Feeds:
Posts
Comments

Posts Tagged ‘healthcare’

Originally published at caesarrodney.org

The cost of healthcare in Delaware is again rising rapidly.  It is looming as a major budgetary issue for the State of Delaware current employees and pensioners. Delaware’s Medicaid budget is increasingly strained. There is a steady flow of articles in the News Journal about the rising cost of health insurance, the rising cost of pharmaceuticals, and the rapid rise in both co-pays and deductibles for patients. There are, however, a few elements in play that have been overlooked, and may have significant effects in the short-term on the overall costs of both insurance and actual healthcare delivery.
While it is abundantly obvious to everyone that utilizes healthcare services that both co-pays and deductibles have risen in an effort supposedly to keep the cost of the overall premium down, the complaint has been made that this discourages the use of health insurance for routine care because of the high out of pocket cost. This is only a part of the problem.
While it is true that discouraging the use of healthcare services saves money for the insurance carrier, there is another side to this disincentive. I am referring to a phenomenon that we see frequently in medicine. Patients, who are usually quite economically aware of the deductible are also very aware that once the deductible has been met, all further healthcare is essentially free for the rest of the year until their deductible resets.
As a consequence, those who have had some healthcare incident recently often then seek out other elective healthcare treatments, medications, and surgery they might otherwise postpone. “I might as well get it done now under this year’s deductible.” Whenever there is an uptick in elective medical services, there is also an uptick in the sheer number of expensive adverse outcomes, although the percentage still may be very small.
Thus costs to the insurer go up. We are seeing this more frequently in our office this year and it is very common toward the end of the year that our services for elective surgeries become highly demanded. In common terms, the patients want to get the elective surgery done before the end of the year when their deductible resets. This is a strong economic motivation.
Quite obviously this will cause a substantial increase in overall costs to Medicare, Medicaid, and the health insurance industry.  All three of these entities have responded to the increasing costs of expanded coverage of the population by increasing the scrutiny over authorized services and increasing the frequency of denials of authorization, in short, rationing services.
The former of these two phenomena, elective utilization of health services after meeting the deductible, tends to raise overall spending on healthcare. The latter, rationing, of course, does the opposite and tends to lower overall expenditure. The question of which will be the dominant effect will be answered by the insurance actuaries when the next year rates are published. Most anticipate substantial rate increases.
There is, however, another phenomenon that we are seeing increasingly. This is the absolute lack of access to physicians. Increasingly, fairly young physicians are retiring from practice for a host of reasons. Dr. Ezekial Emanuel, one of Obamacare’s chief architects, famously said last year on television when asked about this phenomenon that “They will have to work. We will make them”. It turns out not to be true. What turns out to be reality is that doctors will not work under those circumstances and it further turns out that many doctors, especially those who are older and more experienced, easily have the wherewithal to retire.
In addition to this there is the phenomenon of “Community Care Plans”. These are Medicaid plans offered through the Obamacare exchange. In our office we have been getting dozens of phone calls from people asking whether we participate in these plans and if we know anybody who does participate in these plans. The truth is there is a very thin panel of doctors. By my count, looking at the Delaware panel of doctors for United Healthcare “Community Care”, fully one third of the listed entities were either not doctors, were duplicate listings, or were the names of facilities. Most of the family practices on the list are closed to new patients.
In my specialty, Orthopaedics, there are six surgeons listed who are all based at Crozier Chester Hospital in Pennsylvania. In short, there is very limited access to contracted physicians and surgeons. The net result is that the patient’s have a heavily subsidized health insurance card which is not capable of giving them access to healthcare except under convoluted circumstances, usually the Emergency Room. This is of course a very effective mechanism for United Healthcare to control its costs and continue to receive subsidies from both the federal government and the State of Delaware who offers these plans. The State can then say it has expanded the pool of people with health insurance even though that insurance is unusable.
The actual number of previously uninsured people now receiving preventative care is surprisingly small. As the Oregon experiment demonstrated with over a decade of data, the addition of Medicaid insurance to the uninsured population does not change their pattern of choice of the emergency room for their care. In fact, the net result was quite the opposite, emergency room utilization increased. It is not yet clear if that is happening or will happen in Delaware but similar efforts in both Massachusetts and Vermont have had identical outcomes to Oregon.
The news is not bad for everyone. Large hospital systems are suddenly thriving because their previously uninsured patients are now covered by Medicaid. The insurance industry is consolidating and the large carriers are reaping windfall profits from subsidies. For the moment, Delaware continues to have its state Medicaid insurance program subsidized by the federal government.
Soon enough though, federal Medicaid subsidies to Delaware will cease and the full burden of cost will return to the Delaware budget. The insurance industries will be squeezed by the “Death Spiral” as healthy patients decline to purchase the ever more expensive policies and only the expensive chronically ill remain in the insurance pool. In 2018 penalties, fees, and taxes are set to essentially end the health insurance industry as we know it.  Medicare has not yet been reformed and its insolvency has been accelerated by almost a decade. Small hospital systems will consolidate into large systems but will become de facto accountable care organizations, responsible for all community health, but presumably with highly restricted budgets based upon an insolvent single payor. Hospital care is costly and limited access to care is inevitable.
The “Affordable Care Act”, clearly misnamed, appears to be yet another example of “The Uncannily Predictable Law of Unintended Consequences”. Acronym TUPLUC.
C.D. Casscells, MD
Director, Center for Healthcare Policy
Advertisements

Read Full Post »

Earlier today, the Department of Labor published a new rule requiring overtime pay for workers who make up to $50,400 a year are eligible for overtime pay if they exceed 40 hours a week.

The idea, championed by President Obama, is this: If more employees are eligible for overtime pay (the average American worker makes less than 50 grad a year), then businesses will either pay their hardest-working employees more, or hire more workers to avoid paying the additional overtime penalty. The DOL estimates about 5 million people will benefit from this new ruling.

So this is wonderful, right? It’s well-known that for many people, employers can require more than 40 hours a week at no extra pay because employees are salaried and not hourly. The Cato Institute offers an opinion:

“In the very short run, employers affected by this expansion may have little choice but to pay their employees higher total compensation; in the very short run, employers have few ways to avoid this added cost.

But in the medium term, employers will invoke a host of methods to offset these costs: re-arranging employee work schedules so that fewer hit 40 hours; laying off employees who work more than 40 hours; or pushing such employees to work overtime hours off the books.

And in the longer term, employers can simply reduce the base wages they pay so that, even with overtime pay, total compensation for an employee working more than 40 hours is no different than before the overtime expansion.

So, expanded overtime regulation will benefit some employees in the very short term; cost others their jobs or lower their compensation in the medium term; and have no meaningful impact on anything in the long term.

Is that a victory for middle class economics?”

We at CRI agree with Cato. Just like with every other “well-intentioned” government law, those who are likeliest to “suffer” from it (in this case, employers), will find a way around it, especially in the long-haul. Employees who demonstrate clear value will likely not have to worry about their jobs, but anyone who doesn’t demonstrate clear value should be concerned. While many will benefit right away with the increases in pay, new hires may find their base pay is lower, so their potential overtime is lower. After all, time-and-a-half for a worker at $8.50 an hour is much less than at $15 an hour.

Plus, those who benefit now could see hours cut or, if the overtime pay began to turn business revenues from a profit to a loss, the businesses will lay off employees to stay in the black. This is what’s happened for many people as a result of the ACA: turning full-time workers into part-time in order to avoid the penalty, or simply paying the penalty and dumping people into the health exchanges, since that’s cheaper than offering health insurance. And with insurance companies asking for premiums increases, things are not looking up for American workers.

Read Full Post »

The official posture of the De. State Government is that Delaware has a state-sponsored health insurance exchange, Chooseheathde.com. The Supreme Court and the federal Department of Health and Human Services (DHHS) say otherwise, that Delaware has a federal exchange. Why does this matter?

It matters to the 90% of the people who purchased their health insurance through the DE exchange and received a tax subsidy. It also matters to the other 5 million people in the US who did the same. If the Supreme Court decides FOR the plain language of the Affordable Care Act in the King v. Burwell case, which will be heard in March, and upholds the ACA, which is likely, then those aforementioned people lose their subsidy, and likely their insurance, and may have to refund the IRS in their next tax filing for 2014 and 2015. They would be retroactively declared in default of their policy and therefore responsible for their health care costs directly.

The case is very likely to be ruled in favor of the legislation as written, that on January 28th the House Committee on Energy and Commerce requested the contingency plan in writing for the expected ruling from the Supreme Court. The same question put to the office of the Insurance Commissioner and the state Department of Health and Social Services referred me to the Federal DHHS and Sylvia Burwell for answers. Whereas the federal government has a contingency plan should the Supreme Court rule in favor of the plaintiffs in King v. Burwell, Delaware does not have one.

The only possible interpretation of this is that Delaware does not have a state-sponsored exchange and therefore is financially vulnerable to the outcome of the Supreme Court case. The state government should be aggressively making contingency plans for this outcome which will affect not only the thousands of Delawareans who are relying on tax subsidies to cover the cost of insurance plans purchased through the state exchange, but also for our state’s budget, should the cost of health insurance be dumped onto Dover from Washington D.C.

Chris Casscells, M.D.

Director, Center for Healthcare Policy

Read Full Post »

The open period was supposed to start in October and go to Dec 31. That would allow the ins companies to get set for the 2015 year. The previous March deadline was set because they knew few people would sign up right away.
The rates for this year are going to be very high and a lot of employers will drop out. I am expecting a 25-50% rate hike and many people are going to lose their subsidies as the data gets cross checked with the IRS.
Overall the destruction of the health insurance industry is working quite well and there should soon be no other choice but what is offered by the government as in Medicare. Already the exodus of good doctors has started and health related businesses, like the Scooter Store, are going bankrupt and closing. This is going to be a big downturn of 16% of the economy.
Coventry is essentially already out, Aetna remains in a diminished capacity. Blue Cross Blue Shield of Delaware is gone, absorbed by Highmark. The Delaware Health Commission released its plan this week and it disingenuously presumes a constant insurance market which the State can control. The truth is everyone wants a single payer system, everyone also wants to BE that single payer.
And yes, doctors are quickly moving to drop Medicare and Medicaid and some insurance altogether. Many are simply retiring. Some of my close colleagues are retiring by this year’s end and all are younger than me, mostly family practice. Everyone assumes that when control is established  that doctors will just work for less, but to the contrary, they just won’t work. This is the consummate flaw in Ezekiel Emanuel’s thinking. He says that they will have to work as told, but the truth is doctors will not be forced to practice bad medicine and, by and large, they can afford to quit, so they are and will in droves.
On a national and local level, Walmart, Home Depot, Walgreens, and Target have all cut back health insurance for those working less than 30 hours/week. On a local level,  Highmark just had its premium increases cut dramatically by Insurance Commissioner Karen Weldin Stewart, which means that they will not offer some products. They cannot calculate the rates now because the sign up period has been delayed onset until after the election cycle. On good background I believe that Highmark will withdraw risky insurance products in the Delaware market.
On a very anecdotal level, one of my patients who employs 47 people has directed his human resource person to fire 5 people so as to be well beneath the 50 person threshold for ACA. This is just as a precaution, in case they 50 employee mark is hit inadvertently.
The White House Administration has declared a moratorium on data release from CMS and the Federal Exchange Website.  I do not find any reason to be optimistic about the landscape.

Dr. Casscells, Director

Center for Healthcare Policy

Read Full Post »

CRI predicted years ago charity care would soon become a thing of the past. That’s because the Affordable Care Act, which just about everyone calls Obamacare, is set up to remove charity care from the equation.

Charity care is free healthcare many doctors provide as a service to the community. There is (or was) no financial incentive; a doctor did it because he or she believes in helping their fellow human beings. This was a way for very poor people and/or those who don’t have health insurance to receive healthcare they could not otherwise afford. Well, no more (in Delaware at least):

State to cut ‘charity care’ for near-poor

Delawareans pinching pennies near the federal poverty level – making from $16,100 for an individual to a maximum of $47,700 for a family of four – will lose health coverage through the state’s Community Healthcare Access Program (CHAP) starting Feb. 1, state officials said late Monday afternoon.

CHAP is a state-run program that offers discounted medical services for those not eligible for Delaware’s Medicaid program. The state earmarked $478,000 in tobacco settlement funds for the program this fiscal year.

CHAP recipients are ineligible for Medicaid either because they are undocumented immigrants or make more than 138 percent of the federal poverty level, Delaware’s cutoff for Medicaid assistance. The federal poverty level is $11,670 a year for an individual.

State officials said they will offer an alternative to CHAP on a case-by-case basis, only for those who can prove they are ineligible for other plans or are exempt from the federal insurance mandate.”

Now some of those who were on this program were individuals not legally authorized to be in the country. However, some were and will no longer receive help, and even for those here illegally, most medical professionals will tell you their desire is to help everyone who needs it, no matter what, because it is their calling.

“This is charity care and charity care more or less will be going away based on the mandate that everyone must have health insurance,” said Rita Langraf, secretary of Delaware’s Department of Health and Social Services, referencing the 2010 Affordable Care Act’s requirement that everyone should have health insurance.

The department is taking that mantra seriously. Landgraf said the state will continue to offer coverage for the undocumented population past Feb. 1, but CHAP recipients who make up to 200 percent of the federal poverty level will need to find new coverage.”

This is another problem. DHSS Secretary Landgraf is saying the state will ensure those not authorized to be here will receive benefits not extended to American citizens. Why? Because ACA mandates that all citizens must have health insurance- note the bolded words.

The main reason charity care is disappearing is because the government will begin reimbursing doctors for care previously provided as charity. This means taxpayer dollars will flow into doctor’s pockets for services they were going to perform anyway. If you were going to do something you always did, say brush your teeth, and the government offered to pay you to do that, would you turn that offer down? Most people would not and thus the government is ensuring a larger budget deficit for a service they don’t need to pay for. The other thing this will do remove the “good samaritan” role of medicine, eliminating volunteerism in favor of “rent-seeking” from the government (seeking public money for private bank accounts).

The health insurance exchanges open on Saturday and we were now only hours away from knowing what the 2015 insurance rates will be. If you haven’t yet received a letter notifying you of your insurance status for 2015, you will get it very soon. On Thursday CRI will publish another article on healthcare breaking down the new rates, discussing what you can expect going forward, and discussing how you can Impact Delaware!

photo:myptsolutions.com

Read Full Post »

This is a guest post from Mary Sandra Marie, Marketing Coordinator with the Regency Shop based in Los Angeles. In support of Breast Cancer Awareness CRI is posting this guest post. CRI is not being paid to post this nor are we affiliated in any way with the Regency Shop. If you are interested in bidding on these items to raise money for breast cancer awareness you may choose to visit the links below.

Here is How Regency Shop Supporting Breast Cancer Survivors.
October is the official breast cancer awareness month, and whether individual or business, everyone is coming up with creative and innovative ideas to support the social cause. Regency Shop, renowned modern furniture retailer has organized charity auction to financially support breast cancer research and encourage breast cancer survivors.
The furniture retailer has decided to provide beautiful custom designed chair while encouraging people to contribute to an important social cause. Regency Shop has been participating in the movement with three thematic auctions. Participates will get a chance to show their support for breast cancer survivors, and an opportunity to win one-of-a-kind stylish lounge chairs.
According to recent studies, one in every eight American women has chances to develop invasive breast cancer, and the count is expected to increase tremendously. You can generate awareness about the disease and be there for millions of women by taking part in Regency Shop’s exclusive auction during breast cancer awareness month, from 1st Oct to 30 Oct, 2014.
The charity auction organized at Regency Shop is not mere a contest. It’s more like you becoming October’s special hero by supporting a global cause, and support the event. It is indeed the best way to showcase your care for breast cancer survivors and bring a positive change to the world.
Regency Shop is auctioning three magnificent eero aarnio ball chair, hanging bubble chair and barcelona chair. All these three chairs are 100% custom designed and pink as pink is the signature color used in breast cancer awareness campaigns.
For auction listings visit:
Eero Aarnio Ball Chair
http://www.regencyshop.com/p514/Eero-Aarnio-Style-Ball-Chair-Special-Edition/product_info.html

Barcelona Chair
http://www.regencyshop.com/p513/Ibiza-Chair-Special-Edition/product_info.html

Hanging Bubble Chair
http://www.regencyshop.com/p515/Hanging-Bubble-Chair-Special-Edition/product_info.html

Mary Sandra Marie

Marketing Coordinator, Regency Shop

Read Full Post »