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  • Why You Should Eat More Prunes November 24, 2014
    Many people are not fans of prunes, yet sales of “dried plums” are on the rise. Prunes have been a popular digestive remedy for decades with their fiber, stool loosener, and natural laxative compound. They are a sweet treat for …
  • ACA Architect Gruber Insults Voters November 21, 2014
    MIT economist Jonathan Gruber (an architect of Obamacare) has emerged in a handful of videos insulting the American public. In one video, Gruber discusses how voters’ “lack of economic understanding” enabled a politically unpopular tax on “Cadillac” health plans to …
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    Heart disease is the #1 cause of death in the United States. The odds of surviving a heart attack outside of a hospital is only 8%. Four out of five heart attacks occur at home where there is no emergency …
  • Eugenics in America – In the Name of Science November 17, 2014
    Marilyn M. Singleton, M.D., J.D. presents at the AAPS 71st Annual Meeting, September 5, 2014, Charleston, South Carolina
  • Supreme Court to Examine Issue of Obamacare Subsidies November 14, 2014
    The Supreme Court will decide the fate of Obamacare yet again. This new case challenges the key issue of subsidies used to assist in purchasing insurance in the exchanges. This decision to hear the King v. Burwell case has surprised …
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    A new study has discovered that the protein tau (the “tangles”) is the main cause of Alzheimer’s disease, not plaque as was previously believed. Tau determines how much amyloid protein stays in the cell and how much is secreted outside …
  • Direct Primary Care Reduces Healthcare Costs November 5, 2014
    Direct primary care benefits both the patient and the physician. Many people could afford medication if they could afford the office visit it stems from.  Clinics that take insurance have to hire extra people and invest in special technology in …
  • The Problem and Solution for Our Healthcare System November 3, 2014
    by Timothy D. Wingo, MD; Owner – Atlas Healthcare, PA It is obvious to everyone that the healthcare system in our country is broken and getting worse. What is not so obvious is what it would take to fix it. …
  • 3 Steps to Get Rid of Heartburn and GERD Forever October 31, 2014
    Heartburn and GERD are caused by too little stomach acid and bacterial overgrowth in the stomach and intestines. There are three steps to treat heartburn and GERD without drugs and keep them from returning. Reduce factors that promote bacterial overgrowth …
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 5 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 4 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 3 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • The Wasting of Taxpayer Money October 29, 2014
    by G. Keith Smith, MD If you are looking for proof of the fact that the wonderful folks in D.C. are more interested in lining the pockets of their pals than demonstrating good stewardship of the loot from the robbery …
  • Giving Birth in America is Most Expensive in the World October 27, 2014
    While a woman is preparing for giving birth, one worry she doesn’t want to have is about the cost of delivery. Insured women are finding that some policies do not cover maternity care, services that most often do not have …
  • Physicians are Not Medicine’s Top Earners October 24, 2014
    Physicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general …
  • Health Benefits of Honey October 22, 2014
    Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  plant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate …
  • Rotten Food and the VA Hospital October 20, 2014
    by G. Keith Smith, MD Imagine for a moment that you own and operate a restaurant knowing that if you provide spoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to …

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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