Obamacare website dysfunction is least of our worries, the entire system is missing

Obamacare website dysfunction is least of our worries, the entire system is missing

12/04/13

Today ex-President Bill Clinton said that when the healthcare website is fixed in the next few months, few will even be talking about Obamacare.

The ease of this coming out of his mouth is remarkable, for I am sure it was nearsighted and biased based on his support for the president, his plan and his party.

Short term and long term future projections of problems are glaring. Let’s look at a few issues facing the facilitation and implementation of Obamacare.

On January 14, unless something drastically happens the employer mandate will go away. 80 million more Americans will lose their healthcare plans with their employer. Your employer can do away with the shared subsidy that has burdened them for years, essentially putting millions back into the company and shifting the burden to the employee, who is forced to purchase a plan from a government exchange at a higher rate. This simple maneuver by big business and supported by the Chamber of Commerce speaks volumes of their self interest in catering to this plan. It fully explains the deafening silence from big business. Small business, so what, they are an after thought in this process and portray themselves as the red headed step child that has been thrown from the supportive teet.

The newly revealed aggregation rule is going to stifle small business and further place a financial burden on those struggling to survive in today’s economy. For instance, if a small business backs down to 45 employees to dodge the forced purchase of healthcare and hires part-time employees but aggregates or accumulated to an equal of 5 FTEs or full time equivalents they meet the 50 employee threshold and will be forced to purchase insurance for all. 

Young adults are running from Obamacare in droves. Mostly this age group coming out from under the 26 year old protection plan of their parents will soon be out on their own facing huge premiums and less care with extremely high deductibles. So much that many will only pay deductible expenses for their healthcare, essentially seeing no benefit from their plan, assuming they choose to participate.

20 percent of young folks say they are likely to sign up for Obamacare. Which means 80 percent are not going to sign up which spells failure. The young are graduating from school with a burdensome student loan debt, starting a family, buying a home and are in relatively good health. They are not going to be inclined to pay premiums that are 200 to 300 percent more expensive than it was a year ago. 

Less numbers means higher premiums! Fewer people in the share pool will only raise premiums and limit choice. Obamacare reporetdly needs 100 million people enrolled and paying high premiums for the plan to work, to start paying for itself. The risk of less is costly and will drive higher premiums with progressively less and less healthcare choice. If young people dont assume the burden and purchase the insurance, it only makes sense that those enrolled shoulder the burden regardless of their age or ability to pay. This is the death spiral we speak of.

The risk pool is thin. Insuring pre-existing conditions and covering all disease types leaves many layers of risk meaning needs will out live the money pool. Many with disabilities and debilitating pre existing conditions will run to Obamacare because they see it as a bargain, which will drain the system inside a thin risk pool. This measure will drive higher cost and result in higher sharing of that cost on you.

States are not even ready for the onslaught. Tennessee for example, elected not to participate in the federal exchange and opted to allow the government to control the state. Two things stand in the way of this happening. Tennessee is not ready to handle the government enforcing Obamacare and TN has no known plan in place to implement the needed demands of Obamacare. We do not even have a website or a process in place to handle the claims. To complement this statement,  we have to date refused to expand Tenncare, an essential component that could contribute to the success of Obamacare, but remains costly.

When you do sign up there is really nothing more contained within than that. You have signed up. Period! There should really be no discussion beyond this point. But I will digress.

Hospitals are not prepared for implementation of Obamacare. No plans are in place to facilitate the movement of patients through a system designed on Obamacare. No plans whatsoever. Hospitals and providers squawk about the plans but no government sponsored “magic” pill has been delivered. Healthcare providers are moving along the same course and acting as if we are in the same system as before. Nothing had changed that is visible. No education to the public, staff or providers within that system being relied upon to enact and enforce this dreadful system. And this system was accepted in 2010.

Accounting software, enforcement guidelines, payment structure, reimbursement, legal challenges, nothing is in place. The healthcare system is not prepared and things are not in place to get it done.

There is no overseeing authority communicating between the local level, state level or federal level. So far, it’s just been said do it but no one is doing anything, or more accurately no one knows what to do.

The idea of redistributing the wealth on a large scale is not enticing to those having to pay for it. The old saying is that under socialism, you eventually run out of other people’s money. You take from the old, give to the young, wealthy to the poor, those who have to those have not. Many Americans are simply sending a message that we will not continue to pay for someone else or will not participate. Not signing up is a strong message that something is awry.

Small business will take a beating! The concept that large corporations will be protected while small business gets the shaft. This goes in the same vein as redistribution of wealth. This coupled with increasing minimum wage will shut down jobs and businesses all over the nation. Can we see what is happening here folks? The president is implementing the Cloward-Piven strategy that he was mentored to implement. Overwhelm the system till she collapses, then rebuild it, with total dependence on the government.

Just wait till the population that does participate begins to see the problems inside the system and realizes the many promises unkept. A backlash and further dis-enrollment surely to follow.

Out of network caregivers are going to inconvenience and baffle many that are wanting to keep their doctor. Many within the area are and will be seeing a Dr perhaps in Nashville or Memphis. Can you imagine going to see your Dr in Nashville, crossing Monteagle Mountain and hitting the traffic to find your out of network provider for a cold or to refill a prescription.

We do not have a subsidy verification system in place. No computer system that links with our government on any level. There is no communication or grids that can be followed, just a phone call remains as the only way to communicate and if you have ever tried to get a procedure approved or a bill payed by phone you know what a headache that is.

Insurance companies are now going to be given subsidies based on an honor system with insurance companies where insurance companies take taxpayer money to provide healthcare and then settle the difference on the backside. Can you imagine with this fluid reimbursement structure the wide variability in reimbursement causing a great fluctuality in payment and fee schedules? 

Patients are showing up at hospitals with the self conceived concept that they will be turned away or asked to go to another hospital for their care because perhaps this particular hospital didn’t cover their care or they were not covered by Obamacare. As we speak some hospitals are starting to turn patients away based on the demands of Obamacare.

The upwards of 20 or more new taxes made to pay for or fund are not palatable to many folks moving forward. Less money in your pocket is never acceptable.

Doctors are not gonna bother with the insurance obstacles, going to cash for service. Completely bypassing the system. It’s already happening.

The end product is Americans are without more of their hard earned dollars and the government is taking it! 

It does not get more simple than this!  

We are being raped of our healthcare and we are being forced to like it or suffer.
 
We think that fixing the website will fix Obamacare, think again!

This is only a distraction. 

It is not the real issue. The “guts” the “nuts and bolts” are missing. The plan has been spoken but nothing else. 

It has been revealed today that Kathleen Sebelius, Secretary of HHS, only met with president Obama one time before the launch of the ACA, ie, Obamacare website. This is somehow not surprising. The whole system is lacking detail. No plan is in place whatsoever!

Obamacare is crumbling, it’s in a death spiral and you are on the receiving end of it.

Contact your elected officials. Your vote and voice is the only one that can change things.

Hospitals forced to not see non-emergent patients under Obamacare beginning January 2014

Hospitals forced to not see non-emergent patients under Obamacare beginning January 2014

Hospitals and Emergency Centers are being forced to stop rendering healthcare to non-emergent patients beginning January 1, 2014  under the Affordable Healthcare, Obamacare guidelines.

The DSH or Disproportionate Sharing Hospitals will start seeing a large decrease in reimbursement rates to hospitals currently treating indigent, non insurance bearing patients.This action will force hospitals to seek alternatives to delivering “free” or “uncompensated” care just to survive.

Hospitals across America are starting to either opt to not see uninsured patients in an emergent setting, demand payment up front, link payment to a bank account (as reported by BCN in previous blogs) in order to survive.

DSH Reductions will force Emergency rooms, hospitals and providers to resort to third world tactics to survive in a post Obamacare reimbursement world.

Shadac reports; “A national total of Medicaid DSH money is allotted across the states each year, with a 2011 total of $11.3 billion (closer to 20 billion in 2013). ”

“The ACA (Obamacare) reduces the annual Medicaid DSH total by $500 million in 2014; $600 million in 2015; $600 million in 2016; $1.8 billion in 2017; $5 billion in 2018; $5.6 billion in 2019; and $4 billion in 2020.”  

“In implementing these reductions, the statute requires HHS (Health and Human Services) to develop a “DSH Health Reform methodology” that imposes the largest percentage reduction on states with the lowest percent of uninsured or on states that currently do NOT target their DSH payments to hospitals with high volumes of Medicaid patients or high levels of uncompensated care.”

Uncompensated care, decreased allotments to hospital and providers will tip the scale to the patient placing the burden of payment upon them. Those who wish to remain uninsured and reporting to a hospital with a non emergent condition will begin to be turned away. There is no other viable scenario at this juncture.

If you work in or are associated with providing care in an Emergent Center you know that a great percentage of what presents to the Emergency Room, the entry point of any hospital, is either non emergent or uninsured. This population, presently and in the past, was pretty much taken care of by the DSH allotment now being taken away by the Affordable Healthcare Act or Obamacare. 

This action will leave millions vulnerable and seeking a setting where healthcare is delivered by a cash only scenario with very little regulation, a black market approach if you will. The underground provider or nurse with the ability to diagnose and treat on the spot for cash, bypassing the whole system. Think it will not happen?It’s already happening.

The Patient Affordable Care Act was intended to catch those patients or provide the net that was previously cast by hospitals under the Disproportionate Sharing Hospital plan. That safety net is now being removed and many are not going to like the outcome. The  net now has a wide hole in it and patients will be falling through rapidly.

Obamacare was ideally supposed to be the safety net pulling in some 40  million plus uninsured, give them “free or a terrific deal” on an insurance policy that would fix all their healthcare needs, off setting the total cost of healthcare, leaving “all” to share the load, so to speak.

What the “healthcare system” and the patient population system failed to see coming was the disastrous roll out of Obamacare and the many unexpected costs and high premiums associated with it and the amount of people running from it!

With premiums as high as several thousands of dollars a month for a family plan, three to five hundred  for a single young adult you can easily see why those this bill was intended to help will only hurt.

The recent ACA website rollout with it’s whopping 6 patients enrolled and ballooning premiums has left many seeking healthcare seeing a bad case of sticker shock as hospitals and providers look for survival measure to mediate the losses, to balance their budgets.

The proportional shift of most of the cost to young people is forcing millions to reevaluate the “need” to purchase healthcare instead opting to pay the relatively small fine at the end of the year. This leaves many with the inability to seek non emergent healthcare.

A dilemma has surfaced with no quick fix in site and only surmounting issues. 

Millions of Americans and financially strapped families choosing to not participate in Obamacare are facing yet another hurdle. 

Higher premiums, cancelled policies, opting to not purchase government insurance has left many in a quandry with few options leaving many financially strapped individuals to choose between purchasing a bad government forced  insurance, not seek medical treatment or ultimately choosing to say the heck with it all, Im putting food on the table for my family. The latter is the dignified approach and probably the preferred alternative.

This shifts most of the cost now to the employer, small businesses, the middle class and the everyday citizen……you, John and Jane taxpayer.

Higher taxes, up to 20 new taxes in all, higher premiums, increased shared costs with fewer participants  leaves hospitals with no other viable choice but to cease treating patients ie; the uninsured, the immigrant and the non emergent.

EMTALA, a regulation that forces hospitals and providers to care for patients regardless of their ability to
pay will be challenged under new Obamacare guidelines. 

The challenge will now be if you want healthcare in my hospital, you must purchase the insurance that your government is forcing upon you or we cannot see you!

Obamacare or the Affordable Care Act has created a major “boondoggle” of sorts.

It has offered unaffordable, unreliable care, a poor payment structure, reduced reimbursements for hospitals, higher premiums while forcing you to participate and not doing so will result in higher taxes and fines for you not doing so. 

Obamacare has forgotten to close or mend the hole in the safety net. That proverbial hole being hospitals have now trumped the administration using their own rules closing the door to healthcare by opting out of your health care if you don’t buy the mandated government insurance. 

What does a patient do? What does a hospital or provider do?

Well, simply put, patients will continue out of neccesity to not purchase this high premium government insurance forcing hospitals and providers to shut their doors till you purchase the insurance for your non emergent needs?

Will the government now say to the hospitals you must treat these patients regardless of their ability to pay per EMTALA regulations or force you to buy the insurance that the hospitals are now both saying you must buy to dart the door of our emergency room?

 Nothing would surprise me but a simple statement like that would not support the governments plan of forced or mandated healthcare for everyone, this rendering EMTALA non-existent.

Obamacare has contributed to this boondoggle by introducing the Individual Shared Responsibility plan and has placed upon you yet another way to make you pay for your healthcare.

Introducing the Individual Shared Responsibility plan under the  Affordable Care Act directly from the ACA healthcare exchange site.

Beginning January 2014, the Individual Shared Responsibility provision calls for each individual to either have minimum essential coverage (whatever that is) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return. 

On Aug. 27, 2013, the Department of the Treasury and the IRS issued final regulations on the Individual Shared Responsibility provision, Notice 2013-42….

The open enrollment period to purchase health insurance coverage for 2014 through the Health Insurance Marketplace runs from Oct. 1, 2013, through March 31, 2014.

The American Emergency Physician Association has prepared a statement regarding reimbursement under the ACA or Obamacare and I summarize. (See link below for full statement)

The ACA forces doctors, hospitals and providers to treat every pt under EMTALA while reimbursement rates go down. 

The ACA forces non good faith reimbursement scenarios where the hospital is forced to take care of patients with shrinking reimbursement from the government while private insurers reap the benefit of taking advantage of a low loss scenario having the distinct advantage of bypassing the benefit of a high cost uninsured patient population.

This has left hospitals, mainly Emergency Centers to force payment up front or stop treating non emergent patients.

Recently information was passed to Bradley County News from a social media website that depicts the following,

The Appalachian Regional Healthcare system in Kentucky has made the unprecedented move to opt out of treating non-emergent patients. 

A flyer or memo has  recently been sent out to patients and posted in their ERs which states, “Attention patients: Consistent with the Affordable Care Act, we will no longer be able to see  non emergent patients without healthcare coverage beginning January 2014!” The saga begins!

Can you see what is happening here? 

The government is saying you must purchase insurance, the hospitals must provide care  regardless of ability to pay under EMTALA, decreasing reimbursement to those providing care and now the hospitals are taking the desperate steps to say NO, we can no longer see you unless you purchase mandated insurance by the Federal government.  

The end scenario: 

Patients will be unable to enter the ER for non emergent care. They will be unable to pay for a Doctors office visit. This will leave millions without a portal of entry and forced to stand outside hospital doors begging for care and access or seek alternative, perhaps underground behind the scenes treatment inside a newly developed black market.

This is reminiscent of third world country healthcare, then again this end product is intentional isn’t it?

 It is about control of the populace?

Right?

Sources of info:

Disproportionate hospital share is going down!

Click to access PatientProtectionsandAffordableCareAct_PPACA_Position_Statement.pdf

http://www.shadac.org/blog/aca-data-note-hospitals-medicaid-expansion-and-disproportionate-share-hospital-dsh-payments

DSH Hospital Allotments through 2011. TN included.

Click to access DSH%20summary.pdf

http://www.nytimes.com/2012/07/27/nyregion/affordable-care-act-reduces-a-fund-for-the-uninsured.html?pagewanted=all&_r=0

Click to access 2013-21157.pdf

Click to access media.352.pdf

Obama launches 23 executive orders to advance gun control agenda

Hot off the presses: Obama launches 23 executive orders to advance gun control agenda!

The president of the United States just issued 23 new executive orders to push his socialistic agenda of eventually taking your gun rights away from free Americans.

In a press release the White House issued a complete list of orders that will lead to banning guns in the US forever and eroding our constitutional, God given rights.

Our country is in the midst of a complete transition to a socialistic dictatorship. Our forseeable legacy and sadly so we are inevitably going to be known as the generation that let our country and it’s greatness collapse right along with it’s freedoms.

We cannot allow this to happen! Contact your Congress men and women, Senators and Governors and demand they stop this dictator NOW!

We are no longer in a might or conspiratorial mode, we are in it’s happening as you read this. Our country and it’s Socialist Dictator is making his move. We have stood back and observed long enough. We must get our elected body to once again represent the people. We must save this great country! What a shame to see her fold!

Take a look at these extensive executive orders. It seems he is going after our guns with the mental health care issues. Ever had a breakdown? Ever just talked with a psych Dr? Have PTSD? Take psych meds? On Ritalin? Antidepressant? Yeah thats a great deal of Americans. And guess what? He is using Obamacare, aka, the Affordable Care Act to access your records to clear you for your ability to carry a gun!

Concerned now? Best be! Gonna be alot of changes you are not going to like. Going to be a real tough pill to swallow.

THE WHITE HOUSE
Office of the Press Secretary
EMBARGOED UNTIL THE START OF THE PRESIDENT’S REMARKS
January 16, 2013

Gun Violence Reduction Executive Actions
Today, the President is announcing that he and the Administration will:

1. Issue a Presidential Memorandum to require federal agencies to make relevant data available to the federal background check system.

2. Address unnecessary legal barriers, particularly relating to the Health Insurance Portability and Accountability Act, that may prevent states from making information available to the background check system.

3. Improve incentives for states to share information with the background check system.

4. Direct the Attorney General to review categories of individuals prohibited from having a gun to make sure dangerous people are not slipping through the cracks.

5. Propose rulemaking to give law enforcement the ability to run a full background check on an individual before returning a seized gun.

6. Publish a letter from ATF to federally licensed gun dealers providing guidance on how to run background checks for private sellers.

7. Launch a national safe and responsible gun ownership campaign.

8. Review safety standards for gun locks and gun safes (Consumer Product Safety Commission).

9. Issue a Presidential Memorandum to require federal law enforcement to trace guns recovered in criminal investigations.

10. Release a DOJ report analyzing information on lost and stolen guns and make it widely available to law enforcement.

11. Nominate an ATF director.

12. Provide law enforcement, first responders, and school officials with proper training for active shooter situations.

13. Maximize enforcement efforts to prevent gun violence and prosecute gun crime.

14. Issue a Presidential Memorandum directing the Centers for Disease Control to research the causes and prevention of gun violence.

15. Direct the Attorney General to issue a report on the availability and most effective use of new gun safety technologies and challenge the private sector to develop innovative technologies.

16. Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes.

17. Release a letter to health care providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities.

18. Provide incentives for schools to hire school resource officers.

19. Develop model emergency response plans for schools, houses of worship and institutions of higher education.

20. Release a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover.

21. Finalize regulations clarifying essential health benefits and parity requirements within ACA exchanges.

22. Commit to finalizing mental health parity regulations.

23. Launch a national dialogue led by Secretaries Sebelius and Duncan on mental health.