Obamacare causes companies to drop family coverage (no more wife, husband, kids to be insured)

NO INSURANCE…..NO DOCTOR VISITS…..NO PATIENTS…..FALLING PRACTICE REVENUES! How will that allow physicians and health systems to pay the bills (staff, rent, electric, mortgage, medical school loans, etc…)

 

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Aug 21, 2013, 5:13am EDT Updated: Aug 21, 2013, 7:13am EDT

UPS to drop 15,000 spouses from insurance, cites Obamacare

Carla Caldwell, Morning Edition Editor

United Parcel Service Inc. plans to remove thousands of spouses from its medical plan because they are eligible for coverage elsewhere. The Atlanta-based logistics company points to the Affordable Care Act, or Obamacare, as a big reason for the decision, reports Kaiser Health News.

The decision comes as many analysts are downplaying the Affordable Care Act's effect on companies such as UPS, noting that the move reflects a long-term trend of shrinking corporate medical benefits, Kaiser Health News reports. But UPS repeatedly cites Obamacare to explain the decision, adding fuel to the debate over whether it erodes traditional employer coverage, Kaiser says.

Rising medical costs, “combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” UPS said in a memo to employees.

According to Kaiser, UPS told white-collar workers two months ago that 15,000 working spouses eligible for coverage by their own employers would be excluded from the UPS plan in 2014.

UPS expects the move, which applies to non-union U.S. workers only, to save about $60 million a year, company spokesman Andy McGowan said.

The health law requires large employers to cover employees and dependent children, but not spouses or domestic partners, Kaiser adds.

Kaiser said the Obama administration would not respond directly to UPS' statements, but said that employer coverage increased when Massachusetts implemented its own version of the health overhaul.

"The health care law will make health insurance more affordable, strengthen small businesses and make it easier for employers to provide coverage to their workers," said Joanne Peters, spokeswoman for the U.S. Department of Health and Human Services.

 

Fines, taxes, threats of losing a Non-Profit status….Obamacare seeks to close Hospitals that deliver charity!

Fines, taxes, threats of losing a Non-Profit status….Obamacare seeks to close Hospitals that deliver charity!

Obamacare installs new scrutiny, fines for charitable hospitals that treat uninsured people

9:03 PM 08/08/2013

Patrick Howley

Reporter

Charitable hospitals that treat uninsured Americans will be subjected to new levels of scrutiny of their nonprofit status and could face sizable new fines under Obamacare.

A new provision in Section 501 of the Internal Revenue Code, which takes effect under Obamacare, sets new standards of review and installs new financial penalties for tax-exempt charitable hospitals, which devote a minimum amount of their expenses to treat uninsured poor people. Approximately 60 percent of American hospitals are currently nonprofit.

Charity for the uninsured is one of the factors that could discourage enrollment in Obamacare, which requires all Americans to purchase heath insurance or else face new taxes themselves from the IRS.

“It requires tax-exempt hospitals to do a community needs survey and file additional paperwork with the IRS every three years. This is to prove that the charitable hospital is still needed in their geographical area — ‘needed’ as defined by Obamacare and overseen by IRS bureaucrats,” said John Kartch, spokesman for Americans for Tax Reform.

“Failure to comply, or to prove this continuing need, could result in the loss of the hospital’s tax-exempt status. The hospital would then become a for-profit venture, paying income tax — hence the positive revenue score” for the federal government, Kartch said. “Obamacare advocates turned over every rock to find as much tax money as possible.”

Additionally, the rise in the number of insured Americans under Obamacare will make it more difficult for tax-exempt hospitals to continue meeting required thresholds for treating the uninsured, driving more hospitals into the for-profit category and yielding more taxable money for the federal government.

“The requirements generally apply to any section 501(c)(3) organization that operates at least one hospital facility,” according to a “Technical Explanation” report of new Obamacare provisions prepared by the congressional Joint Committee on Taxation (JCT) on March 21, 2010, the day Obamacare passed.

Obamacare’s new requirements could slam hospitals with massive $50,000 fines if they fail to meet bureaucrats’ standards.

 “The hospital must disclose in its annual information report to the IRS (i.e., Form 990 and related schedules) how it is addressing the needs identified in the assessment and, if all identified needs are not addressed, the reasons why (e.g., lack of financial or human resources). Each hospital facility is required to make the assessment widely available. Failure to complete a community health needs assessment in any applicable three-year period results in a penalty on the organization of up to $50,000,” according to the JCT report.

The government is particularly interested in how and why hospitals will be providing discounted or free care to poor patients, requiring each of them to “adopt, implement, and widely publicize a written financial assistance policy” and explain the methods they use to screen applicants for assistance and how they calculate patients’ bills.

A delegate working under the Department of Health and Human Services must review the innumerable reports charitable hospitals file every three years, along with copies of their audited financial statements.

After sifting through this massive amount of information, the delegate and HHS secretary must attempt to identify trends in the hospitals’ spending and send in a comprehensive report of their findings to Congress by 2015, according to the JCT report.

Healthcare experts warn that the Obamacare’s new requirements make it almost impossible for charitable hospitals to navigate treacherous new waters.

“Nonprofit hospitals should be advised that the new PPACA requirements will play a significant role in how they operate and report, specifically when it comes to billing and collections for services provided to the uninsured. The new law leaves many gray areas and hospitals themselves will have to establish eligibility criteria for financial assistance. Following the new procedures as best they can will ensure the best chance of maintaining their tax exempt status,” wrote D. Douglas Metcalf, partner at the law firm Lewis and Roca, in a 2013 op-ed entitled “Will nonprofit hospitals disappear under Obamacare?”

The White House did not return a request for comment.

Cut in employees hours, decrease in the small business work force, and now family is removed from the employed’ s Health coverage leaving defendants on their own to be forced into OBAMACARE---Good luck with that!

Small business has several ways to survive under OBAMACARE

1)     Stay under the 50 employee mark

2)     Cut employees work hours to under 30 per week

3)     Only insure the employee, and not the employees family (since those policies are dictated to cover “kids” up to 26 years of age) EDITORS NOTE: When I was 26 years old I had already served seven years in the U.S. Army! I would rather jump off a bridge then live of my parents at 26!

AP: Small businesses look at axing family coverage when ObamaCare hits

Posted at 12:41 pm on August 8, 2013 by Ed Morrissey

As the ObamaCare mandates approach — even those purportedly postponed — employers are looking for ways to get around the ballooning costs of insurance for their employees.  Larger employers can spread the costs out better and negotiate lower rates, but smaller businesses have fewer options for retaining their benefits.  The Associated Press reports that many smaller business may abandon paid dependent coverage, forcing employees to bear the whole cost, especially for spouses:

One casualty of the new health care law may be paid coverage for families of people who work for small businesses.

Insurance companies have already warned small business customers that premiums could rise 20 percent or more in 2014 under the Affordable Care Act. That’s making some owners consider not paying for coverage for workers’ families, even though insurance is a benefit that helps companies attract and retain top talent. If more small business owners decide to stop paying for family coverage, it will accelerate a trend that started as the cost of health insurance soared in recent years. …

Premiums have been soaring for years because of the rising cost of medical care. But the ACA also has requirements that may drive premiums higher, including a tax on insurance companies that is expected to be passed along to employers. Shoop’s insurer has warned that the tax could send his premiums up more than 20 percent a year from now.

“It’s going to be very significant,” Shoop says. “We’re really going to have to do a juggling act, and so are our employees.”

The ACA requires businesses with 50 or more employees provide coverage to their workers — but family coverage is a different matter.  The mandate requires that employers offer insurance coverage for dependent children (now through age 26, which may be a driver of the increase as well), but does not require employers to cover the cost of that insurance.  Spouses don’t even get that much; the law does not require employers to include them at all, even at the full cost to the employee.  That will send them into the individual exchanges, if employers have to restrict their expenditures enough — and that means more federal outlays for subsidies, and a quicker pace to the barrels of red ink that ObamaCare will produce.

So far, the argument goes that market forces for labor will force employees of all sizes under the mandate to offer health insurance, but that’s a matter of faith rather than reason.  Smaller businesses already have trouble competing against larger businesses on benefits packages. They make up for it with better workplace environments, more satisfying work, upward mobility opportunities, or simply a way to pad the résumé for better jobs in the future.

The bottom line works in this regard, too — and if a few businesses gain an advantage on costs (which then gives them a competitive advantage on price for their products and services), their competition will soon follow, and unpaid dependent coverage will become the norm rather than the exception for all but the largest companies.  For that matter, the fines for non-coverage of employees will exceed the costs of coverage, so the entire exercise will become a waiting period to see how quickly the dam breaks rather than if. Dependent coverage may simply be the first major crack.

At least one group of employees won’t have to worry about this.  Why not?  Well, they work for the people who imposed this mess on the rest of us, so they get a pass:

The White House on Wednesday released the legal details behind its ObamaCare bailout for Members of Congress and their staffs, and if anything this rescue is worse than last week’s leaks suggested: Illegal dispensations for the ruling class, different rules for the hoi polloi.

Thanks to an amendment from Iowa Senator Chuck Grassley that Democrats enacted in 2010, the Affordable Care Act says that “the only health plans that the Federal Government may make available” to Congress are the ones offered on the ObamaCare insurance exchanges. But Members and many aides have been flipping out because they won’t qualify for ObamaCare subsidies and they’ll lose employer contributions they now receive under the Federal Employees Health Benefits Program, or FEHBP, which picks up about three-quarters of the average premium.

At President Obama’s personal request, the Office of Personnel Management decreed that the Members don’t have to get off the gravy train after all. The eat-your-own-cooking provision begins with the phrase “Notwithstanding any other provision of law.” The feds now interpret that clause as a loophole to mean that the Affordable Care Act did not change the 1959 law that created the FEHBP.

Since Members and staff still technically meet the definition of federal employees qualified for the FEHBP, the Administration says they’re still entitled to enroll in the FEHBP concurrently with the exchanges. The feds then “clarify”—their euphemism—that the regulatory meaning of health benefits in the FEHBP can be ObamaCare plans. Voila, taxpayers will continue to chip in $4,900 for individual and $10,000 for family coverage.

Normally, the WSJ explains, Congress includes the “Notwithstanding” language to declare a bill’s primacy over existing legislation.  This takes the curious, and self-serving, position that Congress meant to pass a bill that has no effect in relation to the FEHBP, even though Grassley’s amendment plainly meant the opposite.  It would be interesting to see how a federal court would rule on this interpretation, but I’m not sure who has standing to sue in this case.  Perhaps, oh, 300 million other taxpayers who just got relegated to second-class status by the White House?  Or maybe just the children?

 

 

Health insurance premiums are on the increase!!!! Physician’s reimbursements are decreasing! Obamacare will make it worse….you do the math!

Health Insurance premiums will increase 41% in Ohio….. a 35% increase in FL…..71% increase in Indiana! Didn’t Obama and Congress (Nancy Pelosi) our costs would “go down”? So what were they talking about? My premiums have skyrocketed, and my physician’s reimbursements have hit rock-bottom, and most likely will decrease further!

NEW YORK (CNNMoney)

Where Obamacare premiums will soar

By Tami Luhby August 6, 2013: 1:57 PM ET

 

Get ready to shell out more money for individual health insurance under Obamacare ... in some states, that is.

While many residents in New York and California may see sizable decreases in their premiums (just a note….The auther knows this statement is BULLSHIT…just saying!), Americans in many places could face significant increases if they buy insurance through state-based exchanges next year.

That's because these people live in states where insurers were allowed to sell bare-bones plans and exclude the sick, which has kept costs down. Under Obamacare, insurers must offer a package of essential benefits -- including maternity, mental health and medications -- and must cover all who apply. But more comprehensive coverage may lead to more expensive insurance plans.

Under Obamacare, all Americans must have insurance coverage starting in 2014 or face penalties of $95 or 1% of family income, whichever is greater. Enrollment in the exchanges begins October 1, with coverage kicking in in January. Plans will come in four tiers, ranging from bronze to platinum.

Some lightly regulated states ( just a note….All States should be lightly regulated, and let the market, physicians and patients take care of their own business!), including Indiana, Ohio, Florida and South Carolina, have recently released preliminary rate information highlighting steep price increases. Unlike the blue states of California and New York, these are Republican-led states that have strongly opposed the Affordable Care Act, as Obamacare is officially known.

Comparing this year's and next year's plans isn't easy because the structure of the plans is so different. Each state comes up with its own method.

Behind the numbers in 3 key states. In Florida, for instance, officials constructed a hypothetical silver-level plan based on the offerings available today. Then they looked at how the cost of that plan compares to the average silver plan that will be available on the exchange. Florida found premiums will rise between 7.6% and 58.8%, depending on the insurer. The average increase would be 35%.

The main driver of the premium increases is the Obamacare mandate that coverage be offered to everyone, said Kevin McCarty, Florida's insurance commissioner. There are just short of a million enrollees in the individual market in Florida, while 3.8 million are uninsured. The state does not allow new entrants into a "high-risk pool," which provides coverage to the sick.

"People who are in their 50s with high blood pressure have no coverage options," he said.

Ohio, meanwhile, said there would be an average increase of 41% by comparing a trade association's report of premiums for all plans available today with the average premium expected on the exchange.

Indiana officials said prices would rise an average of 72%. But they were looking at the cost of providing care, not actual premiums.

All of these rate hikes must still be reviewed by the federal government (just another note….”federal government review” yeah….that should wok! That’s sacasim folks!) and do not take into account the fact that Americans with incomes up to $45,960 for an individual and $94,200 for a family of four will be eligible for federal subsidies.

So why aren't there such big premium increases in other states? New York, for example, already required that insurers provide comprehensive coverage to all who apply. Rates there could fall by half since the pool will expand to include many younger, healthier residents under Obamacare. But New York is more the exception than the rule, experts said.

Rate hikes depend on age and gender. To give consumers a better idea of how premiums will change, CNNMoney took a look at the plans provided by one insurer: Physicians Health Plan of Northern Indiana.

Our analysis found that 21-year-old men will pay a lot more for an exchange plan, but 42-year-old women and 62-year-old men will shell out less for a silver-level plan that comes with a $2,500 deductible and a roughly $25 co-pay for office visits.

Under this scenario, a young man's monthly rate will rise to $214 on the exchange next year, up 63% from today. The woman, however, will pay $284, a drop of more than 7%, while the older man will be charged $615, a nearly 6% decrease. This is because Obamacare requires that women pay the same amount as men and does not allow insurers to charge older participants more than three times the young.

Physicians Health expects most enrollees to sign up for bronze or silver plans, which have lower monthly premiums but carry higher deductibles and co-pays, according to Jim Brunnemer, the insurer's chief financial officer. Today, its members typically buy high deductible plans.

To be sure, there are some states where premiums will fall or come in lower than expected. The Obama administration pointed to a recent Department of Health and Human Services study of 11 states with publicly available premium data that showed rates are below Congressional Budget Office projections.

"When the marketplaces open on Oct. 1, plans will have to compete side by side, and consumers will be able to choose the one that best fits their budget and needs," said Joanne Peters, a department spokeswoman.

While premiums may go up in other states, Obamacare advocates say people will receive more comprehensive coverage. Also, the law limits the amount people have to pay out-of-pocket for deductibles and co-pays to $6,350 in 2014.

"A lot of people will get more for their money," said Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities. "Even people paying a higher rate will benefit. It will be a big change in most states."

Physicians promised a 73% increase in Medicaid reimbursement…That’s a good one! I t will never happen!

So here it is…seven months since physicians were promised an increase in the Medicaid reimbursement…..and nothing. But…physicians have seen an increase in Medicaid patients, and still are receiving the lower Medicaid reimbursement! I might remind you that this Medicaid pay rate does not even come close to covering the physicians cost! And it will only get worse!

Obamacare's 73% Medicaid Pay Raise For Doctors Is Delayed

3/15/2013 @ 8:43AM Forbes

Bruce Japsen, Contributor

A huge pay raise promised under the Affordable Care Act for primary care doctors who treat the nation’s poor covered by Medicaid health insurance is nearly three months behind schedule and may take another three months before it kicks in, state Medicaid directors say.

Under the health law, a primary care doctor – a family physician, a pediatrician or an internist – who treats a Medicaid patient will see their reimbursement rise to the level of the Medicare health insurance program for the elderly for scores of primary care services.  Doctors do have to apply to their state Medicaid programs and meet certain criteria in part proving that they have historically treated certain numbers of Medicaid patients.

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Though the pay increase will vary because Medicaid rates differ from state to state, the average pay increase will be about 73 percent given Medicare last year paid on average 66 percent of what Medicare pays for certain primary care services, according to a Henry J. Kaiser Family Foundation study.  Doctors in some states could see payment increases of 100 percent or more.

The idea behind the pay increase, which is funded by federal dollars for two years, is to get more doctors to accept Medicaid patients and prevent other physicians from dropping out of a government program that hasn’t been well funded.  Amid a primary care doctor shortage, eligible patients will need all of the doctors they can get given the health law expands Medicaid coverage to millions more Americans effective Jan. 1, 2014 for participating states.

Because Medicaid is funded via a match of funds from states and the federal government, cash-strapped states that have cut from their programs in also lost federal dollars, allowing payment rates to fall far behind.

“The purpose of the increase in Medicaid physician fees for primary care is to encourage greater Medicaid participation among physicians as the program expands in 2014 and demand for care increases,” the Kaiser report said. “If the enhanced payment rates succeed in increasing physician participation and beneficiary access as intended, interest in extending the higher Medicaid rates beyond 2014 is likely to be high.”

But the Obama administration says the checks will eventually reach doctors and payments will be retroactive to Jan. 1 of this year so physicians who are approved to participate in their states will get what they are due.

“The Medicaid enhanced payments for primary care physician fee was made possible by the Affordable Care Act and is in full effect for calendar years 2013 and 2014,” a spokesman for the Centers for Medicare & Medicaid Services says. “States are moving quickly to implement the higher payment and a number of states have already submitted State Plan Amendments (SPAs) which will permit federal funding to flow to states for the increases.  In addition to submitting the required SPAs, states are also in the process of reprogramming their claims processing systems to pay at the appropriate, higher rates.  CMS has made it very clear that states must make enhanced payments to eligible providers retroactive to January 1, 2013.”

Exactly how federal dollars will be doled out to doctors is unclear in part because an increasing number of states in recent years don’t pay physicians on a fee-for-service basis.

Many doctors are paid bundled rates by health plans like Humana (HUM), Amerigroup, a subsidiary of Wellpoint (WLP), Aetna (AET) or UnitedHealth Group (UNH) or physicians may be employees and are therefore paid through their clinic, practice or other entity, complicating the rollout of the pay increase.  Therefore, the payments for services aren’t necessarily apples to apples comparison when it comes to paying the same as Medicare rates.

“How you do this in a managed care environment is the big challenge,”  Matt Solo, executive director of the National Association of Medicaid Directors said in an interview.  “It is not at all clear.”

Solo estimates the money might not reach doctors until late in the second quarter of this year, which would be by June 30.

“The money will flow,” Solo said. “It will eventually flow.”

Meanwhile, doctor groups wait patiently for their funds.

“It is vital that Medicaid receive sufficient funding to support an adequate network of caring physicians and maintain its purpose as a social safety net,” said Dr. Jeremy A. Lazarus, AMA president. “New federal funds authorized for primary care payment increases by the Affordable Care Act are an important step in the right direction to encourage more physician participation in the Medicaid program. The AMA and other physician organizations have urged state Medicaid programs and governors to move forward with filing the necessary paperwork with the federal government so that increased Medicaid payments can be paid to eligible primary care physicians.”

Canadians run to America for Medical Care. Americans eyeing the Caribbean for their health needs

So when Obamacare “hits”, and most physicians see a huge decrease in their earnings, and there are long waits for service, and quality decreases, and consumer costs and taxes go through the roof…..Where will Americans go? Hello Caribbean!

Report: Thousands fled Canadian health system in 2012

9:38 PM 07/08/2013    Michael Bastasch

Thousands of Canadians continue to flee the country to seek medical treatment abroad, with the United States a common destination.

An estimated 42,173 Canadians left their homeland in 2012 to seek medical treatment elsewhere. This is a decrease from the 46,159 Canadians who fled the country in 2011 for medical treatment.

“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to a report by the Fraser Institute — a free-market Canadian think tank. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.”

While the number of Canadians looking abroad for health solutions is still significant, it’s unclear whether or not the drop in the number leaving is related to the implementation of the Affordable Care Act in the U.S.

“While a number of external factors may have led to a decline in the number of Canadians seeking care abroad, wait times for care in Canada also improved a little in 2012 both for specialist consultations and treatment,” Nadeem Esmail, Fraser’s director of health policy studies, told The Daily Caller News Foundation in an email.

The Fraser Institute asks doctors across Canada every year about what percentage of their patients got non-emergency care outside the country in the last 12 months. Those numbers are then averaged for each medical specialty and combined with the number of actual medical treatments performed in each province.

While the total number of fleeing Canadians decreased, some provinces saw increases in the number of patients leaving Canada.

Fraser reports: “Increases between 2011 and 2012 in the estimated number of patients going outside Canada for treatment were seen in Saskatchewan (from 1,221 to 1,380), Quebec (4,600 to 6,308), New Brunswick (526 to 997), and Newfoundland and Labrador (433 to 649).”

One reason for these departures is the long waits imposed on patients by national health planners. The median wait time for treatment after consulting a specialist fell last year to 9.3 weeks. Wait times increased in seven Canadian provinces and only fell in three — Saskatchewan, Manitoba, and Ontario.

The largest group of patients who fled Canada in 2012 — 4,594 — were those in the “ophthalmology” category. An ophthalmologist is a specialist for medical and surgical eye problems.

Thousands also left the country looking for “general surgery,” “orthopedic surgery” as well as for gynecological and urological treatments or procedures.

 

33% percent of all Internal Medicine and Family Medicine residency training programs are not producing graduates seeking rural medicine practice. That’s a huge problem!

33% percent of all Internal Medicine and Family Medicine residency training programs are not producing graduates seeking rural medicine practice. That’s a huge problem!

U.S. producing 'abysmally low' number of primary care doctors

UPI 06 15 2013

WASHINGTON, June 15 (UPI) --
Despite a shortage of U.S. primary care doctors, less than 25 percent of new doctors go into this field, and fewer still work in rural areas, researchers say.

Lead study author Dr. Candice Chen, an assistant research professor of the George Washington University School of Public Health and Health Services, said the study also found only 4.8 percent of the new primary care physicians set up shop in rural areas.

"If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse," Chen said in a statement. "The study's findings raise questions about whether federally funded graduate medical education institutions are meeting the nation's need for more primary care physicians."

Chen and colleagues studied the career paths of 8,977 physicians who had graduated from 759 medical residency sites from 2006-08. Three to five years after the program ended, the researchers found 25.2 percent of the physicians worked as primary care doctors, although this number almost certainly was an overestimate because it included graduates who practiced as hospitalists, Chen said.

In addition, the researchers found 198 out of 759 institutions produced no rural physicians at all during the study period.

Currently, the United States is producing primary care physicians at rates that are "abysmally low," Chen said.

U.S. producing 'abysmally low' number of primary care doctors