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  • Health Insurance Exchanges Waste Taxpayer Money September 29, 2014
    Obamacare may surpass Cash for Clunkers to become the prime example of federal taxpayer resource mismanagement. For every dollar in premiums for exchange coverage, taxpayers paid 94 cents in subsidies to either enroll people or encourage them to do so. …
  • Mesothelioma: An avoidable cancer? September 26, 2014
    by Sue Redmond Did you know? Mesothelioma is an aggressive cancer that attacks the lining of the body cavity called the mesothelium (80% of which occur within the lining of the lungs). The only known cause to mesothelioma is exposure …
  • Government Healthcare is Breech of Contract September 24, 2014
    by G. Keith Smith, MD One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years.  He has advised me, among other things, …
  • Dr. Alieta Eck Campaign Update September 24, 2014
    Dr. Eck http://EckForCongress.com speaks to colleagues at AAPS 71st annual meeting on September 5, 2014.
  • Is There A Provider In The House? September 22, 2014
    by Marilyn Singleton, MD, JD Physicians have a proud heritage. We can boast Dr. Benjamin Rush, a founding father, signer of the Declaration of Independence, Surgeon General of the Continental Army, and opponent of slavery. And Dr. James Derham, born …
  • From EBM to Guidelines September 20, 2014
    Richard Amerling, MD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 5, 2014.
  • Flaw In Federal Software Lets Employers Offer Plans Without Hospital Benefits September 19, 2014
    A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits such as hospitalization coverage, according to brokers and consultants. The calculator …
  • Ralph Weber Talks About Cost Shifting – Video September 17, 2014
    How do hospitals come up with their prices? Medicare patients cause them to lose money. They have to make up the difference by charging the self-insured more. Non-profit hospitals keep beds vacant or build other facilities so as not to …
  • Here’s The Thing #4 Cost Shifting HD September 17, 2014
  • The Commoditization of Medicine September 17, 2014
    Parvez Dara, MD, FACP, MBA, author of http://jedismedicine.blogspot.com/, speaks at the AAPS 71st Annual Meeting in Charleston, SC.
  • The Progressive Train Wreck: From Medicare to HillaryCare to ObamaCare September 15, 2014
    Jane M Orient, MD presents at the AAPS 71st annual meeting, September 5, 2014, Charleston, SC.
  • Varying Prices for Lab Tests are Absurd September 15, 2014
    by Adrienne Snavely The health needs of a community vary by market. If you cannot find what you need or afford it, you should have the opportunity and information to go elsewhere without being penalized. A patient in Chicago went …
  • The Future Of Medicare September 14, 2014
    Lawrence R. Huntoon, MD, PhD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 6, 2014, Charleston, South Carolina.
  • Unethical ABMS behaviors and the MOC Scam: How It Will Be Used to Control Medical Practice September 13, 2014
    Paul Kempen, MD, PhD presenting at 71st annual meeting of AAPS, September 6, 2014, Charleston, SC.
  • How is that low fat diet working out for you? September 12, 2014
    by Sue Redmond First, let’s ask where did the idea for the low diet come from? In the late 50’s and early 60’s the AMA worked on a theory and published a report that a low fat diet could help …
  • EHR: Remote Control – Craig M. Wax, D.O. September 12, 2014
    Dr. Wax of http://ip4pi.wordpress.com examines how government-controlled electronic health records undermine quality medical care and patient privacy. Presentation at 71st Annual AAPS Meeting Sept. 4-6, 2014.
  • Evidence-Based Medicine as Junk Science — Twila Brase RN September 11, 2014
    Twila Brase, President of http://CCHFreedom.org outlines how so-called evidence-based medicine (EBM) encourages one-size-fits-all healthcare, is a tool for increased control by insurance companies and the government, and is detrimental to individualized patient care.
  • What ObamaCare Means for Patients September 11, 2014
    Kris Held, MD addresses the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 4, 2014 in Charleston, SC.
  • Private Health Care is Individualized Care, Not Public Health — Richard Amerling, MD September 10, 2014
    AAPS President-Elect Richard Amerling, MD opens the 71st Annual Meeting, Sept. 4, 2014, Charleston, SC.
  • Come Together – The Kidney Stones September 10, 2014

Preparing for the obamacare Exchanges

Some states are very anxious to install an obamacare exchange. I think it has to do with addiction to government money. Legislators don’t always understand that the government doesn’t actually make any money (other than running printing presses). It is the citizens and residents who make money. The government simply takes it from us, and borrows it from China. So when you hear the term “federal monies”, these are your dollars and mine.

http://thehealthcareblog.com/blog/2011/09/22/preparing-for-exchanges/

By JOHN GRAHAM

What is the biggest waste of effort in American health care today?

I’d suggest it is the hustle and bustle to establish PPACA’s Health Benefits Exchanges.  The health insurers’ trade association, AHIP, has an entire educational series on “preparing for exchanges.”  The likelihood of exchanges being up and running by January 2014 is vanishingly close to zero.  Indeed, they may not exist at all except in very few states – whether or not President Obama wins re-election.

Last January, I wrote in The Health Care Blog that states should not collaborate with the federal government in establishing exchanges.  Almost all states have taken this course.  Recent days have brought forward new evidence that exchanges are facing even bigger problems than previously understood.  The New York Times reports that Republican state senators are blocking a bill that would allow the state to establish an exchange and claim federal handouts to get it up and running. (A few weeks previously, Kansas governor Brownback actually sent a $31.5 million federal PPACA grant back to D.C.).

If they can’t get a PPACA exchange up and running in New York, of all places, where the heck will they? Only 13 states have passed pro-exchange legislation (and some of these bills don’t do much more than establish study groups).

Republican state politicians are clearly hardening their stance against exchanges. It appears that they are no longer fooled by the argument that if they do no collaborate to establish state-based exchanges, the federal government will enter their state and do it for them. Recent close reading of the law has debunked this notion. As written, the Patient Protection and Affordable Care Act (PPACA) has (at least) two clauses that will prevent this from happening – even if the Obama Administration had the operational capacity to establish federal exchanges (which it does not.  That’s why it desperately pitched “Partnership Options” to states the other day.)

First, courtesy of Investors’ Business Daily’s David Hogberg and the Cato Institute’s Michael Cannon, we learn that federal exchanges will not be able to funnel the gusher of refundable tax credits to individuals who enroll in them.  The gist of the argument is that the law only allows state-established exchanges to funnel the tax credits. If a state fails to establish an exchange, and the federal government steps in, that exchange is not eligible for the tax credits.  Neither Hogberg nor Cannon cite it, but it appears that they are referring to section 1401 of PPACA (on page 110 of this version), which clearly refers to section 1311 (state-based exchanges) as eligible for the tax credits, and does not mention section 1321 (federal exchanges).

Please read the section yourself. I hate to play barrack-room lawyer, but I’m 80% to 90% sure that Hogberg and Cannon are right.  Writing in The Health Care Blog, Professor Timothy Stoltzfus Jost makes an argument that no court would accept this interpretation – even though it’s what the law states!  (The reconciliation act, which Professor Jost cites, does not amend this constraint.  It merely demands that federal exchanges report any tax credits, not provide them.)  As for “standing,” Hogberg notes that any business (in a state with a federal exchange) which is fined for not providing health benefits, should have strong claim to standing.

Maybe it is ridiculous to think that a court would actually adjudicate what the law states, rather than what its proponents wish it to state.  But courts do interesting things.  When I first heard that some attorneys general were planning to challenge PPACA’s constitutionality, I thought they were in fantasyland.  Today, the law hangs by a judicial threat, and will eventually be adjudicated by the U.S. Supreme Court.

Second, as I noted in a recent article, states can also stop federal exchanges by threatening to pull the licenses of health insurers which intend to participate in them (p. 58 of this version). The law defines a “qualified health plan” as one that is “licensed and in good standing in each State…”, and only qualified health plans can participate in exchanges.

So, federal exchanges have a double whammy against them. States have learned not to fear that the federal government will step in and operate exchanges for them. Health IT vendors and other businesses that are investing in winning business from exchanges would be well advised to cut their losses, and reinvest in more fruitful business development.

John R. Graham is Director of Health Care Studies at the Pacific Research Institute, & Senior Fellow at the National Center for Policy Analysis.



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