Tag Archives: Health care

In Kansas, doctors may “learn” just by doing their jobs

A proposed bill in Kansas should make us question the rationale of continuing medical education requirements for physicians.

The bill is HB 2615, titled “Charitable healthcare providers; continuing education credits for gratuitous care of eligible patients.”

The bill’s supplemental note explains the bill “… would allow charitable healthcare providers and dentists to fulfill one hour of continuing education credit for performance of two hours of gratuitous service to medically indigent persons.”

In an op-ed published in the Wichita Eagle Representative Dan Hawkins explained “we believe that this system has the potential of generating more than $18 million in free care for the neediest Kansans.” (Rep. Dan Hawkins: Plan increases access to health care, reduces cost, March 7, 2016)

Contrary to Hawkins, the care won’t be free. It may not cost the state anything, but it will have a cost to the doctors who supply the “free” care.

Perhaps more importantly, this bill should make us question the purpose of continuing medical education requirements for physicians and dentists. In Kansas, physicians must participate in 50 hours of continuing medical education annually. This education requirement is satisfied by participating in “activity designed to maintain, develop, or increase the knowledge, skills, and professional performance of persons licensed to practice a branch of the healing arts.”

But HB 2615 will let physicians satisfy 20 hours of this requirement by providing 40 hours of health care to needy people. Having doctors perform routine medical care — doing their daily job, in other words — doesn’t seem likely to advance the “knowledge, skills, and professional performance” of doctors, which is the stated goal of the regulation.

We have, therefore, a regulation that seems reasonable — ensuring that doctors are up-to-date in professional knowledge — instead being used by the state to “encourage” doctors to provide free labor.

Episodes like this should be a lesson in the powers and abuses of the regulatory state.

The Kansas regulations

According to the Kansas Board of Healing Arts, physicians must participate in continuing medical education each year, earning “50 hours with a minimum of 20 hours of Category I and a maximum of 30 hours of Category II.”

In more detail, the regulations state the continuing education is “activity designed to maintain, develop, or increase the knowledge, skills, and professional performance of persons licensed to practice a branch of the healing arts.” 1 Category I continuing education is “presented by a person qualified by practical or academic experience” and may consist of lectures, panel discussions, workshops, seminars, symposiums, and other formal learning opportunities. 2 The requirements are 20 hours of this education annually.

Category II continuing education comprises activities that are less formal, such as “clinical consultations with other healing arts practitioners that contribute to a practitioner’s education, participation in activities to review the quality of patient care, instructing healing arts and other health care practitioners, patient-centered discussions with other health care practitioners, participating in journal clubs, using searchable electronic databases in connection with patient care activities. and
using self-instructional materials.” 3 The requirements are 30 hours of this education annually.

Of note, HB 2615 doesn’t seem to specify into which category will fall the hours of continuing medical education earned by providing service to needy patients.


Notes

  1. K.A.R. 100-15. (2016). Ksbha.org. Available at: http://www.ksbha.org/regulations/article15.shtml#kar100154.
  2. ibid.
  3. ibid.

Inspector General evaluates Obamacare website

The HHS Inspector General has released an evaluation of the Obamacare website HealthCare.gov, shedding light on the performance of former Kansas Governor Kathleen Sebelius.

The Office of Inspector General for the Department of Health and Human Services has released a report titled HealthCare.gov: Case Study of CMS Management of the Federal Marketplace. An excerpt from the executive summary holds the main points:

What We Found

The development of HealthCare.gov faced a high risk of failure, given the technical complexity required, the fixed deadline, and a high degree of uncertainty about mission, scope, and funding. Still, we found that HHS and CMS made many missteps throughout development and implementation that led to the poor launch. Most critical was the absence of clear leadership, which caused delays in decisionmaking, lack of clarity in project tasks, and the inability of CMS to recognize the magnitude of problems as the project deteriorated. Additional HHS and CMS missteps included devoting too much time to developing policy, which left too little time for developing the website; making poor technical decisions; and failing to properly manage its key website development contract. CMS’s organizational structure and culture also hampered progress, including poor coordination between policy and technical work, resistance to communicating and heeding warnings of “bad news,” and reluctance to alter plans in the face of problems. CMS continued on a failing path to developing HealthCare.gov despite signs of trouble, making rushed corrections shortly before the launch that proved insufficient. These structural, cultural, and tactical deficiencies were particularly problematic for HealthCare.gov given the significant challenges of implementing a new program involving multiple stakeholders and a large technology build.

The problems are not solved. Challenges remain, the report says, including “contract oversight, the accuracy of payments and eligibility determinations, and information security controls.”

Who is responsible for the debacle? In a hearing before Congress, HHS Secretary and former Kansas Governor Kathleen Sebelius said “hold me accountable.” View a video clip below, or click here to view at C-SPAN.

WichitaLiberty.TV: The Sedgwick County budget and more episodes of “Love Gov”

In this episode of WichitaLiberty.TV: As Sedgwick County proposes small spending cuts, those who benefit are vocal in their displeasure. Then, two more episodes from “Love Gov” covering health care and the housing market. View below, or click here to view at YouTube. Episode 91, broadcast August 9, 2015.

Medicaid found to increase, not decrease, emergency room usage

Those who continue to call for the expansion of Medicaid in Kansas should be aware of this astonishing finding, which contrary to what the conventional wisdom has told us about health care.

For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. “Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,” said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured.

Continue reading at New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare

Krugman on solutions to health care

Following are excerpts from New York Times columns by economist and Nobel Laureate Paul Krugman. You may tweet your reaction to him at @NYTimeskrugman.

Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.

No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate. (Health Care Confidential, January 27, 2006)

“You see, we actually have a real live case of impressive cost control in health care: the VA system.” (Medicare and the VA, May 27, 2009)

What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform.

Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.

What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years. (Vouchers for Veterans, November 13, 2011)

Medicaid expansion: The impact on the federal budget and deficit

From Kansas Policy Institute.

Medicaid Expansion: The Impact on the Federal Budget and Deficit

By Steve Anderson

Medicaid.gov Keeping America HealthyThe problem with the uninsured is not going to be solved by expanding Medicaid. Even amongst Medicaid’s staunchest proponents you’ll be hard pressed to find any who will claim it to be the equivalent of high quality private health insurance coverage. The number of federal senators and representatives that choose to exclude their staffers from Obamacare shows that many Washington politicians understand the quality of government insurance plans Medicaid and Obamacare represent. The simple fact is, that health insurance is not to be confused with health care.

Medicaid’s proponents can only claim anecdotal claims of improving health outcomes of recipients. Even in pre-ObamaCare Medicaid, beneficiaries largely do not access available preventable care services. In fact, a Harvard University study shows that emergency room visits actually increased by 40 percent for Medicaid recipients in Oregon after their expansion. Citizens would do well to remember, a “decrease in ER visits” was a key selling point of ObamaCare generally and Medicaid expansion specifically. ER visits are the most expensive form of care. When these increased visits are paid for by Medicaid, the taxpayers are picking up BOTH the state and federal portion of the high cost of emergency room visits. This flies in the face of the Obama Administration’s claim that Medicaid expansion would actually save money by limiting this sort of behavior.

It doesn’t stop there and this is the part that hardly anyone has mentioned, and what the Obama Administration would rather you not know — a staggering number of those enrolling in ObamaCare will actually be sent to Medicaid and not be in the private market. And by “private market” we mean one established and controlled by government.

The following charts are the pre-Medicaid expansion projection of revenues versus expenditures from the Congressional Budget Office. They were completed before the decision by 25 states and the District of Columbia to expand eligibility.i

The three lines with the steepest slopes and therefore the fastest growing expenditures are Medicaid, Unemployment payments (called Income Security) and Other Programs. The U.S. House of Representatives has addressed the unemployment expense growth by bringing the program back to its original intent – to provide a safety net between jobs. Other Programs will be largely controlled if current trends hold and extension of the various “stimulus” programs are curtailed. However, the one that is going to accelerate with expansion and is larger than the other two combined in total state and federal expenditures is Medicaid. At least 3.9 million of Obamacare participants are expected to be enrolled in Medicaid and 19 million nationwide overall will be added to Medicaid in the next year. A 35 percent increase in Medicaid participants.ii Picture these two charts with 35 percent greater additional costs for the Medicaid entitlement and you have an idea how problematic this is for the federal budget and deficit. Is it any wonder that President Obama has started to back track from the claim that the federal government—which let’s not forget, is funded by you the taxpayer — will pay all the costs for 3 years and 90 percent thereafter. Instead, his administration and he himself talk about blended rates that will transfer a sizeable portion of the cost to state budgets.iii Despite his promises to the contrary.

The Impact on the Kansas State Budget

Even the leftist Center on Budget and Policy Priorities, which typically finds spending citizens’ tax dollars an event to celebrate, is cautioning that the “blended rate” shift by the President will “likely prompt states to cut payments to health care providers and to scale back the health services that Medicaid covers for low-income children, parents, people with disabilities, and/or senior citizens (including those in nursing homes). Reductions in provider payments would likely exacerbate the problem that Medicaid beneficiaries already face regarding access to physician care, particularly from specialists.”iv This analysis actually left out the administrative cost of expansion that is largely being absorbed by the states. If anything, this suggests that reality will be more dire than CBPP’s predictions.

KPI’s own cost study of Medicaid expansion, conducted by a sitting member of the Social Security Advisory Board and former chief economist at the Federal Reserve in Cleveland, shows that Kansas taxpayers can expect to pick a $600 million tab if Medicaid is expanded. Hardly the “free money” that the Kansas Hospital Association has tried to foist on your family. They’ve even hired a former George W. Bush cabinet secretary to aggressively lobby for this “free money.” They’ve also yet to explain what services they recommend the state cut to fund the expansion and if their members are willing to pick up the additional costs when “blended rates” almost certainly take effect.

As a taxpayer you are going to pay for this on both the federal and state level and you deserve answers when any special interest groups come asking for more of your money.

http://directorblue.blogspot.com/2011/01/liberals-democrat-party-will-split-if.html
ii http://www.bloomberg.com/news/2014-01-02/obamacare-s-medicaid-expansion-may-create-oregon-like-er-strain.htm
iii http://www.cbpp.org/cms/index.cfm?fa=view&id=3521
iv Ibid

Voice for Liberty Radio: Milton Wolf

Voice for Liberty logo with microphone 150

In this episode of WichitaLiberty Radio: Dr. Milton Wolf is a candidate for United States Senate from Kansas and will face incumbent Pat Roberts in the August Republican primary election. We spoke by telephone on January 23, 2014. As Wolf is a physician, it should be no surprise that health care was a major topic. Also, he answers the question that’s on everyone’s mind: Jayhawks, Wildcats, or Shockers? This is podcast episode number 6, released on January 23, 2014.

Shownotes

Milton Wolf campaign website
Pat Roberts campaign website
Columns by Milton Wolf at Washington Times
Kansas Republican Party and convention information

Medicaid found to increase, not decrease, emergency room usage

This is an astonishing finding, and contrary to what the conventional wisdom has told us about health care.

For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. “Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,” said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured.

Continue reading at New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare

Exchange data security breaches don’t require notification

The breach of consumer data at Target has brought the issue of data security in focus. Yesterday a senator called for more protection and accountability for consumers and retailers. The following story from Watchdog.org tells us that government does not want to hold itself to the standards it wants the private sector to observe. There has been legislation proposed. Rep. Diane Black [R-TN6] has introduced H.R. 3731: Federal Exchange Data Breach Notification Act of 2013, whose title is “To require an Exchange established under the Patient Protection and Affordable Care Act to notify individuals in the case that personal information of such individuals is known to have been acquired or accessed as a result of a breach of the security of any system maintained by the Exchange.”

Feds not required to report security breaches of Obamacare exchange website

By 

HACKED OFF: Hackers or careless bureaucrats could cause private information to be spilled across the Internet. But the federal government, unlike most states, don't have to tell users when they have been compromised.

HACKED OFF: Hackers or careless bureaucrats could cause private information to be spilled across the Internet. But the federal government, unlike most states, don’t have to tell users when they have been compromised.

By Eric Boehm | Watchdog.org

Americans who buy health insurance through the federal Obamacare exchange website could have their personal information stolen by hackers and never even know it.

Most of the state-run health exchange websites will be covered by state laws that require notification when government databases are breached by hackers. But there is no law requiring notification when databases run by the federal government are breached, and even though the Department of Health and Human Services was asked to include a notification provision in the rules being drawn up for the new federal exchange, it declined to do so.

Other protections for individuals’ privacy, like the Health Insurance Portability and Accountability Act, or HIPAA, do not apply to the government-run exchange, only to health providers and insurance companies operating within the exchange.

Privacy advocates and cyber-security experts have had concerns about the lack of a federal notification law for years and hope the scrutiny of the Obamacare exchange will finally bringchange.

“The notification requirement is a very important part of overall security,” saidDeven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology. “People should be told when their information is at-risk.”

The lack of a notification requirement is particularly bad for the health insurance exchange website because of all the questions surrounding the site’s security. Poor security, coupled with the website’s high-profile problems, could make it a target for hackers either seeking to steal identities or embarrass the government.

Unfortunately, security is often an afterthought for the government, said David Kennedy, CEO of TrustedSEC, an Ohio-based cyber-security firm. Kennedy has testified before Congress about security threats in the Obamacare exchange and the need for notification laws.

“All we need is something that says if the federal government is breached, all we have to do is alert the public,” he told Watchdog.org. “Healthcare.gov is just one website of hundreds that have had these issues going back through the years.”

Together it creates a possible nightmare scenario. Without strong security on the front end, the hastily built and not fully operational website could become a treasure trove for hackers looking to steal identities. But without any laws requiring that those victims be notified by the federal government users of the Federal health exchange will be in the dark about any potential security breaches of their private data.

When the federal Obamacare exchange was being developed by HHS prior to its troubled launch on Oct. 1, experts told the department that it should include a data-breach provision in its policies for the website even though one was not required under federal law.

The department flatly declined to do so.

The final rules for the exchanges were approved on March 27, 2012, meeting of HHS officials, according to the Federal Register.

At that meeting, two commenters asked HHS to ensure the exchanges would promptly notify affected enrollees in the event of a data breach or unauthorized access to the exchange’s databases. One suggested that a full investigation be launched each time such a breach occurred, with the goal of holding hackers legally and financially accountable for breaking into the website.

The department’s response: “We do not plan to include the specific notification procedures in the final rule. Consistent with this approach, we do not include specific policies for investigation of data breaches in this final rule.”

Since there is no federal notification requirement, breaches of any and all federal databases can occur without the public ever being informed.

The only way to find out a hack has occurred is when the government decides to disclose it — as several federal law enforcement agencies did last month in response to attacks from Anonymous, a group of super-hackers who threatened to take down the FBI website and others.

But hacks that happen behind the scenes —potentially stealing everything from Social Security numbers to Department of Homeland Security watch lists — never have to be reported.

“That’s alarming because there could be a number of federal databases that are compromised already and we don’t know about it,” Kennedy said. “The exchange is part of a bigger problem.”

Federal privacy protections contained in HIPAA also do not apply to the databases created by the federal exchange website, McGraw said, even though health insurers doing business through the exchange must be HIPAA compliant.

In other words, the health plan itself is covered by HIPAA and any breaches of security that affect a consumer who has purchased a specific plan would have to be reported. But the process of choosing and purchasing a plan through the federal exchange — along with any information entered into the federal exchange as part of that process — is not subject to HIPAA protections.

“The problem with the exchanges is that they are such new entities, and they are so unique that existing laws don’t really cover them,” McGraw said.

But 48 states have laws on the books requiring that they give notification to individuals who may have had personal information stolen or leaked from a government database. Many states require that government agencies and departments alert the state attorney general so investigations can be launched.

In states that opted to run their own health insurance exchanges, those laws generally cover security breaches of the exchanges, McGraw said, though it depends on the specific wording of each state law.

Those state laws are how data breaches of several state-level health insurance exchange websites have come to light.

In September, Watchdog.org reported on a data breech of the Minnesota health exchange — known as “MNsure” — that potentially affected as many as 2,400 people.

In Florida, concerns about data breaches of the state-run exchange website prompted Gov. Rick Scott to send a letter to Congress saying Floridians would not exchange privacy for insurance.

On the federal exchange, such breaches are possible, maybe even likely, since the site was launched without comprehensive testing of the security controls for the system.

A Sept. 27 memo to Medicare chief Marylin Tavernner said insufficient testing of the website before the Oct. 1 launch “exposed a level of uncertainty that can be deemed a high risk,” the Associated Press reported in October.

Even though the federal government does not have to report any breaches of security, at least a few already have occurred.

The most high-profile case so far is that of Thomas Dougall, a South Carolina lawyer who had his personal information accidentally leaked to another person after using the Obamacare exchange last month.

We logged on and compared some prices,” Dougall later told Fox News’ Greta Van Susteren. “We came home last Friday night to have a young man from a completely different state calling to tell me that when he logged on … he got all my personal information in exchange.

Dougall only found out about that breach of security because the recipient was kind enough to give him a call.  Without a requirement that the exchanges report such problems — whether the result of nefarious hackers or glitches in the programming — it is impossible to tell how many other Americans have had their private information released by the federal exchange.

Kennedy said he would not recommend that anyone use the federal exchange until it is more secure and until breaches of security are reported.

“I would say think twice about it, at least until we get more details,” he said.

Kennedy says he supports universal health care and his criticisms of the website are not rooted in political motivations. But the former U.S. Marine whose firm provides computer security to several Fortune 100 companies says there have been “zero changes” to the security of the health insurance exchange website in the run-up to the much-touted Dec. 1 re-launch.

Congress has debated a federal notification law in each of the past three years, but one has never been passed.

In July, during a hearing of the House Committee on Energy and Commerce, lawmakers heard testimony from a variety of experts who explained the need for a federal breach notification requirement.

David Thaw, a law professor at the University of Connecticut who specializes in cyber-security and the legal framework around it, said data breach notification laws, combined with comprehensive data security, are an essential part of protecting consumers and businesses.

I analogize the effects of breach notification alone to locking the bank or vault door while leaving a back window wide open,” he said.

With the federal health insurance exchange, there are questions about whether the vault door has been adequately locked.

But there is no doubt that the back window is still wide open.

Boehm is a reporter for Watchdog.org and can be reached at [email protected]. Follow him on Twitter @EricBoehm87

WichitaLiberty.TV December 22, 2013

WichitaLiberty.TV.34In this episode of WichitaLiberty.TV: United States Representative Tim Huelskamp of Kansas appears to explain the recent budget bill, Obamacare, the government shutdown, the debt ceiling, government spending, and whether he is optimistic or pessimistic about the country’s future. Episode 25, broadcast December 22, 2013. View below, or click here to view at YouTube.

Rep. Huelskamp’s Congressional website is huelskamp.house.gov.

Study: Kansas premiums to spike following Obamacare rollout

From Kansas Watchdog.

Study: Kansas premiums to spike following Obamacare rollout

By 

ON THE RISE: A new report from the Heritage Foundation says Obamacare premiums are significantly higher in Kansas compared to average rates before the rollout of the new health care law.

By Travis Perry, Kansas Watchdog

OSAWATOMIE — Good news: Kansas landed in the top 10 in a recent study conducted by the conservative Heritage Foundation! Bad news: It’s for massive insurance premium hikes because ofObamacare.

Kinda puts a damper on things, huh?

As I said, before dashing your optimism with harsh reality, Kansas is among the top 10 states to possibly see the largest premium increases following the rollout of the federal health care exchange, according to a recent report from Heritage’s Center for Data Analysis. In a nutshell, the report states Obamacare health premiums available to Kansans will be higher than existing policies.

According to the Heritage report, the average premium for a 27-year-old Sunflower State resident will rise from $87.40 to $200.14, a massive 129 percent bump. This gives Kansas the unfortunate privilege of boasting the sixth-highest increase for young people nationwide.

The news gets slightly better for other groups, but not by much. Average premiums for a 50-year-old adult could increase from $198 to $341.08 (72.3 percent increase), while a family of four may see an increase from $553.92 to $676.05 (22 percent increase).

“Many families and individuals will face this reality as they apply for coverage, and the implications of experiencing sticker shock are important to consider if enough people choose not to sign up for coverage for various reasons,” policy analyst Drew Gonshorowski wrote in the Oct. 16 report.

The massive increase in premiums for young people should be especially concerning, as they’re the one group Obamacare can’t afford to do without. The successful implementation of the Affordable Care Act depends heavily on the young and healthy signing up to help pay for the elderly and infirm.

It’s important to note the Heritage study compares premium prices straight-up, not including government subsidies designed to decrease the cost to low-income individuals and families.

“This analysis represents the change in unsubsidized rate levels,” Gonshorowski wrote. “The purpose of this research is to provide further details on the changing premium levels across the country.”

Source Report: How Will You Fare in the Obamacare Exchanges?

Contact Travis Perry at [email protected], or follow him on Twitter at@muckraker62.

Pompeo votes to delay Obamacare, keep government open

From the office of U.S. Representative Mike Pompeo:

Pompeo Votes To Delay Obamacare, Keep Government Open

Washington –- Congressman Mike Pompeo, R-Kansas, is voting tonight to delay Obamacare for ordinary citizens, pay the armed services, ensure that the government continues running. He released the following statement:

“Well-connected friends of President Obama shouldn’t be the only Americans spared from the looming health care law — delaying Obamacare for businesses and not for individuals is irresponsible and reckless. This continuing resolution would also provide the hard-earned funding for our amazing armed forces and that the government is still providing services to the American people.

“The President has shown his willingness to delay Obamacare unilaterally in some instances, we are simply urging him to do so on a broader scale. I hope that Senate Majority Leader Harry Reid will also vote to keep the government open.”

ObamaCare chart updated

obamacare-chart

Republicans of the Joint Economic Committee of the U.S. Congress have released an update of a chart to help us navigate ObamaCare. (Click on it for a larger version.) From the July 2010 press release accompanying the original chart: “Four months after U.S. House Speaker Nancy Pelosi famously declared ‘We have to pass the bill so you can find out what’s in it,’ a congressional panel has released the first chart illustrating the 2,801 page health care law President Obama signed into law in March. Developed by the Joint Economic Committee minority, led by U.S Senator Sam Brownback of Kansas and Rep. Kevin Brady of Texas, the detailed organization chart displays a bewildering array of new government agencies, regulations and mandates.”

Read all about it at Health Care Chart — Updated Chart Shows Obamacare’s Bewildering Complexity.

ObamaCare employer mandate delayed, start of train wreck?

aspirin-bottleScheduled to take effect on January 1, the employer mandate portion of the Affordable Care Act (ObamaCare) has been delayed for one year.

Curiously, this announcement was made on an obscure Treasury Department blog, along with articles titled “Meeting, and Exceeding, Our Small Business Procurement Goals in FY 2012” and “In Case You Missed It: Top Executives Say U.S. Is #1 for Foreign Direct Investment.”

The employer mandate requires those who employ more than 50 full time-equivalent employees to provide insurance or pay a penalty. Cato Institute’s Michael D. Tanner notes the general problem, and a specific problem based on the decision to delay the employer mandate:

In postponing the implementation of the Affordable Care Act’s employer mandate until after the 2014 mid-term elections, the Obama administration has tacitly admitted what critics of the law have long contended: that Obamacare is unworkable and would be a significant burden for American business and the economy at large. Stay tuned for further dominoes falling.

Actually, the Administration’s decision to postpone the employer mandate may make a bad situation worse. Because the individual mandate remains in place, workers may now face a situation where they must purchase their own insurance or pay a penalty because their employers don’t provide coverage. In effect, the administration’s decision shifts the cost from employers to workers. This hardly seems fair, and may force the administration to rethink the individual mandate as well. (And So the Obamacare Train Wreck Begins … )

Will the implementation of other parts of ObamaCare be delayed? I think it seems likely. But: Section 1513 AVC states, regarding the employer mandate: “The amendments made by this section shall apply to months beginning after December 31, 2013.” So does the administration have the legal authority to make changes like this?

uninsured-estimates-2013-05

Also: For all the wrenching debate and changes, there will still be many uninsured people. Here’s a chart based on the Congressional Budget Office May 2013 estimate of the effects of the Affordable Care Act on health insurance coverage.

This is just the start of discovery of pathologies built into ObamaCare. Here’s Avik Roy explaining an incentive contained within the employer mandate:

The strong penalty vs. the weak penalty

The employer mandate actually consists of two different penalties, based on two different categories of employer behavior. These originate from Section 4980H of the Affordable Care Act. Subsection (a) requires steep penalties for employers who offer no coverage at all. Subection (b) requires modest penalties for employers who offer “minimum essential coverage under an eligible employer-sponsored plan.” This difference — between the strong penalty in 4980H(a) and the weak penalty in 4980H(b) — is crucial to understanding how things will play out in the future.

Under the strong penalty, in which an employer “fails to offer to its full-time employees…the opportunity to enroll in minimum essential coverage,” and “at least one full-time employee” enrolls in an exchange, the employer has to pay a fine of $2,000 times the total number of full-time-equivalent employees at the firm, minus 30. (The employer mandate only applies to firms with 50 or more full-time-equivalent workers.) So if you employ 50 workers, that’s a fine of 20 * $2,000 = $40,000. And the fine isn’t tax-deductible, adding to the pain.

Under the weak penalty, in which an employer does offer “the opportunity to enroll in minimum essential coverage,” but that coverage doesn’t meet Obamacare’s requirements for affordability or actuarial value, and at least one worker enrolls on an exchange instead, the fine is $3,000 times the number of workers who enroll on the exchanges. So, if you employ 50 workers, and three of them get coverage on the exchange instead, the fine is a much lower 3 * $3,000, or $9,000. (Technically, in subsection (b), employers pay the lesser of the weak penalty or the strong penalty, but this in most cases should be the weak penalty.)

So: Employers avoid the strong penalty and gain eligibility for the weak penalty by offering “minimum essential coverage.”

Roy goes on to explain that “minimum essential coverage” means coverage my any insurance plan that can legally be sod in a state, including plans that provide limited coverage or services. Roy writes that companies may offer these bare-bones plans to their employees and escape the penalties.

This behavior, which federal officials have confirmed is allowed, evidently wasn’t considered by officials, writes Roy: “Nonetheless, Obamacare’s designers expressed surprise that employers would do such a thing. ‘Our expectation was that employers would offer high quality insurance,’ said Robert Kocher, a former Obama health care adviser. It wouldn’t be the first time that the law’s authors didn’t recognize how economic incentives actually work.”

Economic incentives are what makes the world work. They’re based on human behavior, and that isn’t easily changed, even to suit Barack Obama’s desires.

The future of Obamacare, now he tells us

This is a sad commentary on the state of politics and governance in the U.S., from the Boston Globe:

Unencumbered by the political pressures of a reelection campaign, Baucus is in a position to call out both the failure of federal officials to prepare for implementing Obamacare as well as the unintended consequences of its complex regulations.

A short while ago, before U.S. Senator Max Baucus announced his retirement, U.S. Representative Mike Pompeo of Wichita noticed the incongruity of Baucus complaining about a law he passed, tweeting the following:

Following are excerpts from a letter Pompeo sent to Baucus, followed by the entire letter.

My shock wasn’t because I disagreed: You’re right to say this legislation has led to great uncertainty for hard-working Americans, small business owners, and families. No, I was shocked because you wrote this bill. I was saddened because your acknowledgment of the harm caused by PPACA has come so late.

No one in the country bears more responsibility for the complexity of this law than you. When your supermajority couldn’t pass the bill using normal procedures, you and your Senate colleagues rammed through the final legislation by using parliamentary gimmickry. Then, in the House, Speaker Pelosi cheerfully urged members to pass the legislation “in order to find out what’s in it.” This was not good policy-making, and now we’re seeing the consequences.

Secretary Sebelius’s implementation of the law is certainly flawed, but the policy process produced a law that could not possibly be implemented successfully. As legislators, it is our responsibility to write bills that clearly explain our meaning and have achievable goals. By your own admission, this law is a disaster.

You drafted it, you twisted arms to get it passed, and, until now, you have lauded it as a model for all the world. Your attempts to pass the buck to President Obama’s team will not work, nor will they absolve you of responsibility for the harm that you have brought via this law.

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Well-intentioned policies do more harm than good

By Derrick Sontag, Americans for Prosperity-Kansas. A version of this appeared in the Wichita Eagle.

Medicaid.gov Keeping America Healthy

Governor Brownback and legislators in Kansas must make an important decision this legislative session. Following the Supreme Court’s ruling in June 2012, Kansas must decide whether it will vastly expand its Medicaid rolls. Adding hundreds of thousands of Kansas residents to Medicaid is the exact wrong policy for our state.

The desire to expand Medicaid is well-intentioned, but will do more harm than good. The plan ignores the realities of the Medicaid system.

Medicaid is a broken, costly system traditionally serving low-income populations focusing on pregnant women, children and the disabled. Its expansion is a key component of the President’s health care law.

Unfortunately, Medicaid is rife with problems. Medicaid’s unique structure–jointly managed by the state and the federal government — results in subpar outcomes for covered families. Medicaid combines countless restrictions and paperwork requirements for providers while at the same time paying half of other insurance plans. This results in a lose-lose for providers, forcing many out of the Medicaid market. A recent study found 32 percent of Kansas doctors won’t accept new Medicaid patients.

These problems lead to even bigger problems for Medicaid patients and families. The health outcomes for Medicaid patients dramatically lag those on private insurance or Medicare. Study after study has confirmed these results.

Adding hundreds of thousands of people to this system will only make these problems worse and does not qualify as real health reform.

Even if Medicaid wasn’t a broken system, Kansas can’t afford to expand coverage.

The federal government is making gigantic promises to encourage states to comply. According to the President’s health care law, the federal government will pay 100 percent of expenses for newly eligible individuals for the first three years stepping down to 90 percent by 2020.

This seems like a great deal for Kansas. The state can leverage federal funding to provide for its residents. But not so fast.

The federal government can’t afford these promises. The President himself has twice suggested the government cut its reimbursement to states due to the high costs imposed. Even if the government honors its generous promises, Kansas taxpayers will pay an additional $525 million in the next 10 years just for this expanded population.

By refusing to create a health insurance exchange last year, Gov. Brownback admitted the health care law won’t result in better care or better outcomes for patients. Expanding Medicaid, while well-intentioned, is just another flawed health care idea coming from Washington.

Instead of subject Kansas to a broken, costly system, Kansas’ leaders should refuse to expand the Medicaid rolls in the Sunflower State.

ObamaCare explained: What could go wrong?

An Illinois State Senate candidate who happens to be a physician diagnoses and explains the problems with the Affordable Care Act, also known as ObamaCare. Here’s a transcription of what Barbara Bellar said:

Let me get this straight: We’re going to be gifted with a healthcare plan we are forced to purchase,
and fined if we don’t,
which purportedly covers at least 10 million more people,
without adding a single new doctor,
but provides for 16,000 new IRS agents,
written by a committee whose chairman says he doesn’t understand it,
passed by a congress that didn’t read it but exempted themselves from it,
and signed by a president who smokes,
with funding administered by a treasury chief who didn’t pay his taxes,
for which we will be taxed for four years before any benefits take effect,
by a government which has already bankrupted Social Security and Medicare,
all to be overseen by a surgeon general who is obese,
and financed by a country that’s broke.

So, what the blank could possibly go wrong?

Huelskamp: Kansas needs Health Care Freedom Amendment

An open letter from Congressman Tim Huelskamp of the Kansas first district to Republican Kansas State Senators Pete Brungardt, Jay Emler, Terrie Huntington, Jeff Longbine, Carolyn McGinn, Steve Morris, Tim Owens, Roger Reitz, Vicki Schmidt, Jean Schodorf, Ruth Teichman, Dwayne Umbarger, and John Vratil. These are the “traditional,” “reasonable,” “moderate” Kansan Republicans.

July 31, 2012

Dear Senator:

While all Republicans in Washington are working hard to fulfill Kansans’ wishes to stop ObamaCare from destroying our liberties, I am disappointed that you and many other Topeka politicians are actually hindering our efforts.

The reasons to undo ObamaCare are countless. It carries a trillion-dollar price tag over the next decade. It increases family premiums, burdens our small businesses, invades our privacy, and stomps on our religious freedom. States like Kansas will continue to bear the costs of expensive federal mandates. And, Secretary Kathleen Sebelius has refused to offer waivers she was more than willing to grant to unions and businesses connected to the Obama Administration.

As you may know, before being elected to Congress, I strongly supported adding the Health Care Freedom Amendment to our state Constitution. If passed, it would allow Kansans to have a say on a law they fundamentally oppose: ObamaCare. The citizens of Ohio were given this opportunity — so should the people of Kansas.

However, when this Amendment came to you during the 2012 Session, I was extremely disappointed that you refused to allow a vote of the people if the law was upheld by the Supreme Court. What a mistake. Kansans deserve to have a say on ObamaCare — whether you like it or not — and whether a narrow Supreme Court majority refuses to defend the Constitution.

As you know, ObamaCare is a significant threat to the wallets, the liberties, and health care access of Kansans. It was rammed through Congress behind closed doors, without public input, and many are still reading it “to see what was in it.” And for you to hide behind the Supreme Court and with Obama, Pelosi and Reid instead of the people of Kansas — that is very disappointing.

In closing, please reconsider your opposition to putting the Health Care Freedom Amendment to a vote of the Kansas people.

Sincerely,

Tim Huelskamp

Kansas Health Care Freedom legislation: The real story

By Kansas Senator Mary Pilcher-Cook, R-Shawnee

We need honesty and integrity in campaigns. It is crucial that Kansas citizens receive correct information about legislators’ voting records and not just rhetoric with platitudes. Kansas Senate President Steve Morris said he never supported the Patient Protection and Affordable Care Act, also known as Obamacare. However, his actions and votes indicate he was not willing to protect Kansas citizens and their liberty against the controversial federal health care law.

Over the course of three years, President Morris was continually asked to allow a vote on the Senate floor for a Kansas Health Care Freedom Amendment so Kansas citizens would be able to vote for it on the ballot this year and continue to act freely concerning their own health care decisions. State sovereignty as guaranteed by the Tenth Amendment in our U.S. Constitution gives the primary duty to the state to protect the liberty of the people in regards to their health care. However, the legislation was repeatedly given roadblocks in the Senate and it was necessary to maneuver the measure around several Senate leadership-imposed barriers.

Please review the votes from official Senate journals so you are not deceived by “Washington-DC style politics.” The accurate historical record with links to these journals is on www.kansashealthcarefreedom.com, which also explains the voting gymnastics that transpired over the years.

In 2010, the proposed constitutional amendment was referred to two committees and a subcommittee (usually a bill is only referred to one committee by leadership). One committee passed it without a recommendation, and the second committee referred it to a subcommittee. In the final hours before adjournment, a motion was made to move the measure out of committee. President Morris voted against this motion. (Senate Journal April 28, 2910. A “Yea” vote was in favor of health care freedom. Yeas: Abrams, Apple, Barnett, Brownlee, Bruce, Colyer, Donovan, Huelskamp, Kelsey, Lynn, Marshall, Masterson, Ostmeyer, Petersen, Pilcher-Cook, Pyle, Schmidt D, Taddiken, Wagle. Nays: Brungardt, Emler, Faust-Goudeau, Francisco, Haley, Hensley, Holland, Huntington, Kelly, Kultala, Lee, McGinn, Morris, Owens, Reitz, Schmidt V, Schodorf, Steineger, Teichman, Umbarger, Vratil.)

In the 2011 session, I amended the language of the Health Care Freedom Amendment into a prescription health care bill on the Senate floor as the “Kansas Health Care Freedom Act” — a law instead of a constitutional amendment. President Morris voted against the floor amendment. Only after the amendment was added and it was obvious the measure was going to pass is when “every” Republican in the Kansas Senate voted for it. (Senate Journal Mar 22, 2011. A “Yea” vote was in favor of health care freedom. Yeas: Abrams, Apple, Bruce, Huntington, Kelsey, King, Longbine, Love, Lynn, Marshall, Masterson, McGinn, Merrick, Olson, Ostmeyer, Petersen, Pilcher-Cook, Pyle, Schmidt V, Schodorf, Steineger, Taddiken, Teichman, Umbarger, Vratil, Wagle. Nays: Brungardt, Emler, Faust-Goudeau, Haley, Hensley, Kultala, Morris, Owens, Reitz, Schmidt A. Present and Passing: Francisco, Holland, Kelly. Absent or Not Voting: Donovan.)

In the 2012 session, the Health Care Freedom Amendment was defeated in the Senate. Interestingly, seven senators who voted for final passage first voted to send the measure back to committee. (Senate Journal Feb. 23, 2012. A “Nay” vote is in favor of health care freedom. Yeas: Brungardt, Emler, Faust-Goudeau, Francisco, Haley, Hensley, Holland, Kelly, Kultala, Longbine, McGinn, Morris, Owens, Reitz, A. Schmidt, V. Schmidt, Teichman, Umbarger, Vratil. Nays: Abrams, Apple, Bruce, Donovan, Kelsey, King, Love, Lynn, Marshall, Masterson, Merrick, Olson, Ostmeyer, Petersen, Pilcher-Cook, Pyle, Schodorf, Steineger, Taddiken, Wagle. Present and Passing: Huntington.)

As far as money being involved in politics, President Steve Morris is in charge of a Senate Leadership PAC that receives out-of-state money and spends massive amounts sending out nasty and false attacks on fellow Republicans who did not vote for President Morris to be in his leadership position. President Steve Morris voted against abolishing this PAC last session.

When there are conflicting views, please get the facts and evaluate the votes. On Tuesday, August 7, be prepared to vote for the candidates who stand with integrity about their votes.