HR 3200 Discussion

[WhiskeyGirl]

I've been looking at this bill and was wondering if anyone read it and can answer some questions.

This section is advertised as a 'reinsurance program'.  It doesn't look like reinsurance to me.  It looks like a pass through/gift/taxpayer funding for he UAW retiree healthcare program.  I keep thinking about this.  Is this a program for all the autoworkers losing their jobs that are between 55 and Medicare eligibility?

HR 3200 - SEC. 164. REINSURANCE PROGRAM FOR RETIREES. 

UAW Pass Through?

the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceeds $15,000, but is less than $90,000. Such amounts shall be adjusted each year based on the percentage increase in the medical care component of the Consumer Price Index (rounded to the nearest multiple of $1,000) for the year involved.

Where is the reinsurance?  This is payment.  If these plans are already funded, why reinsure for the large claims?

Why isn't there reinsurance for employer and individual commercial insurance? 

What can the money be used for? 

...Amounts paid...shall be used to lower the costs borne directly by the participants and beneficiaries for health benefits provided under such plan in the form of premiums, co-payments, deductibles, co-insurance, or other out-of-pocket costs. Such payments shall not be used to reduce the costs of an employer maintaining the participating employment-based plan...

Will healthcare be free for UAW retirees be free?

If you're 'reinsuring' why are you paying the claims between $15,000 and $90,000?

You're paying more to these funds than will be paid out to cover premiums, copays, deductibles, coinsurance, and other out of pocket costs.  The plan will probably be making money at taxpayers expense.  mo

The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans...

The audit is for the 'claims data'.  What are they going to find looking at claims data? 

Where is the requirement for a meaningful audit?  One that audits the administrator?  Are they paying claims?  Are they paying excessive money for compensation and bonuses?  Political activism?

What are they going to do with the leftover money when the last eligible person leaves the plan?  I would imagine the plan will have a healthy surplus, thanks to taxpayer debt.

LIMITATION TO AVAILABLE FUNDS- The Secretary has the authority to stop taking applications for participation in the program or take such other steps in reducing expenditures under the reinsurance program in order to ensure that expenditures under the reinsurance program do not exceed the funds available under this subsection.

This suggests to me that it will be a VERY limited enrollment.  Do the intended recipients have their application ready?  Maybe the application has already been given out?  After they receive a few, they'll stop taking applications?  Long before any other plans get wind of this Congressional and White House largess?

It seems like these plans aren't subject to any claims experience refunds, it's a flow of money out.  Any taxes on this Gold Plan?

You may find the bill here - http://www.opencongress.org/bill/111-h3200/text

[WhiskeyGirl]

The thing that galls...the Obama administration wants to cut Social Security.  Certain plans get 'reinsuranc' - free healthcare for their participants.  Will the reinsurance plan providers be subject to anemic reimbursements? 

[WhiskeyGirl]

This almost slipped my mind - "BUDGETARY IMPLICATIONS- Amounts appropriated under clause (i), and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Trust Fund."

Does this mean it's an "off budget" program?  Hidden from public viewing?  Secret?

[WhiskeyGirl]

A pass through to special interest providers?  A back door to eliminating plans that fall into disfavor?

SEC. 204. CONTRACTS FOR THE OFFERING OF EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.

(3) ENFORCEMENT OF NETWORK ADEQUACY- In the case of a health benefits plan of a QHBP offering entity that uses a provider network, the contract under this section with the entity shall provide that if--

(A) the Commissioner determines that such provider network does not meet such standards as the Commissioner shall establish under section 115; and

(B) an individual enrolled in such plan receives an item or service from a provider that is not within such network;

then any cost-sharing for such item or service shall be equal to the amount of such cost-sharing that would be imposed if such item or service was furnished by a provider within such network.

SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.
(a) In General- A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

(b) Provider Network Defined- In this division, the term ‘provider network’ means the providers with respect to which covered benefits, treatments, and services are available under a health benefits plan.

In my private health insurance, I pay big time if I go out of network.  What incentive is there for participants in the government plan to stay in network?  Any?

The Commissioner is a political appointee.  Might his decisions be politically motivated?

It seems real easy for some 'providers' to avoid participation in any plan.  They make more money!!!   

How much will plans be forced to pay out to non-network providers?  Full price?  It seems like some clever person might by marketing on TV or other media encourage participants to go out of network. 

Would it cost the participant more?  I don't think it would.

Would it cost the plan more?  I think it would.

Where is the cost savings?  What if the plans have higher than expected losses?  Will they get 'reinsurance' from the government? 

Anyone else?

jmho

[WhiskeyGirl]

SEC. 206. OTHER FUNCTIONS.

(b) Coordination of Risk Pooling- The Commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among QHBP offering entities offering Exchange-participating health benefits plans of premiums collected for such plans that takes into account (in a manner specified by the Commissioner) the differences in the risk characteristics of individuals and employers enrolled under the different Exchange-participating health benefits plans offered by such entities so as to minimize the impact of adverse selection of enrollees among the plans offered by such entities.

This is a long winded sentence/paragraph.  What exactly does it mean?

I'll make some wild guesses -

Since it talks about adjustments in premiums payable among the QHBP entities, and the differences in 'risk' characteristics...I think this is to level the playing field among the government plans due to 'pre-existing' conditions.

It doesn't seem to apply to the private plans.

If there is 'adverse' selection in the private plans, how will the Insurance Exchange minimize that impact?

It seems like community activists could send extremely ill people to sign up for a private plan and put it out of business. 

If the community activists sent those same folks to a government plan, it seems like the government plan would be compensated for this 'adverse' selection.

Is adverse selection OK as long as it happens to the evil insurance companies?  Adverse selection is not OK if it happens to the government plans?

If you had the same pool of participants, what is the difference in premiums they are allowed to charge? 

Would the premiums for both private insurance and government plan be the same?

Is this an unfair subsidy for the government plans?
 
jmho

Anyone else?

[crazybabyborg]

I'm on a rant here!

I just saw on TV that they estimate 23 billion a year is paid fraudulantly on behalf of Medicare and Medicaid recipients. Even the OIG admits it's primarily to providers who haven't navigated the rules and regulations properly around providing those services to Governmentally insured individuals. GEE! YA THINK? It might have something to do with the THOUSANDS of pages of regulations that change monthly! So, included in the Health Care proposal is 100 million to catch those providers who are just providing Health Care and have either miscoded something, allowed a patient in the waiting room while a provider takes lunch (yeah, that's a rule), has a sign in sheet with anyone elses name on it, is a day late on the required monthly treatment plan, or has a transcription service who gets the transcripts back in 48 hours rather than 24!

I'm serious here: I could provide services for 1/3 the cost if I could simply employ a Board Certified Physician to provide health care to patients, submit the claim, complete with notes if they'd like, and expect payment. I have no problem at all being reviewed for quality of services provided. But, I have compliancy consultants to help me navigate the requirements, accountants to help me structure fee and compensation schedules to meet the rules, employees hired to oversee Physician notes, and staff to keep up with the paperwork. Providers are scared to prescribe pain medications when they are genuinely needed because it's a short path to red flags and it automatically requires random drug screenings and pill counts and that just adds another logistical layer to keep up with. Licensed Psychiatric Professionals must be brought in for counselling if chronic pain is the problem and any kind of long term pain medication is required.

I don't know what else I can do to try to do this right, yet I live in fear for everything I've worked for all my life. Recently, a cardiac group in Nashville was "descended" upon by an outsourced Medicare company to "spot inspect" and they were cited for over a million dollars in payback. All Medicare payments stopped while the group filed an appeal. The issue? Labs were done without a specific written order. All payments for each patient were marked for repayment. The cardiologists were sending the patients to the lab for work and the charts included the presenting problem, complete with references to proposed course of actions based on lab results, the lab results themselves and follow up care based on the lab results, but there wasn't a seperate written order for the labs. The group SPENT over a million dollars on the appeal and won a year later. They had the deep pockets to weather it. I wouldn't. I don't have the money to withstand that kind of assault, and all my personal assets would be subject to seizure for payback. The outsourced companies doing the inspections work on commission, and they have every incentive to find something, anything, that will pay their salaries.

It's wrong. It's just wrong.

OK, thanks for your patience. Rant over.

[WhiskeyGirl]

A 'front or side door' for illegal immigrants?

SEC. 242. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL.

(1) IN GENERAL- For purposes of this division, the term ‘affordable credit eligible individual’ means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)--

Does this mean it INCLUDES folks in subparagraphs (K), (T), (U), and (V)?

I looked up the "Immigration and Nationality Act" here - http://www.visaportal.com/page.asp?page_id=139

101(a)(15)(K) subject to subsections (d) and (p) of section 214, an alien who--

101(a)(15)(K)(i) is the fiancÉe or fiancÉ of a citizen of the United States and who seeks to enter the United States solely to conclude a valid marriage with the petitioner within ninety days after admission;

101(a)(15)(K)(ii) has concluded a valid marriage with a citizen of the United States who is the petitioner, is the beneficiary of a petition to accord a status under section 201(b)(2)(A)(i) that was filed under section 204 by the petitioner, and seeks to enter the United States to await the approval of such petition and the availability to the alien of an immigrant visa; or

101(a)(15)(K)(iii) is the minor child of an alien described in clause (i) or (ii) and is accompanying, or following to join, the alien; Leg Hist

101(a)(15)(T)

101(a)(15)(T)(i) subject to section 214(o), an alien who the Attorney General determines—

101(a)(15)(T)(i)(I) is or has been a victim of a severe form of trafficking in persons, as defined in section 103 of the Trafficking Victims Protection Act of 2000,

101(a)(15)(T)(i)(II) is physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands, or at a port of entry thereto, on account of such trafficking,

101(a)(15)(T)(i)(III)

101(a)(15)(T)(i)(III)(aa) has complied with any reasonable request for assistance in the investigation or prosecution of acts of trafficking, or

101(a)(15)(T)(i)(III)(bb) has not attained 18 years of age, and

101(a)(15)(T)(i)(IV) the alien would suffer extreme hardship involving unusual and severe harm upon removal; and

101(a)(15)(T)(ii) if the Attorney General considers it necessary to avoid extreme hardship—

101(a)(15)(T)(ii)(I) in the case of an alien described in clause (i) who is under 21 years of age, the spouse, children, unmarried siblings under 18 years of age on the date on which such alien applied for status under such clause, and parents of such alien; and

101(a)(15)(T)(ii)(II) in the case of an alien described in clause (i) who is 21 years of age or older, the spouse and children of such alien,

if accompanying, or following to join, the alien described in clause (i);

101(a)(15)(U)

101(a)(15)(U)(i) subject to section 214(p), an alien who files a petition for status under this subparagraph, if the Attorney General determines that

101(a)(15)(U)(i)(I) the alien has suffered substantial physical or mental abuse as a result of having been a victim of criminal activity described in clause (iii);

101(a)(15)(U)(i)(II) the alien (or in the case of an alien child under the age of 16, the parent, guardian, or next friend of the alien) possesses information concerning criminal activity described in clause (iii);

101(a)(15)(U)(i)(III) the alien (or in the case of an alien child under the age of 16, the parent, guardian, or next friend of the alien) has been helpful, is being helpful, or is likely to be helpful to a Federal, State, or local law enforcement official, to a Federal, State, or local prosecutor, to a Federal or State judge, to the Service, or to other Federal, State, or local authorities investigating or prosecuting criminal activity described in clause (iii); and

101(a)(15)(U)(i)(IV) the criminal activity described in clause (iii) violated the laws of the United States or occurred in the United States (including in Indian country and military installations) or the territories and possessions of the United States;

101(a)(15)(U)(ii) if the Attorney General considers it necessary to avoid extreme hardship to the spouse, the child, or, in the case of an alien child, the parent of the alien described in clause (i), the Attorney General may also grant status under this paragraph based upon certification of a government official listed in clause (i)(III) that an investigation or prosecution would be harmed without the assistance of the spouse, the child, or, in the case of an alien child, the parent of the alien; and

101(a)(15)(U)(iii) the criminal activity referred to in this clause is that involving one or more of the following or any similar activity in violation of Federal, State, or local criminal law: rape; torture; trafficking; incest; domestic violence; sexual assault; abusive sexual contact; prostitution; sexual exploitation; female genital mutilation; being held hostage; peonage; involuntary servitude; slave trade; kidnapping; abduction; unlawful criminal restraint; false imprisonment; blackmail; extortion; manslaughter; murder; felonious assault; witness tampering; obstruction of justice; perjury; or attempt, conspiracy, or solicitation to commit any of the above mentioned crimes; or

101(a)(15)(V) subject to section 214(q), an alien who is the beneficiary (including a child of the principal alien, if eligible to receive a visa under section 203(d)) of a petition to accord a status under section 203(a)(2)(A) that was filed with the Attorney General under section 204 on or before the date of the enactment of the Legal Immigration Family Equity Act, if—

101(a)(15)(V)(i) such petition has been pending for 3 years or more; or

101(a)(15)(V)(ii) such petition has been approved, 3 years or more have elapsed since such filing date, and--

101(a)(15)(V)(ii)(I) an immigrant visa is not immediately available to the alien because of a waiting list of applicants for visas under section 203(a)(2)(A); or

101(a)(15)(V)(ii)(II) the alien's application for an immigrant visa, or the alien's application for adjustment of status under section 245, pursuant to the approval of such petition, remains pending.

Is this the front or side door to illegal immigrants qualifying for the public plan? 

What if they are employed outside of the tax system?  No way to verify their income?

Does this allow the Attorney General to wave a magic wand in the future and let everyone who comes here illegally apply?

How will there ever be enough money for this public plan?  More and more folks get 'credits', higher and higher taxes for folks who report their income.

How is Obama planning on paying for this?  Stopping the flood of immigrants who will likely come here for free healthcare, and bring their families?

[WhiskeyGirl]

Just another wild chase -

A 'front or side door' for illegal immigrants? The tie in with eligibility.

SEC. 205. OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN.

(3) AUTOMATIC ENROLLMENT FOR NON-MEDICAID ELIGIBLE INDIVIDUALS-

(B) SUBSIDIZED INDIVIDUALS DESCRIBED- An individual described in this subparagraph is an Exchange-eligible individual who is either of the following:

(i) AFFORDABILITY CREDIT ELIGIBLE INDIVIDUALS- The individual--

(I) has applied for, and been determined eligible for, affordability credits under subtitle C;

(II) has not opted out from receiving such affordability credit; and

(III) does not otherwise enroll in another Exchange-participating health benefits plan.

Would this work to make illegal immigrants eligible for the public plan?

Illegal immigrants would be eligible because they are 'determined eligible for, affordability credits'? 

Automatic coverage for illegal immigrants?

[WhiskeyGirl]

SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

At this point, will there be any undocumented aliens?  I can't imagine anyone not having documentation after going through the affordability credit loopholes, and eligibility process.

[WhiskeyGirl]

I'm on a rant here!

I just saw on TV that they estimate 23 billion a year is paid fraudulantly on behalf of Medicare and Medicaid recipients. Even the OIG admits it's primarily to providers who haven't navigated the rules and regulations properly around providing those services to Governmentally insured individuals. GEE! YA THINK? It might have something to do with the THOUSANDS of pages of regulations that change monthly! So, included in the Health Care proposal is 100 million to catch those providers who are just providing Health Care and have either miscoded something, allowed a patient in the waiting room while a provider takes lunch (yeah, that's a rule), has a sign in sheet with anyone elses name on it, is a day late on the required monthly treatment plan, or has a transcription service who gets the transcripts back in 48 hours rather than 24!

I'm serious here: I could provide services for 1/3 the cost if I could simply employ a Board Certified Physician to provide health care to patients, submit the claim, complete with notes if they'd like, and expect payment. I have no problem at all being reviewed for quality of services provided. But, I have compliancy consultants to help me navigate the requirements, accountants to help me structure fee and compensation schedules to meet the rules, employees hired to oversee Physician notes, and staff to keep up with the paperwork. Providers are scared to prescribe pain medications when they are genuinely needed because it's a short path to red flags and it automatically requires random drug screenings and pill counts and that just adds another logistical layer to keep up with. Licensed Psychiatric Professionals must be brought in for counselling if chronic pain is the problem and any kind of long term pain medication is required.

I don't know what else I can do to try to do this right, yet I live in fear for everything I've worked for all my life. Recently, a cardiac group in Nashville was "descended" upon by an outsourced Medicare company to "spot inspect" and they were cited for over a million dollars in payback. All Medicare payments stopped while the group filed an appeal. The issue? Labs were done without a specific written order. All payments for each patient were marked for repayment. The cardiologists were sending the patients to the lab for work and the charts included the presenting problem, complete with references to proposed course of actions based on lab results, the lab results themselves and follow up care based on the lab results, but there wasn't a seperate written order for the labs. The group SPENT over a million dollars on the appeal and won a year later. They had the deep pockets to weather it. I wouldn't. I don't have the money to withstand that kind of assault, and all my personal assets would be subject to seizure for payback. The outsourced companies doing the inspections work on commission, and they have every incentive to find something, anything, that will pay their salaries.

It's wrong. It's just wrong.

OK, thanks for your patience. Rant over.

HR 3200 has a whole section of what sounds like gibberish.  It relates to compliance and penalties on business.  Lots of penalties, and tough to understand.

In our new 'electronic' medical records future, what would be the point of a 'written' order for labs?

[WhiskeyGirl]

Can't be certain of this, couldn't find anything concrete on the web ~

‘subpart b. surcharge on high income individuals.’.

(c) Section 15 Not To Apply- The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.

(d) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2010.

SEC. 442. DELAY IN APPLICATION OF WORLDWIDE ALLOCATION OF INTEREST.

(a) In General- Paragraphs (5)(D) and (6) of section 864(f) of the Internal Revenue Code of 1986 are each amended by striking ‘December 31, 2010’ and inserting ‘December 31, 2019’.

(b) Transition- Subsection (f) of section 864 of such Code is amended by striking paragraph (7).

I found all kinds of interesting bits and pieces, lots of amendments. 

Is this a gift to Wall Street banks?  Global corporations?  Those big banks and insurance companies where folks make millions a year in total compensation?

[WhiskeyGirl]

I wonder if these are also gifts to Wall Street, Dark Pool participants, and large global corporations -

SEC. 452. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE.

SEC. 453. PENALTIES FOR UNDERPAYMENTS.

There is a lot of talk about "Nondisclosed" and  "Noneconomic Substance Transactions" - WTF is that?   

Dark Pool profits? 

[nonesuche]

WhiskeyGirl, you have likely read more of the bill than many of the Democrats. We'll see how many of them who are up for re-election within the next two years are willing to nose dive their chance to remain in office by voting for HR 3200? I expect with Obama's approval rating finally dropping like a stone, that not many will.

I understand the flow chart to administrate this fine smoke and mirrors lets play socialist plan is a pure exercise in layer after layer of bureaucracy.

reality is that 10 M of our currently 'uninsured' are the illegal aliens.

[WhiskeyGirl]

WhiskeyGirl, you have likely read more of the bill than many of the Democrats. We'll see how many of them who are up for re-election within the next two years are willing to nose dive their chance to remain in office by voting for HR 3200? I expect with Obama's approval rating finally dropping like a stone, that not many will.

I understand the flow chart to administrate this fine smoke and mirrors lets play socialist plan is a pure exercise in layer after layer of bureaucracy.

reality is that 10 M of our currently 'uninsured' are the illegal aliens.

I think the illegal aliens will have a back door to citizenship and the number will probably be closer to 20 million, and more coming every day.

There are also race, ethnic, and disparity clauses everywhere in this bill.  These characteristics seem to be linked to the coverage offered, premiums, and payments to providers.  It seems mandate discrimination for those groups determined to be at some kind of disadvantage.  It also includes money for education, also linked to race, ethnic, and disadvantage. 

Institutional discrimination against people who have done nothing wrong, just born a different race or ethnic background.

[nonesuche]

WG the real disaparity will be against the elderly in our country. Medical care will be for the young, not for the sick or the elderly. Our government will be deciding who lives and who dies - anyone who believes otherwise is off their rocker. What better way to reduce the numbers drawing social security?

Michelle Obama led a similar plan in Chicago years ago when she was still with the medical center there. It was a disaster, on paper of course it sounded like the perfect plan to open new clinics to provide for indigents and those without insurance that were utilizing emergency rooms for non-emergency care. When implemented however, it did not provide adequate ongoing care for a population that needs support and education to even recognize the value of consistent medical care. Another black hole the Obama's have created.

Obama is trying to bully us into this socialized medical care and all one has to do is speak with one patient with life-threatening cancer or heart disease in Canada, to realize that you can be diagnosed with a critical and possibly terminal illness - then told you will have to wait 6 weeks just to have surgery to address it. I have colleagues in Canada, they lament instance after instance of this to me occurring within their family and friends.

And 230 BILLION dollars in new spending for this smoke and mirrors health plan ??? Just like Obama's economic stimulus which did NOT provide the loans for small business as promised; the home loans for those who qualify; or decrease unemployment. It's just pure debt on our shoulders and our children's shoulders to pay off with no return.

Just as predicted by those of us who respect the free enterprise system, Obama's promises are nothing more, than promises. NOT ONE RESULT, NOT ONE BENEFIT, NADA.

[Nut44x4]

This may have been posted. I happened to come across this while searching for other stuff. Thought you all may want to have a look.

http://patientsunitednow.com/

There seems to be a lot of info there on the Health Care debate

[WhiskeyGirl]

The University of Chicago Medical Center is forging ahead with a major financing plan to pay for a large part of its new hospital pavilion in the face of a turbulent economy that has triggered layoffs and spending reductions at the facility this year.

The South Side teaching hospital early next month plans to issue bonds to raise $225 million through the Illinois Finance Authority to support the university's capital projects, "highlighted by the construction of a new patient tower pavilion on the main campus," according to a report released last week by Moody's Investors Service.

...The total cost of the pavilion will be about $700 million, with additional funds to finance the facility coming from fundraising and the medical center's cash.

Like other hospitals across the country, U. of C. has been hit hard by an increasing number of uninsured patients who cannot pay bills. The medical center cut about $100 million from its budget, including more than 450 jobs. It also stepped up relationships with community hospitals and clinics as part of its Urban Health Initiative, designed to free up space for specialized patients who can generate more revenue.

The U. of C.'s plan comes as rivals put off building or expanding facilities amid the recession. Among them are Loyola University Medical Center in Maywood and Advocate Health Care, the largest Chicago-area provider of medical care.

But medical center Chief Executive Dr. James Madara is committed to what he has called a "high technology platform" and is forging ahead with plans to open the new pavilion in 2013. Construction began in May.

Note that it is expected to open in 2013, when healthcare costs kick in big time. 

Where does Illinois get all that money?

http://www.chicagotribune.com/business/chi-thu-notebook-uofc-0723-jul23,0,7136721.story

Also, how much will they get in all the budget, stimulus, recovery, education, and healthcare bills?

Don't we have an organ shortage?  Where are they getting the organs?

[WhiskeyGirl]

NorthShore-U of C program seeks slice of transplant market
By: Mike Colias July 22, 2009

(Crain’s) — NorthShore University HealthSystem and University of Chicago Medical Center are teaming up on a new organ-transplant program, the hospitals said Wednesday. Under the pact, U of C specialists will treat NorthShore patients at a new transplant evaluation center in Evanston. Patients who are candidates for heart, liver, lung or other organ transplants would get diagnostic work and other services there and then likely would be referred to U of C in Hyde Park for surgery.

...

“This essentially could be a way to enhance (U of C’s) marketshare by establishing a beachhead in Northwestern’s service area,” says Roger Evans, a Minnesota-based consultant who advises hospitals on their transplant programs.

...

But the transplant venture underscores the business opportunities for both hospital systems. It gives U of C better access to the affluent northern suburbs. And NorthShore gets to leverage the U of C brand: The program is named the University of Chicago Transplant Evaluation center.

http://www.chicagobusiness.com/cgi-bin/news.pl?id=34853.

With the government plan set to kick in, won't there be enough patients in the Universities neighborhood?  Where will these folks go for treatment?

I believe Medicare pays secondary to any private insurance.  It seems like there is a three month elimination period and a 30 month coordination period.

Medicare rules here - page 14 is of interest
http://www.medicare.gov/Publications/Pubs/pdf/esrdcoverage.pdf

Today, after you leave your employer, you may keep your COBRA for a limited amount of time.  Now, government subsidizes the premium through tax credits to your employer.  What happens if you're allowed to keep your group insurance for life?  What if you still have access to the employer funds?  Many large employers self insure to save money.

My understanding of the HR 3200 world, the government provides a creative subsidy to it's contracted providers.  They get to 'retain' money for expensive individuals. 

There is no such creative subsidy for private insurance. 

If you offer individual insurance, what happens to the cost shift mixture if community activists send sick people to take out policies?  Any company could be targeted for ruination. 

Most private insurance plans are regulated by the states and require rate (premium) approvals with some kind of actuarial analysis to prove their case.  What happens if all your new business will cost you hundreds of thousands of dollars a year?  How will you ever collect enough money, or have a large enough risk pool?  Adverse selection.

The government plans have a convoluted blank check.

How many private insurance companies will continue to offer private insurance if and when a bill like HR 3200 takes effect?

One more.  Where are they going to get all the organs necessary for these transplants?  Isn't there an organ shortage?

Maybe there will be some kind of taxpayer funded incentive for donation?  Forced donations?

jmho

[WhiskeyGirl]

Bidding on the Contracted Government Plan business.

After mulling it over for a few days, it seems like the government will be outsourcing much of the Government Pplan business.  Entities will bid on offering the plan.

What are the opportunities to make money?  It looks like the government plan will collect money from some 'voluntary' participants.  I didn't understand how all of his will work.  It seems like the contracted government plans will then send money collected to the Treasury.  They will retain a larger portion of the take, for those folks with expensive healthcare problems, a kind of subsidy, not allowed for private individual/group/self-insured. 

Special groups, get 'reinsurance' - I think this is intended for the UAW VEBA, just a guess.

Odd, it seems like the Treasury will 'invest' the excess money, in a manner similar to what is being done with Social Security and Medicare today.  There is no trust and there is no fund accounting?  I'm not an expert, but that's what my simple brain is telling me.

How much excess will there be in the Government Plan collections?  In the private insurance, they will be forced to refund all moneys above a government determined loss ratio.  Will this put folks out of business?  Or, perhaps all the new government regulations will put them out of business?  What if your losses go above that?  Will these private folks get 'reinsurance'?

What happened to a level playing field?

It also looks like those that do not have coverage, including employers that do not offer coverage will pay directly to Uncle Sam, the punative taxation rules, with awesome penalties.  Probably you will see the growth of specialized law firms to help those that run afoul of the Government Plan. 

There are also pages and pages of 'gibberish' that speak to what is income and what is not income, and what should not be counted toward income.  Is this gibberish a gift to Wall Street?  All those Dark Pool traders?  The High Frequency Traders?  They make money...but for some reason, the government says it's not income.

No special favors for Main Street.

No need to worry about your trades becoming public, you don't own owe the government money on anything you make in your secret trades, because it's not real income.   

I didn't see anything (I may have missed it) that suggested that the contracted Government Plans will have to refund excess premiums.  Anyone see that in there?  Or does that just apply to the private plan?  Who's keeping the Government, and Government Plans honest?

Also, with the Contracted Government Plans, will they be getting fees, kick-backs, rebates, from hospitals, providers for all the business they send?  Will this drive up costs?  The fees, kick-backs, and rebates, a bonus profit?

Will there be large monetary incentives to send/accept Contracted Government Plan participants rather than Original Medicare enrollees?  "Enhanced Medicare payments"?

Will anyone be looking for volume/participation payments, fee, kick-backs, rebates, going from the hospitals, and other provider networks to the Contracted Government Plans?  Perhaps the Contracted Government Plans will direct any such payments elsewhere?

Maybe they'll get volume/participation payments, fee, kick-backs, rebates, from those large companies that provide supplies to hospitals and other providers? 

For some reason, HR 3200 breaks out a few things like motorized wheel chairs, oxygen, and other stuff.  Why?

Who's keeping the Contracted Government Plans honest? 

Anyone else have ideas?

jmho

[WhiskeyGirl]

The other thing that comes to mind about the Contracted Government Plans, Goldman Sachs was in the new recently for investing in a Texas company that planned to sell the plans.  Goldman was reported to have have no risk, but would be making fees.

How much are these Contracted Government Plans going to be making off taxpayers?  Any limits on the profits of those that manage the Government Plans?