Obamacare progression to Medicaid.

UPDATE: A new wrinkle appeared today. Obama now says anyone who was canceled can buy a “catastrophic plan” and keep it for a year. Of course, the “catastrophic plans offered are larded with Obamacare mandates. It is looking like surrender is getting near. The lefties look like fools but what did we expect when this thing began?

All of this, along with previous time extensions for sign-ups, suggests Obamacare is heading for a spectacularly awful January. The president is so obsessed with ameliorating the political problem that he is dismantling his own plan, bit by bit, both undermining its economic viability and aggravating voters and political allies. Is this the handiwork of the triage maven John Podesta? If so, they’ll need a clean-up man to clean up from Podesta.

The comments after this post should be hilarious. Let’s look…

Obamacare is a done deal. Obama has three more years to patiently work this through. Even if GOP takes the senate in 2014 they will not have a veto proof majority. GOP has absolutely no alternatives (except selling across state lines, which is another way of saying huh..).

Heritage foundation worked this out carefully in pre-Obama days; Romney was not stupid when he did this in Mass.; they knew that individual mandate is the only way to cover preexisting conditions (you may want to think this through if you are a bit slow….or ask anyone who works in insurance)

There is the old lefty lie about Heritage and the mandate plan from 20 years ago. This one is even funnier…

Not sure why there’s so much concern from Jen on whether Dems will stick with the President in 2014. ACA website glitches will be a thing of the past; people will find out that taxpayers are quite generous with subsidies.

The nature of Obamacare is becoming more and more clear as the months go by. A hearing before Darryl Issa’s committee brought out a few facts which have been thin on the ground lately.

Dr. Patricia McLaughlin, an ophthalmologist based in New York City, said insurers are introducing limited networks and announcing new plans that will offer only in-network benefits, excluding all out-of-network doctors.

She noted the problem of limited networks is that many health plans have substantially reduced or eliminated previous coverage options that allowed patients to see the doctor of their choice.

This is necessary as the insurers try to limit their losses as the risk pools evaporate. I haven’t yet learned if out-of-network doctors can charge cash prices. As employer sponsored plans dry up, there will be fewer contracts to be violated by offering services at lower prices. At present, a doctor who offers a cash price substantially below the contract price risks cancellation of the contract. Medicare is even more ferocious in protecting its “discounts” by threatening prosecution of a Medicare provider who offers more or cheaper services than those “allowed” by Medicare, even though payment is a fraction of the “allowed” charges.

Dr. Jeffrey English, a neurologist at the Multiple Sclerosis Center of Atlanta, said the law punishes doctors like him because he recommends too many costly procedures, such as MRIs and brain-image scans, compared to his peers.

“In reward for my passions to prevent real people from becoming disabled, CMS and insurance companies like United Healthcare are going to post negative grades in my name,” he said. “They will financially penalize me or the institution I work for, as I am trying to practice quality care to some of our most vulnerable patients.”

This is an old story. When DRGs appeared in 1986, the hospitals turned on a dime. I was used to fending off hospital employees peddling home care and other “optional” services to my Medicare patients. In one day, the hospital started to send “discharge planners” to tell patients they had to go home. No extra services were offered. Then the next step came. As a vascular surgeon, I had many elderly sick patients who required big operations and lengthy recuperation. Suddenly, I became a “high cost” provider. I began to get a monthly printout listing my admissions and describing the costs and revenues. Those that cost the hospital more than the DRG paid, were money losers and I was a money loser for having admitted them. It didn’t matter that the operations were necessary.

Rep. Gerry Connolly (D-Va.) complained that Republicans on the committee had cherry-picked doctors who held negative views of Obamacare and had refused to allow more supportive witnesses to testify. ??“The idea that your experience is to be generalized as universal is false. And it does a disservice, in my opinion, to this discussion,” Connolly told the witnesses. “None of you are policy experts. And none of you universally speak for your profession.”

Issa replied the Democrats had not suggested any doctors for the panel, and the only witness they had requested was a policy expert.

The Democrats probably could have found a few academic physicians who are salaried employees of university hospitals and have no contact with the nuts and bolts of medical care to testify. I’m surprised they didn’t. Such “experts” are looking forward to service on death panels and on committees that will establish “guidelines” based on no data but merely the opinions of such “experts.” They are not likely to contradict their future employers.

Avik Roy testified before the committee. He is not a physician but he is one of those health policy guys.

Roy said research by the Manhattan Institute shows that underlying premiums will increase by an average of 41 percent across the nation. Among the states seeing large increases are Nevada (179%), New Mexico (142%), North Carolina (136%), and Vermont (117%).

The analysis also found that eight states will see average premiums decreased under the law, including New York (-40%), Ohio (-21%), and Massachusetts (-20%).

New York and Massachusetts are , of course, the highest cost states for individual plans.

Roy had more to say today.

Leaders of the Minnesota, Maryland, and Hawaii exchanges have all resigned. The executive director of the Oregon exchange took medical leave in early December with no announced return date. And in a u-turn, after severe criticism, the executive director of the Colorado exchange backed off her request for a year-end bonus. So who could be next to face increased scrutiny?

Those, of course, are the “success stories” of the administration. The states that set up their own exchanges. How is California doing ? Not too well.

Adding to consumer confusion ahead of a major enrollment deadline, California’s health insurance exchange sent flawed eligibility notices to nearly 114,000 households due to a computer error.
The Covered California exchange said the letters sent from Nov. 22 to Dec. 7 had blank spaces or missing information on people’s eligibility for insurance or federal premium subsidies.
“The letters would say you are eligible for Covered California, but you are ineligible for blank,” said exchange spokeswoman Anne Gonzales. “It seemed to contradict whether the enrollee was eligible. It was confusing to people.”

The plot thickens, as they say. This will be a rolling disaster until the time that major employer plans start to be cancelled, and they will be.

If you read the Affordable Care Act when it was passed, you knew that it was dishonest for President Obama to claim that “if you like your plan, you can keep your plan,” as he did—and continues to do—on countless occasions. And we now know that the administration knew this all along. It turns out that in an obscure report buried in a June 2010 edition of the Federal Register, administration officials predicted massive disruption of the private insurance market.

On Tuesday, White House spokesman Jay Carney attempted to minimize the disruption issue, arguing that it only affected people who buy insurance on their own. “That’s the universe we’re talking about, 5 percent of the population,” said Carney. “In some of the coverage of this issue in the last several days, you would think that you were talking about 75 percent or 80 percent or 60 percent of the American population.” (5 percent of the population happens to be 15 million people, no small number, but let’s leave that aside.)

As usual, Carney was lying.

“The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” wrote the administration on page 34,552 of the Register. All in all, more than half of employer-sponsored plans will lose their “grandfather status” and become illegal. According to the Congressional Budget Office, 156 million Americans—more than half the population—was covered by employer-sponsored insurance in 2013.

Note the date: “By the end of 2013.” Obama has delayed the employer mandate but that regulation continues to exist.

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2 Responses to “Obamacare progression to Medicaid.”

  1. neuro says:

    Hi Dr. Kennedy! I enjoyed your book A Brief History of Disease, Science and Medicine. Could I ask if you plan to have an eBook version of your book available? Thank you!

  2. MikeK says:

    Amazon cut the price so I may do a kindle version. Right now, I am working on the next one which is a memoir of 50 years in medicine. Not a biography but an account of the patients I remember.