The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

“Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling.
Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.
Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier — and less expensive.
“It’s the same insurance companies that are up to the same strategies: Take in as much premium as possible and pay out as little as possible,” said Jerry Flanagan, an attorney with the advocacy group Consumer Watchdog.”

“Ascension Health, one of the nation’s largest hospital owners, is expanding rapidly with a string of announced deals that its CEO says will grow its reach beyond hospitals to keep pace with rapid Obamacare-induced changes in the marketplace.
But notably, Ascension is not on an acquisition spree. Its latest deals—in Illinois, Michigan, Arizona and Wisconsin—are not outright purchases, but rather agreements with regional rivals and other national players to jointly own, operate or contract for hospitals and insurance companies.
The deals pair Ascension with well-established players in each market and allow the system to avoid costly competition or wasteful duplication by capitalizing on partners’ resources that Ascension lacks, said Robert Henkel, Ascension Health’s chief executive. The strategy also will allow Ascension to jointly develop broader services to care for patients at home, in nursing homes and other locations outside of hospitals. “There are times we don’t have all the pieces,” he said.
The shift by healthcare systems away from providing care in hospitals has accelerated since the 2010 health reform law, as Medicare and Medicaid introduced new financial incentives for lower-cost care under reform and commercial health plans followed. An explosion of dealmaking across healthcare has followed as hospitals, medical groups, insurance companies and drug and devicemakers consolidated or diversified, depending on strategy.”

“Bill Jacobs spent four nights in a hospital in Florida battling pneumonia. His kids visited each day, fluffed his pillows, brought his favorite Sudoku puzzles and got regular updates from his nurses and doctors. Imagine their surprise when they found out that their 86-year-old father was never actually admitted; instead, he was treated as an outpatient under what Medicare refers to as “observation status.”
What difference does that make? Actually, more than you might think. If your parents are on Medicare, the difference between being considered an inpatient or an observation patient could be thousands of dollars out of their pocket, if not more.
First, Medicare Part A will cover all hospital services, less the deductible, but only if you’re admitted to the hospital as an inpatient. The one-time deductible covers all hospital services for the first 60 days in the hospital. Doctors’ charges are covered under Medicare Part B. After you meet the deductible for Part B, you’ll then owe 20 percent of the Medicare-approved amount for doctor services, according to the Centers for Medicare and Medicaid Services’ Are You A Hospital Inpatient Or Outpatient?”

“Every day in intensive care units across the country, patients get aggressive, expensive treatment their caregivers know is not going to save their lives or make them better.
California researchers now report this so-called “futile” care has a hidden price: It’s crowding out other patients who could otherwise survive, recover and get back to living their lives.
Their study, in Critical Care Medicine, shows that patients who could benefit from intensive care in UCLA’s teaching hospital are having to wait hours and even days in the emergency room and in nearby community hospitals because ICU beds are occupied by patients receiving futile care. Some patients die waiting.
On one day out of every six, the researchers found, UCLA’s intensive care units contain at least one patient receiving useless care while other patients are unable to get into the ICU.
More than half the time, over a three-month period the researchers examined, the hospital’s intensive care units had a least one patient receiving futile care. The study shows the ripple effects of that futile care within the UCLA hospital and in surrounding hospitals where patients were waiting to be transferred.
“It is unjust when a patient is unable to access intensive care because ICU beds are occupied by patients who cannot benefit,” the authors write.
“The ethic of ‘first come, first served,’” they say, “is not only inefficient and wasteful, but it is contrary to medicine’s responsibility to apply health care resources to best serve society.””

“Thought HealthCare.gov had problems?
Another federal government-run website created under ObamaCare is suffering the same symptoms as the troubled federal health care exchange — grappling with delays, data problems and other hiccups as the deadline to take it public nears.
At issue is a database known as the Open Payments website. It was created under the Affordable Care Act to shed light on the financial ties between doctors and pharmaceutical companies as well as device manufacturers.
The transparency initiative is supposed to include detailed information about drug payments made by doctors as well as the value of gifts and services given by drug makers. Such items can include everything from meals to swanky retreats.
The database project, though, is dealing with a minefield of technical problems and confusion over the data. The problems led the Centers for Medicare and Medicaid Services to shut down what is currently a private site for 11 days earlier this month.”

“Noridian Healthcare Solutions, the company fired by Maryland officials after the disastrous launch of the state’s health insurance exchange, received a request from federal auditors last month to turn over documents related to the troubled project, chief executive Tom McGraw said Tuesday.
McGraw said in a statement that Noridian was “cooperating fully” with the July 30 request by the inspector general’s office for the Department of Health and Human Services, which has been auditing the use of federal funds in creating the Maryland Health Benefit Exchange.
McGraw’s statement came after Rep. Andy Harris (R-Md.), a fierce critic of the exchange and the federal health-care law that led to it, said that federal auditors had issued subpoenas as part of their review.
“The Office of Inspector General has moved this from an audit into a full-blown investigation,” he said in a statement. “Now we know that fraud may have occurred.””

“While average compensation for top health insurance executives hit $5.4 million each last year, a little-noticed provision in the federal health law sharply reduced insurers’ ability to shield much of that pay from corporate taxes, says a report out today.
As a result, insurers owed at least $72 million more to the U.S. Treasury last year, said the Institute for Policy Studies, a liberal think tank in Washington D.C.
Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans, finding they earned a combined $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as a business expense, estimates the report. Before the health law, 96 percent would have been deductible.”

“Middle Tennessee State University (MTSU) is restricting student work because of compliance issues associated with the Affordable Care Act (ACA), commonly known as Obamacare.
In an email last week, MTSU President Sidney McPhee explained that “due to our interpretation of the reporting requirements of ACA,” graduate assistants, adjunct faculty members, and resident assistants are barred from working on-campus jobs that exceed 29 hours of work per week.
“[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus.” Tweet This
Now, they cannot take on multiple campus jobs.
“[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus,” the email stated.
McPhee noted that violations of the law “could add up as high as $6 million” in penalties.”

“Planned Parenthood Action Fund released today a t-shirt designed by actress Scarlett Johansson that targets the Supreme Court’s Hobby Lobby decision.
The front of the pink t-shirt reads “Hey Politicians! The 1950s called…” and the back reads, “They want their sexism back!”
“When I heard that some politicians were cheering the Supreme Court’s decision to give bosses the right to interfere in our access to birth control, I thought I had woken up in another decade,” explained Johansson in a statement.
“Like many of my friends, I was appalled by the thought of men taking away women’s ability to make our own personal health care decisions,” she added.
Um … what?
Let’s look at some facts, beginning with that the Hobby Lobby decision was fairly narrow. As Heritage policy experts Sarah Torre and Elizabeth Slattery explained, the decision didn’t strike down the Department of Health and Human Services Obamacare mandate that forces business to provide insurance coverage for twenty abortion-inducing drugs and birth control devices. “The Court did not strike down the mandate,” write Torre and Slattery, “but said that the government cannot force these two family businesses that object to providing coverage of four potentially life-ending drugs and devices to comply with the mandate.””

“Revenue at not-for-profit hospitals grew at an all-time low of 3.9% last year with sluggish gains in both inpatient and outpatient activity, according to a report on 2013 medians from Moody’s Investors Service.
In comparison, hospital revenue increased 5.1% in 2012 and historically has grown about 7% per year.
Moody’s pegged the increased popularity of high-deductible health plans for leading people to postpone care or seek out lower cost retail clinics. “Patients have more skin in the game,” said Jennifer Ewing, an analyst at Moody’s.
The volume decline also is coming amid a number of Medicare reimbursement cuts, including the ones known as sequestration triggered by the 2012 Budget Control Act and reductions in disproportionate-share hospital payments under the Patient Protection and Affordable Care Act. In addition, Medicare’s two-midnight rule has made it harder for hospitals to bill short stays as inpatient care, and commercial payers have offered lower payment rate increases.”