Prediction : Obama will win a 2nd term in office

Quote from: klaasend on December 04, 2011, 03:00:30 PM

I base my prediction on the lack of a serious GOP challengers.

Just posting my prediction now to see how good I am at predicting

I'd say you're a prophet, Klaas.

Unfortunately, while Obama may still be around, the thousands........ perhaps millions, of poor rural citizens may not be, when faced with no access to health care. We've taken critical hits since the passage of The Affordable Care Act (Obamacare) as a Rural Health Clinic and it hasn't even come into full swing yet. This message hit my inbox at 3:08pm today. I got it at 4:30pm. I've just gotten off the phone with 6 Congressional Offices who are all in agreement that the bill will pass the house...... I believe the vote is happening as I type this. The devastation to the RHC's was added to the bill late last night and there has been virtually no coverage in the media about it:

To: RHC Community

From: Bill Finerfrock

Re: Congressional Action harmful to RHCs and CAHs

Later today, the House of Representatives is scheduled to vote on a bill that has a provision that, if adopted, could be VERY harmful to RHCs. H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2011 is a lengthy bill (more than 300 pages) that is intended to extend the current payroll tax cut adopted last year, temporarily prevent a cut in physician fee schedule payments due to the SGR formula among other things.

In order to “pay for” the extension of the payroll tax cut and the SGR “fix”, Congress is required to cut expenditures in other federal programs to offset the cost of these initiaives. One of the “pay for” proposals included in H.R. 3630 is a phased-in cut in the amount of bad debt RHCs and Critical Access Hospitals (CAHs) can claim from 100% to 55%. The financial impact on individual RHCs and CAHs could be devastating.

I am writing to urge you to contact your Representative and ask him or her to oppose the reduction in the amount of bad debt RHCs and CAHs can claim. It would be very helpful if you could let your elected Representative know how a reduction in bad debt will affect your RHC (or CAH is you are connected to a CAH).

You message does not have to be lengthy and it is important that you contact your Representative as soon as possible because the vote is likely to occur as early as later today.

You can contact your elected officials directly by going to: http://www.house.gov/

In the upper right hand corner of this page, you will see where you can enter your zip code. Once you’ve put in your zip code, his “go” and you will be taken to the home page of your Representative. Each Member’s home page has an icon you can click on to send an electronic message. Click on this icon and fill out the necessary information and send a message. Here is a sample message for your consideration:

“Please oppose H.R. 3630 as it includes a provision that would be harmful to our RHC by limiting the amount of bad debt we can claim on our RHC cost report. If you have any questions or need any additional information, please contact the National Association of Rural Health Clinics at: info@narhc.org and they will be happy to provide you with more information about RHCs and the importance of being able to claim 100% of bad debt.”

NARHC will be contacting every Congressional Office with a more detailed message but your Congressman/woman needs to hear from you!

Please note that we expect a similar proposal to come before the United States Senate and I will contact you again if and when it is appropriate to contact your Senators with a similar message.

Your assistance in this effort is appreciated.

Sincerely,

Bill

Bill Finerfrock (I've redacted Bill's phone number and address).

The "Bad Debt" referred to in the message is the money for services provided (allowed by Medicare and Medicaid) that the patient cannot pay. We are required to make documented, multiple collection efforts, but having done that, are allowed to count the cost of providing those services in the formula that sets our flat rate for all services we provide. That's the way a Rural Health Clinic works.......... we get a flat rate for each service based on the cost it takes to provide services to all our Medicare and Medicaid patients. The costs incurred to provide services to private pay patients is carved out of the equation. There is a cap on the rate.......... I think it's currently at $102.00. Our rate is $72.00.

You have to be in a designated underserved area to qualify to be a Rural Health Center. Hands down, we are. One of our Physicians drives 2 hours to come to work. Because of the demographics of the population we serve, our Bad Debt is critical to setting the rate at something that allows us to keep the door open. We serve more indigent patients in one year than the closest FQHC does in 3, yet they receive over a million dollars per year in grants (on TOP of the capped rate) by mere virtue of the fact that they are directly working for the Federal Government. Don't think I haven't pointed out to anyone who would listen, the contrast in efficiency.

Our patient population is made up of 72.6% Medicare and Medicaid. Obviously, a large portion of that is made up of geriatric patients. The SGR "fix" needed within H.R. 3630 is because of the cuts in Medicare made to make Obamacare "cost neutral". What a joke! They knew it would have to be fixed at the time the Affordable Care Bill passed, but they rightly guessed that the public wouldn't make the connection later when the money had to be found to do it.

I'll loose the business, but that's nothing compared to what the patients are going to face. Somebody's cruelly making correct calculations and calling it just right. The older patient in my clinic is hardly sophisticated, uneducated, and up until my clinic opened, largely without healthcare at all. I can't tell you how many patients we've seen that needed pain medications when the problem was that their teeth had rotted. We've worked it out with area churches so that they are cared for. We get concerned when a regular patient doesn't show up for an appointment, and it's common that someone from the office will go check on them. If snow has been on the ground for too many days, we make the rounds with groceries to those that live across a creek or hang in a trailer from the side of a mountain. But they are just the elderly. They don't know how to use their voice. They are on the receiving end of their government. They are the silent sufferers and those in Washington know there will be no real opposition. Have any of you heard anything at all about the impact to Rural Health Centers attached to this bill? I haven't. Those poor people are not worthy of the attention.

Just saw on the news that the bill has passed the House. I could care less if it was a Republican or a Democrat that voted for it's passage. It makes me physically ill.

I think you're right, Klaas. Obama will be a two term President. I don't have any faith in those the GOP has put forth either. Surely, he'll change his campaign motto this time, though. "Change We Can Believe In" gets stuck in my throat.