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  • Medical Debt Still a Problem for Those With Health Insurance January 23, 2015
    by Adrienne Snavely Medical debt can affect anyone of any age in any state in any income bracket. Medical debts account for more than half of debt collections on credit reports. One in three Americans struggle to pay medical bills, …
  • Q&A with Direct Pay Physicians January 22, 2015
    Direct pay physicians answer colleagues’ questions about third-party-free medical practice. From January 9, 2015, New Orleans AAPS workshop.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 2 January 21, 2015
    The pitfalls of Obamacare are that it makes healthcare affordable to the employee, yet unaffordable to dependents. Some plans cover children, but not spouses. This means less options for families. The independent physicians are being bought out by hospitals and …
  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.
  • Opting Out of Medicare January 20, 2015
    Lawrence Huntoon, MD, PhD, presents via Skype at the AAPS 21st Thrive Not Just Survive Workshop on Third Party Free Practice, January 9, 2015
  • Say Goodbye to 3rd Party Medical Payments January 19, 2015
    Obamacare is increasing costs, restricting access to care, and putting Medicrats in charge. Out of this adversity comes innovative physicians who are changing the world of medical care. Doctors know what is best for their patients, so they must be …
  • My Direct Pay Practice January 19, 2015
    Brenda Arnett, MD http://arnettmd.com, talks about why and how she launched a third-party-free internal medicine practice. From January 9, 2015.
  • AtlasMD: Direct Pay Primary Care better for patients and physicians January 18, 2015
    Dr. Josh Umbehr, founder of http://atlas.md speaks at AAPS XXI Thrive Not Just Survive Workshop, January 9, 2015 in New Orleans, LA.
  • Epiphany Health, Affordable, high-quality direct primary care January 17, 2015
    Lee Gross, MD, Founder, Epiphany Health http://www.epiphanyhealth.net & President, Docs 4 Patient Care Foundation http://www.d4pcfoundation.org addresses the AAPS Thrive Not Just Survive XXI conference, January 9, 2015, in New Orleans, Louisiana.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 1 January 16, 2015
    Wayne Brough of FreedomWorks interviews MediBid’s CEO, Ralph Weber, about Obamacare and Weber’s book MediCrats. Weber has found innovative ways to bring the free market to healthcare. MediCrats, by definition, are medical bureaucrats who add administrative burdens and increase costs. …
  • Third Party Free Specialty Practice January 16, 2015
    Gerard J. Gianoli, M.D., F.A.C.S. of The Ear and Balance Institute, Covington, Louisiana, http://EarAndBalance.net speaks at the AAPS Thrive, Not Just Survive workshop held January 9, 2015 in New Orleans.
  • Stop the Interstate Licensing Compact January 15, 2015
    Dr. Ken Christman explains how the FSMB’s proposed compact is a backdoor for MOC and MOL. January 9, 2015, New Orleans, LA.
  • Update on AAPS Legal Initiatives in War on Doctors and Patients January 15, 2015
    Andrew Schlafly wraps up Thrive XXI with a look at ongoing and future AAPS legal initiatives to protect patients and their physicians.
  • The Answer to American Medicine is NOT Coming from DC January 15, 2015
    … it is coming from physicians who are kicking ObamaCare and insurance OUT and working directly with their patients, explains AAPS Executive Director, Jane M. Orient, MD. From AAPS Thrive, Not Just Survive XXI, Jan. 9, 2015, New Orleans, LA.
  • The End of the 10-Minute Doctor’s Appointment January 14, 2015
    The patient-physician relationship should be balanced, not one-sided with physicians skimping on visit time and not allowing patients to ask enough questions or explain their symptoms well. Eighteen seconds is the average time a patient is allowed to talk before …
  • The Physicians Declaration of Independence in 2015 January 14, 2015
    We need a critical mass of truly independent doctors and core who will pass along the art of medicine to the next generation, explains AAPS President Richard Amerling, MD on January 9, 2015 at talk to colleagues in New Orleans, …
  • Physicians & Patients: Take Your Power Back January 14, 2015
    Dr. Elaina George explains that it is crucial for patients and physicians to work together outside of ObamaCare and insurance-dominated system. She discusses alternatives to ObamaCare such as health care sharing programs like Liberty HealthShare: http://LibertyOnCall.com
  • Self-Funded Awareness & The Movie “Dune” January 7, 2015
    by G. Keith Smith, MD “The sleeper has awakened.” Anyone who has seen the movie “Dune” knows the scene where Paul Atreides proclaims his new awareness. Having recently attended the annual meeting of the Self-Insurance Institute of America I was …
  • Perils of Obamacare Reenrollment January 5, 2015
    Obama has come up with the 95% solution to make reenrollment figures look good: A senior federal official told CNBC that an estimated 95 percent of HealthCare.gov enrollees—some 5.1 million people—will be signed up for the 2015 plan year and …
  • Chris Hobbs on MediBid’s Value-Based Medical Care December 31, 2014
    Chris Hobbs, CFO of MediBid, spoke with David Saltzman on ShiftShapers podcast about how MediBid works. As a former banker and recent immigrant from Canada, Hobbs sees the free market as the solution to the current broken system in delivery …

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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