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Sunday, August 4, 2013

The "Do Nothing Congress" heads home for six weeks to prepare for the assault on ObamaCare

Forget "HIT." Forget "Meaningful Use" and "REBOOTING" (or just "BOOTING") it. Forget "HIE." Up next? "HIX" -- the PPACA "Health Insurance Exchanges" that comprise a critical next step in the operational implementation of "ObamaCare" (or, as I sometimes call it, "AHIPcare," which is what it mostly is).

Hard right "Republicans" have vowed to obstruct (or, preferably, kill) the ACA, vowing to cause a federal debt default and government shutdown on October 1st if necessary to "defund ObamaCare" -- which, tactically at this point means, as a priority, throwing truckloads of sand in the HIX gears and cause insurance exchange failures at every turn.

Should be "interesting."

I would think that, for now, Health IT is off the radar, "REBOOT" Congresscritters notwithstanding. HIT is chump change relative to the money at stake in the PPACA.

Below, a concise HIX infographic (click image to enlarge).

Above, the Teabagger wet dream. I loves me Photoshop.
Groups go door-to-door to encourage enrollment in Obamacare
By Sandhya Somashekhar, Washington Post

MIAMI BEACH — Her clipboard said the man who lived in the pink stucco apartment building a few blocks from the hotel-lined beach might not have health insurance. So Laura Botero climbed the darkened staircase to the second floor and knocked on the door.

Eduardo Devine, 49, an unemployed beach waiter in black, square-framed glasses, peeked into the dim hallway. He confirmed he had been without coverage since he was laid off a month ago, and his face lit up when Botero mentioned “Obamacare.”

“I just heard about it on the news, but I don’t know how it works,” he said, taking a pamphlet. “It will help. That’s all I know.”

It was a small but critical victory for Botero, a volunteer for Enroll America, a nonprofit group that is fielding a small army to spread the word about Obamacare. In recent weeks, President Obama’s signature health-care law entered a new phase as hundreds of advocates began the arduous task of identifying the uninsured and coaxing them, one by one, to sign up for coverage.

For the law to succeed, groups such as Enroll America, whose officials include several veterans of Obama campaigns, will need to cajole millions of Americans, including many healthy ones, to enter the insurance market. It could be a tough sell. Confusion about the law is rampant. The online insurance sites, which open for enrollment Oct. 1, could be tricky. Some people who rarely need medical care might view even low-cost health plans as too pricey...
Wouldn't surprise me if PPACA opponents mount a counter-campaign to challenge ObamaCare HIX signups. Similar to their initiatives to challenge voter registrations in many states.

Meanwhile, HHS is ramping up at

The HHS explanation of the "fee" for not complying with the "Individual Mandate."
What if someone doesn't have health coverage in 2014?
If someone can afford it but doesn't have health insurance coverage in 2014, they may have to pay a fee. They must also pay for all of their care.

When the uninsured need care

When an uninsured person requires urgent—often expensive—medical care but doesn't pay the bill, everyone else ends up paying the price.

That's why the health care law requires all people who can afford it to take responsibility for their own health insurance by getting coverage or paying a penalty.

People without health coverage will also have to pay the entire cost of all their medical care. They won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy...
The fee in 2014 and beyond
The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.

In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.

It's important to remember that someone who pays the fee won't get any health insurance coverage. They still will be responsible for 100% of the cost of their medical care.

After open enrollment ends on March 31, 2014, they won't be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event...
OK, let's say you're a "young invincible" median income earner. Round number $50,000. You opt to decline and pay the "fee" of $500 (rising to $1,250). You're betting that the "fee/fine/penalty" will be cheaper than buying "minimum essential coverage" from a legitimate insuror.

Keyword "legitimate." There will no doubt be all manner of scammers out there conveniently pricing "coverage" for less than the "fee."

Coverage that will be declined when you actually try to use it.


 Above, from "A Health Plan for Rugged Individualists" on THCB.

Below, the FreedomWorks "ObamaCare Draft Card."

How witty and original.
“We are on target and ready to flip the switch on Oct. 1,” [Kathleen] Sebelius, secretary of the U.S. Department of Health and Human Services, told reporters. The markets “are already increasing competition and giving consumers a better deal.”


Those who follow the PPACA wrangling will know that the Obama administration has pushed compliance with the ACA "Employer Mandate" back by a year, until 2015. Many pundits conclude that this tactic is designed to get it off the mid-term elections radar.

But, here's an interesting view from Elizabeth Lee Vliet:
The employer mandate requires that businesses with more than 50 full-time employees must provide health insurance for all employees, and that insurance must meet the new standards set forth in the new law. Businesses that do not comply must pay a financial penalty for each employee, which for large companies can run into the millions of dollars annually.

To understand the reason for this "selective enforcement," we must first understand this fact: President Barack Obama wants a single-payer healthcare system in the U.S. This is not a secret. In 2003, he said: "I happen to be a proponent of a single-payer healthcare system for America, but as all of you know, we may not get there immediately." In 2007, he said: "But I don’t think we will be able to eliminate employer-based coverage immediately. There is potentially going to be some transition time."

...By forcing individuals to purchase compliant healthcare plans but not forcing employers to provide those plans, Obama is creating a swell of 10 million to13 million workers that must enroll in health insurance, but cannot obtain it from their employers. These workers thus have no choice but to use the government-controlled health insurance exchanges, or else pay a financial penalty. This will double the number of workers forced to get health insurance on the exchanges. That, in turn, leads to massive cost-shifting onto the backs of taxpayers subsidizing the health insurance exchanges, rather than having businesses pay for employees’ health insurance.

Higher taxes are the result. Individuals are also facing 20 percent to 100 percent increases in their private health insurance premiums for 2014 to pay for the expanded mandates of Obamacare required coverage. That means workers no longer getting health insurance from their employer will be paying far more for individual coverage. Squeezed from both directions, it is obvious that all this will collapse on itself. At that point, there will be no other option but for the government to step in and save the day, which is what the Obama administration wanted all along.
...Obama and his party advocates sold the healthcare "reform" to the public by saying "reform" would increase competition and patient choice. But the perverse incentives, draconian regulations, and massively complex and unworkable law is a clever disguise for the real goal: to drive people out of private, employer-provided insurance, as a stepping stone to a government-run, single-payer system. Once we know the ultimate goal, the purpose behind the delay of the employer mandate seems clearer — to hurry the "transition time" away from employer-based health insurance and push more workers into the arms of government control to reach their dream of a single-payer system.
Hmmm... Obama's Cleverly Disguised Machiavellian Master Plan.


I'd like to think I've added some value to the Health IT space from an REC grunt perspective.



Meaningful Use progress 'uneven' for hospitals
August 5, 2013 | By Marla Durben Hirsch

The attestation outlook for hospitals is not quite as sunny as the government has indicated, with smaller, more rural hospitals struggling to meet Meaningful Use and at risk of incurring penalties, according to a new study in the August issue of Health Affairs.
The researchers, from Mathematica Policy Research and elsewhere, found that there was a "significant" increase in the percentage of hospitals receiving incentive payments for achieving Meaningful Use between 2011 and 2012--from 17.4 percent to 36.8 percent.
However, the majority of eligible hospitals still did not achieve Meaningful Use in the first two years of the program, according to the researchers. Moreover, hospitals are making "uneven" progress, typically associated with the "digital divide," with larger, teaching, for profit and Northeast hospitals the most successful...
The inpatient setting is unsurprisingly difficult.

Mostashari to step down as ONC chief
HHS Secretary announces Mostashari's planned leave-taking in a memo to staff

n a letter to HHS staff, Secretary Kathleen Sebelius said that Farzad Mostashari, MD has said he intends to step down from the national coordinator post this fall.

Mostashari spent four years with ONC, first as a deputy national coordinator, then taking over as the National Coordinator in 2011...
Well, I hate to see him go. From Politico:
“It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on,” he [Farzad] wrote.

His departure comes at a critical time in the world of health technology. The government has pumped billions of dollars into more advanced health systems since the 2009 stimulus law, and the administration only upped those efforts in the Affordable Care Act. Hundreds of thousands of doctors and other health care providers have updated their practices to include health technology, earning incentive payments from the federal government.

According to HHS, Medicare and Medicaid have paid more than $12 billion in those payments as of February [$15.5 billion in the latest report -BG] to encourage the adoption of electronic health record systems.

The results have been mixed. A study published in Health Affairs on Monday suggests that smaller hospitals have struggled to adopt electronic records because their smaller cash flow prevents that kind of large-scale investment. They also might have a harder time attracting IT staff and competing for limited vendors.

HHS Secretary Kathleen Sebelius sent her own email to staff, hailing Mostashari’s work and describing him as “an important adviser” to her and the agency.
“His expertise, enthusiasm and commitment to innovation and health IT will surely be missed,” she wrote...

More to come...

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