Whether you approve or disapprove of the Healthcare Reform Bill that was passed in 2010, you have to admit that it is bringing out the best in some Americans. Good old American ingenuity is coming to the forefront of some American’s thinking as they try to devise ways to circumvent the law.
The latest attempt to avoid paying the fine imposed on employers by the Patient Protection and Affordable Care Act. (PPACA) is by small business owners with more than 25 employees. The PPACA mandates that employers with more than 25 employees to provide healthcare insurance for their employees, while employers with 25 or fewer employees are exempt from this requirement. Some small business owners are proposing that they split their company into smaller, separate companies with less than 25 employees each, thus avoiding the requirement to provide healthcare insurance for their employees.
Not so fast says the Obama administration. They point to an IRS ruling which states that if two or more companies are held beneficially by the same ownership, then the separate companies can be treated as one entity for tax purposes. The Obama administration has claimed that this ruling should apply to small businesses who try to avoid the employer provided healthcare insurance mandate by splitting up companies into smaller divisions. They claim that if several small businesses are owned by the same individuals, the total number of employees working for all the businesses should be considered the total number of employees.
This difference of opinion will set-up a court battle, and frankly, I wouldn’t bet against the government on this one. A better solution to the problem of keeping the total number of employees under the 25 employee threshold would be for a business of 90 employees to be split-up between 4 or more owners, but with each owning a ‘baby’ business individually, rather each of the 4 owners owning 25% of 4 different ‘baby’ businesses. I realize that will create a whole new set of problems, such as equitable division of the parent company, but I have faith in Americans’ ingenuity.
Another area that is causing a great deal of concern within the healthcare community is the formation of Accountable Care Organizations (ACO). ACO’s are a cornerstone of the anticipated savings that are promised by the PPACA. Doctors and hospitals are supposed to join forces and agree to treat a certain patient population for a minimum of 5 years for a fixed amount. The problem with ACO’s is that several states had passed laws banning collusion between doctors and hospitals which restricts doctors from owning and operating testing facilities and rehabilitation clinics to which they refer. Texas had to pass a new law allowing hospitals and doctors to form partnerships as required by ACO’s. Other states have to revise their existing laws to allow ACO’s to operate within the state.
Another problem that I see with the ACO’s is that they appear to be no different than the HMO’s of the 80′s and 90′s. Many people have soured on the idea of HMO’s because they, too, treated people for a set amount each year, and tried to turn a profit by decreasing service to patients and reducing salaries paid to doctors and staff. I still feel that the idea of ACO’s is to condition Americans to the idea of less treatment and less personalized treat from their doctor so that when the Federal government ends up running the healthcare system, there will not be a huge uproar as services are cut or taxes are raised to provide ‘free’ healthcare for everyone.
So, the long and the short of the result of the PPACA is that there is something for everyone to hate about it. Which, as I recall, was what some politician said indicates that that is the result of a good compromise. That’s a sad comment on the mindset of our politicians, today.
In a recent poll released by the Associated Press-GIK (data collected March 24-28) the public’s support for the Healthcare Reform Bill is at an all-time low. This latest poll shows that 35% of Americans support the ACA, 45% oppose the expansion of the Federal government’s role in healthcare, ad 17% are neutral on the subject.
One of the concerns over the Healthcare Reform Bill is the increased cost to the taxpayer at a time when the Federal Government budget is already running huge deficits. The American public seems to understand that the ACA will increase the amount of money needed by the government to implement the plan, even if many politicians don’t understand this fact.
Of particular interest in this poll are the responses by senior citizens, the acknowledged wisest among us. 59% of seniors oppose the new health care law, while only 29% support the changes. 62% of seniors disapprove of Obama’s handling of health care, while Republicans are more trusted than Democrats to handle the issue, by a 51 percent to 36 percent margin.
Several items of interest, related to Healthcare Reform were proposed this week, as part of the budget battle. House Budget Chairman Paul Ryan, (R-WI), proposed converting Medicare into a “premium support” program. Instead of traditional Medicare, people who are now 54 and younger would get a fixed payment, or voucher, from the government to buy private health insurance of their choice when they retire. This program would be means tested, with lower income participants receiving a larger voucher. He also proposed that Medicaid, which serves low-income people, would be funded by a block grant to the states who administer the program. Both of these proposals would allow competition to increase which should reduce overall healthcare costs.
Dr. Donald Berwick, who oversees the Medicare and Medicaid programs, as well as the implementation of the new health care law, told Associated Press reporters Tuesday that the Republican approach would set back efforts to improve quality and squeeze waste. In contrast, Berwick said, he wished “the tempo of the law were faster,” so that Americans could experience the benefits of increased coverage for most Americans and policy changes to reward doctors and hospitals for quality care, not just the volume of tests and procedures. Perhaps Dr. Berwick doesn’t understand that the only way the Healthcare Reform Bill is remotely revenue neutral is for the tax increases to be implemented now, while the increase in costs to the government be postponed as long as possible, as the ACA is currently structured.
President Obama unveiled his own plan on reducing Medicare costs $340 billion dollars over the next ten years. His plan relies on controlling prescription drug costs and changing how the federal government distributes Medicaid dollars to states. It also gives more cost-cutting power to an advisory board created by last year’s Healthcare Reform Bill. (Read -cut doctor and hospital payments). Unfortunately, President Obama’s plan is short on specifics though delivered in a great oratorical style.
On Tuesday, the Obama administration began implementing a new program which is aimed at improve safety in hospitals, which have serious problems with infections and medical mistakes.
The new ‘Partnership for Patients’ program will assist hospitals to adopt new protocols to reduce these problems significantly, with the goal of preventing nearly 2 million patient injuries and saving more than 60,000 lives over the next three years. The program’s goal is to also save Medicare $10 billion over that period.
Editor’s note: Do we really need a new government program to tell doctors and hospitals how to save lives. And what is the cost, in new government employees to administer the program. While the program may save billions of dollars in Medicare costs, how much in administrative and enforcement costs will the program incur?
There was a lot of news concerning the Healthcare Reform Bill this week. There was good news for everyone and bad news for everyone. Depending on your view of the Healthcare Reform Bill, the same news could be viewed as good or bad.
This week the Senate passed a bill repealing the provision within the ACA which required businesses to send 1099 forms to every vendor from which they purchase a minimum of $600 worth of goods or services during the calendar year. President Obama is expected to sign the bill, making this the first portion of the ACA which is being scrapped. Removing this provision from the bill will save businesses millions of dollars in accounting costs and save a small forest due to the reduced paper work required.
House Budget Committee Chairman Paul Ryan (R-WI) revealed his budget proposal for 2011. Part of his budget proposal was to completely repeal the ACA, which he claimed would save the country $4 trillion over the next ten years. This is in direct contrast to the Obama administration, which has said we need to pass the Healthcare Reform Bill in order to save the government trillions of dollars over the ten years. I’m pretty sure that both positions can’t be right, so who do we believe. I vote for the person who does not have record of being untruthful.
The number of waivers that President Obama’s administration has given out has risen by another 128 waivers in March. This brings the total of waivers granted to1,168 businesses, insurers, unions and other organizations. The total number of Americans who benefit from these waivers is almost 3 million and is sure to grow. “The fact that over 1,000 waivers have been granted is a tacit admission that the healthcare law is fundamentally flawed,” said Rep. Fred Upton (R-MI.).
In a related story, Crossroads, a conservative think tank based in Washington, DC has filed a lawsuit against the Obama administration for failing to comply with the Freedom of Information Act (FOIA) by not responding to its requests for information on how the Health and Human Services (HHS) determines who receives ACA waivers. The concern is that groups such as, labor unions, certain states, and other Liberal supporters, as a pay back for supporting Liberal politicians and the passage of the ACA.
While he was campaigning for the presidency, Barrack Obama promised that his administration would be the most transparent presidency ever. The facts demonstrate otherwise. A recent report by The Associated Press claims that the Obama administration has denied the release any material in more than 33% of all FOIA requests and even when it did respond, the average wait time was getting longer not shorter. Only 20% of “urgent” FOIA requests received replies within the 20 day period required by the FOIA time. That is also less than the previous year.
Republican representative Steven King (R-IA) is trying to use the debate over a continuing budget resolution as a means to defund the Healthcare Reform Bill. He is trying to block any passage of a continuing resolution unless the resolution blocked funding for the ACA. King and Rep. Michele Bachmann (R-MN) circulated a letter to lawmakers last month urging them to vote against any continuing resolution that didn’t block funding for the reform law. King has conceded that complete defunding of the ACA is unlikely at this time.
Other healthcare reform news that is of significance is the Republican sponsored tort reform bill which limits the amount of non-economic damages in medical malpractice lawsuits. This type of reform will actually lower medical costs by lowering medical liability insurance premiums that doctors and hospitals are required to pay. The bill has already passed through the House Judiciary Committee and will be next taken up by the House Energy and Commerce Committee. We’ll follow the progress of this bill as it works its way through the House.