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  • The Truth About Sugar December 15, 2014
    The past decade’s focus on low-fat diet has led to an unintended consequence, an increase in sugar consumption. Many people are not aware of exactly how much sugar they are actually consuming. The sugar, processed food, and beverage industries do …
  • Yet Another ObamaCare Miscalculation December 12, 2014
    by Marilyn Singleton MD, JD On November 13th, the Government Accountability Office (GAO) issued a report finding that that enrollment for the state-operated Small Business Health Options Program (SHOP), created by the Affordable Care Act, was significantly lower than expected. …
  • Ralph Weber Talks About Root Causes of High-Priced Healthcare – Video December 10, 2014
    The main reasons that health care costs so much are because of lack of transparency, lack of competition, and the complexity of the system. There is a lack of transparency between the patient and the provider, as well as between …
  • Here’s The Thing #6: Root Causes December 10, 2014
  • Yogurts: Not All Are Created Equal December 8, 2014
    by Adrienne Snavely Most commercial yogurts are full of artificial colors, flavors, and sugar, which stimulate disease-causing bacteria, yeast, and fungi in the gut. This overpowers your good bacteria, increasing the chance you’ll get sick. Healthier yogurts are pasteurized at …
  • The Scientist, the Sage, and the Homunculus: The Psychology of Direct Pay Medicine December 7, 2014
    How Patients and Doctors Make Decisions About Payment for Care. Dr. Robert Emmons and Dr. Josh Umbehr of http://Atlas.MD discuss the psychology behind direct pay medical care. From September 4, 2014, AAPS 71st Annual Meeting.
  • “The Rich, Fat Giant & the Free Market” – A Bedtime Story December 5, 2014
    by G. Keith Smith, MD When my children were young, I used to make up bedtime stories for them, stories they recently reminded me they remember even now.  I hope you enjoy the following actually true story, many versions of …
  • Hysteria’s History Episode02 FINAL December 4, 2014
  • Should You Worry About Phthalate Exposure While Pregnant? December 3, 2014
    Chemicals called phthalates are used to make plastic items more flexible. They are found in packaged foods and personal care products. In the past few years, studies showed that phthalate exposure put pregnant women at risk of complications and fetal …
  • Beyond Mere Board Certification: Paul Kempen, MD, PhD December 3, 2014
    Dr. Paul Kempen exposes the truth about Maintenance of Certification (MOC) in a presentation to physicians in the St. Louis area on November 22, 2014.
  • Health Benefits of Coconut Oil December 1, 2014
    Coconut oil is a saturated fat that helps you lose weight, decreases inflammation, fights infection, and protects the brain from Alzheimer’s disease. It works the opposite way other saturated fats do by improving the ratio of “good” to “bad” cholesterol …
  • Thanksgiving Special from MediBid for Physicians & Patients November 26, 2014
    Happy Thanksgiving from MediBid! MediBid is offering 25% off annual registration to give thanks to all of the freedom fighting doctors and facility administrators we have out there! We have a large group of self pay patients looking for quality …
  • Fraser Institute: Waiting Your Turn, Medical Wait Times in Canada 2014 November 26, 2014
    The Fraser Institute study, Waiting Your Turn: Wait Times for Health Care in Canada, is Canada’s only comprehensive measurement of wait times for medically necessary health care. Based on an annual survey of physicians practising in 12 specialties in each …
  • 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 …
  • Are You Vitamin D Deficient? November 19, 2014
    Many Americans believe they are not at risk for Vitamin D deficiency because they eat D-fortified foods. These foods do not contain enough Vitamin D to benefit your health. Vitamin D is not a regular vitamin, but a steroid hormone …
  • Ambulance Drones Could Help You Survive a Heart Attack November 17, 2014
    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 …
  • Apples to Protect Against Obesity November 12, 2014
    An apple a day may be as beneficial as daily statin use. Apples and pears reduce the risk of stroke by more than 50%. A new study has found that the bioactive compounds in apples not absorbed during digestion boost …

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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