neal Psychiatric Hospital 10 days to correct their problems.  

The LA Times reports that California is considering taking away all investigations from the Medical Board and giving it to the Attorney General.  This would leave the Medical Board with licensing.  Amazing, the Board agreed to the legislative requirements of coming down harder on over prescribing physicians but not on giving their treasured investigative powers to the Attorney General.

