Checking Up On Health: November 11, 2014

Health Care News and Views
Compiled by Benita M. Dodd



You’re stupid. Don’t sweat all this complicated gubmint stuff. 

This week’s big health care story is the revelation of a 2013 video clip by Jonathan Gruber, an architect of the Affordable Care Act. It has stirred up a hornets’ nest. Gruber, addressing an academic conference, said that the passage of ObamaCare hinged on two things: the stupidity of American voters and ObamaCare proponents’ obfuscation.

First, as a lesson to you all, let me recall the poet Omar Khayyam:

“The Moving Finger writes; and, having writ,
Moves on: nor all thy Piety nor Wit,
Shall lure it back to cancel half a Line,
Nor all thy Tears wash out a Word of it.”

You get it. The cameras were rolling as Gruber told attendees at the 2013 conference, “Lack of transparency is a huge political advantage. And basically, call it the ‘stupidity of the American voter’ or whatever, but basically that was really, really critical to getting the thing to pass.”

Clearly, Mr. Know-It-All didn’t learn from his FIRST mistake. If you been following the ObamaCare discussions, you may remember Gruber. He’s the same ObamaCare expert who said, in a 2012 video clip, that the law did not include tax subsidies for federal exchanges – those established by the feds if states refused to establish their own:

I think what’s important to remember politically about this, is if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits. But your citizens still pay the taxes that support this bill.

That became an issue that’s now headed to the U.S. Supreme Court after 36 states opted not to set up an exchange for buyers of health care plans. The Obama Administration and the IRS are talking “intent” of the law. But as the editors of National Review write, “Even if Democratic legislators are not very deft at crafting legislation, it is not the responsibility of the Supreme Court to bail them out.”

  • Gruber’s explanation for the 2012 video? It was he was “speaking off-the-cuff. It was just a mistake.” “But there was never any intention to literally withhold money, to withhold tax credits, from the states that didn’t take that step. That’s clear in the intent of the law and if you talk to anybody who worked on the law. My subsequent statement was just a speak-o – you know, like a typo.”
  • His defense for the 2013 video? “The comments in the video were made at an academic conference … I was speaking off the cuff and I basically spoke inappropriately and I regret having made those comments.”

As Kathleen Parker writes in The Washington Post, “It is a beautiful thing when Truth trots out the door before Oops can catch him.”

If you’d like to find out more about citizen journalist Rich Weinstein, the sleuth who uncovered the video clips, you should read the report by Bloomberg News: “Meet the Mild-Mannered Investment Adviser Who’s Humiliating the Administration over ObamaCare.”

Supreme Court to hear Federal subsidies case

The Supreme Court has agreed to hear the case involving subsidies on the federal exchange established under the Affordable Care Act. The law provides that state exchanges can offer customers premium subsidies, but when 36 states opted not to set up an exchange, the Obama administration decided unilaterally to extend the subsidies to buyers on the federal exchange at Arguments will be heard in the spring of 2015, with a decision likely in June. A three-judge panel of the DC Circuit Court already ruled correctly, but the court’s the also agreed to an en banc rehearing, so it’s curious the justices are basically nullifying that case.

 Lower ObamaCare enrollment expectations

It’s no surprise no Democrats ran on ObamaCare’s success during the mid-term elections. The Reason Foundation reports that the Obama administration now expects to see dramatically fewer enrollments in the second year of the Affordable Care Act than originally projected. Also, that hitting its long-term enrollment goals will likely take years longer than initially believed. By next year, the Congressional Budget Office (CBO) had estimated in April, enrollment in private health plans under ObamaCare would soar to 13 million people. It’s currently at 7.1 million (down from April’s announcement of 8 million). But the administration now says announced that it expects the number to be between 9 and 9.9 million.

Carte blanche or prix fixe?

My friend and health care expert John Graham reports that, back in 2008, California Employees Retirement System (CALPERS) and WellPoint introduced reference pricing for knee and hip replacement surgery. This meant that the employer would pay a fixed fee to have the operations done at high-quality, low-priced facilities. Employees who wanted to go to higher-priced facilities paid the difference. As a result, high-priced facilities cut their rates by one third. You would think that, by now, WellPoint would have introduced such reference pricing to all its corporate clients across the United States, Graham says. “No such luck. As a result of ObamaCare, the U.S. Department of Labor (DOL) is threatening to regulate this practice, saying that it is “concerned that such a pricing structure may be a subterfuge for the imposition of otherwise prohibited limitations on coverage, without ensuring access to quality care and an adequate network of providers.” He adds that this negotiated price is an approach that hospitals would love to eliminate.

100 things to know about Medicare and Medicaid

Becker’s Hospital Review shares some fascinating facts about the two government-run programs of Medicaid and Medicare. Such as: Did you know Harry Truman was the first Medicare enrollee? Or that the Centers for Medicare and Medicaid, part of the Department of Human and Health Services, manages Medicare and oversees the state operation of Medicaid. CMS is an $820 billion industry, providing health care for more than 100 million Americans today. CMS employs more than 4,000 people in 10 regional offices. Read more here.

YOU may need a second opinion … about your physician.

That specialist your physician sends you to may be all wrong for you. Nearly 20 million patients are inappropriately referred to a provider who is not the right match for their condition every year, according to the 2014 Kyruus Physician Referral Survey. The survey found 75 percent of specialists have received at least one “clinically inappropriate” referral in the past year.

Making the call on telemedicine

Telemedicine is growing in popularity and acceptance across the nation. Currently, 12 states are revising their telemedicine regulations through rulemaking or other means, according to a report in Politico, although some are moving forward and others backward. An October survey at the Academy of Integrative Health and Medicine conference in San Diego found 33 percent of physicians say they are delivering services using telemedicine, but just 19 percent say they have a system in place to get paid for telemedicine services. A whopping 56 percent say telemedicine technology is ahead of their states.

Some hospitals are safer than others

One in four Georgia hospitals earned an “A’’ grade in recently released ratings on patient safety, according to Georgia Health News. The only hospital in the state earning an “F’’ was Wayne Memorial Hospital in Jesup in southeast Georgia. See whether and how your hospital was ranked here.

Government games Medicare

The Georgia Public Policy Foundation’s commentary on Friday was “Time for Truth in Medicare Accounting,” in which Kelly McCutchen and Patrick Gleason pointed out that unless the “Doc Fix” is permanently fixed, Georgia’s Medicare beneficiaries are in for a lot of hurt. Read it here.

Quotes of note

“Few people would voluntarily buy health insurance from an ObamaCare exchange if the health insurers on the exchanges did not receive subsidies to enroll people. The premiums would be too high otherwise.” – John Graham

“CMS is trying to use its financial clout to motivate health care providers to provide higher quality care. The readmission policy is one of many reimbursement changes built into the Affordable Care Act (a.k.a. Obamacare). But it is a policy that probably needs revision. Evidence is continuing to accumulate that the readmission policy will unduly harm hospitals that care for low income patients.” – Dr. Peter Ubel