Expand search form

Health Policy, Healthcare Reform, Law, Politics

They’re Baaack! Legislative Update – October 7, 2016

No Comments

Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.

It was a slow summer as our Congresspersons took their highly coveted 7-week vacation.

Even as premiums skyrocket and ACA co-ops fail, health care reform has been below the fold during much of this presidential campaign.

Thanks to Bill Clinton, the ACA is gaining the attention it deserves. The former president while shilling for his wife in Flint, Michigan, called Obamacare “the craziest thing in the world.”  He said, “you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half.”

He continued, “on the other hand, the current system works fine if you’re eligible for Medicaid, if you’re a lower-income working person; if you’re already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care. . . But the people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies.”

For example, the largest approved premium hikes on individual market plans for 2017 are: (1) Tennessee, Blue Cross, Blue Shield, 62%; (2) Kentucky, Golden Rule Insurance Co., 47%; (3) Iowa, Wellmark, 42%; (4) Nebraska, Medica, 39%; (5) Maryland, CareFirst, Blue Cross, Blue Shield, 31%.

 

More Fixes to the ACA

The CO-OP Consumer Protection Act, H.R. 954 which was introduced by Rep. Adrian Smith (R-NE) in February 2016, passed the House on September 22nd. The legislation was in response to the fact that only 6 of the 23 ACA Co-ops have not failed. This bill temporarily exempts from penalties for failing to purchase and maintain minimum essential health care coverage (i.e., individual mandate penalty) individuals whose coverage under a plan offered by a qualified nonprofit health insurance issuer receiving funds through the Consumer Operated and Oriented Plan program was terminated or otherwise discontinued.

Full text: https://www.govtrack.us/congress/bills/114/hr954/text.

 

On September 13, 2016, H.R. 6019, the Relief from Obamacare Mandate Act of 2016 was introduced by Rep. Todd Young (R-IN) and referred to the House Ways and Means Committee. The bill would to provide an exemption to the individual mandate to maintain health coverage for certain individuals whose premium has increased by more than 10 percent.

Full text: https://www.govtrack.us/congress/bills/114/hr6019/text.

 

On September 14, 2016, S. 3322 was introduced by Sen. Jeff Flake (R-AZ) and referred to the Senate Finance Committee. The bill would modify the ACA’s hardship exemption to the individual mandate to maintain health coverage for certain individuals residing in service areas with no health insurance issuers offering plans on an Exchange.

Full text: https://www.govtrack.us/congress/bills/114/s3322/text.

 

On September 15, 2016, H.R. 6049, the Protection from Insurance Exchange Monopolies Act was introduced by Rep. Joseph Heck (R-NV) and referred to the House Ways and Means Committee. This bill amends the Internal Revenue Code to exempt from the requirement to maintain minimum essential health coverage any individual residing in a county with fewer than two health insurance issuers offering qualified health plans on an exchange.

Full text: https://www.govtrack.us/congress/bills/114/hr6049/text.

 

On September 19, 2016, H.R. 6067, the Relief from Obamacare Exchange Failures Act was introduced by Rep. Diane Black (R-TN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code to provide an exemption from the individual mandate for certain individuals without access to Exchange coverage.

Full text: https://www.govtrack.us/congress/bills/114/hr6067/text.

 

On July 6, 2016, H.R. 1270, the Restoring Access to Medication Act of 2015 was passed in the House and was sent to the Senate for consideration. This bill repeals provisions of the Internal Revenue Code, added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs).

Full text: https://www.govtrack.us/congress/bills/114/hr1270/text.

 

On May 25, 2016, H.R. 5324, Health Savings Account Expansion Act of 2016 was introduced by Rep. Dave Brat (R-VA) and referred to the House Ways and Means Committee. This bill amends the Internal Revenue Code to modify the requirements for health savings accounts (HSAs) to:

increase the maximum contribution amounts, permit the use of HSAs to pay health insurance premiums and direct primary care expenses, repeal the ACA’s restriction on using HSAs for over-the-counter medications, eliminate the requirement that a participant in an HSA be enrolled in a high deductible health care plan, and decrease the additional tax for HSA distributions not used for qualified medical expenses.

Full text (House): https://www.govtrack.us/congress/bills/114/hr5324/text.
Full text (identical Senate): https://www.govtrack.us/congress/bills/114/s2980/text.

 

On Sep 15, 2016 Senate Resolution 561, a resolution supporting efforts to increase competition and accountability in the health insurance marketplace, and to extend accessible, quality, affordable health coverage to every American through the choice of a public option, was introduced by Sen. Jeff Merkley (D-OR) and referred to the Senate Health, Education, Labor, and Pensions Committee.

This resolution expresses support for efforts to build on the ACA by adding the public option. The resolution posits that the public option would (1) lead to increased competition and reduced premiums; (2) cut wasteful spending on administration, marketing, and executive pay; and (3) ensure that consumers have the affordable choices they deserve; and (4) save taxpayers billions of dollars according to the Congressional Budget Office.

Full text: https://www.govtrack.us/congress/bills/114/sres561/text

 

Tax Relief for Consumers

On Jun 29, 2016, S. 3111, the Seniors Tax Hike Prevention Act of 2016 was introduced by Sen. Rob Portman (R-OH) and referred to the Senate Finance Committee. This bill amends the Internal Revenue Code to extend through 2018, the rule that permits individuals who are 65 and older to deduct certain medical expenses that exceed 7.5% of adjusted gross income. (Under current law, the rule that reduces the 10% threshold for the medical expense deduction to 7.5% if a taxpayer or a taxpayer’s spouse is 65 or older expires at the end of 2016.)

Full text: https://www.govtrack.us/congress/bills/114/s3111/text.

 

Support for Direct Pay Practices

On September 13, 2016, H.R. 6015, the Primary Care Enhancement Act was introduced by Rep. Erik Paulson (R-MN) and referred to the House Ways and Means Committee. (Identical bill in Senate, S 1989). This bill amends the Internal Revenue Code to: (1) permit an individual to pay primary care service arrangement costs from a health savings account; (2) allow an eligible taxpayer enrolled in a high-deductible health plan to take a tax deduction for cash paid into a health savings account, even if the taxpayer is simultaneously enrolled in a primary care service arrangement; and (3) for purposes of certain tax-deductible expenses for medical care, expand the definition of “medical care” to include periodic provider fees and pre-paid services. A “primary care service arrangement” is an exchange of ongoing primary care services for a fixed periodic fee which is not billed to any third party on a fee-for-service basis.

The bill also amends title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation (CMI) to test a primary care medical home model for payment and service delivery. Under this type of model, qualified direct primary care medical home practices are reimbursed a periodic fee for serving Medicare enrollees. In selecting qualified direct primary care medical home practices to participate, CMI shall give priority to practices seeking to enroll dual-eligible individuals.

Full text House version: https://www.govtrack.us/congress/bills/114/hr6015/text.
Full text Senate version: https://www.govtrack.us/congress/bills/114/s1989/text.

 

Pro-Physician Volunteer Legislation

On June 27, 2016, S. 3101, the Good Samaritan Health Professionals Act of 2016 was introduced by Sen. Bill Cassidy (R-LA) and referred to the Senate Health, Education, Labor, and Pensions Committee. This bill amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional’s capacity as a volunteer, and in a good faith belief that the individual being treated is in need of health care services.

This protection from liability does not apply if: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of alcohol or an intoxicating drug.

Full text: https://www.govtrack.us/congress/bills/114/s3101/text

 

More Control Over Physicians as Part of the Opiate Wars

On July 13, 2016, S. 3209, the Prescription Drug Monitoring Act of 2016 was introduced by Sen. Amy Klobuchar (D-MN) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would require the use of prescription drug monitoring programs and to facilitate information sharing among States.

Full text: https://www.govtrack.us/congress/bills/114/s3209/text.

 

Legalized Physician Assisted Suicide Is On the March

Attempting to join Washington, Oregon, Vermont, Montana, California, on October 4, 2016, a Washington, D.C. city council panel voted 3-2 to advance a bill allowing physician-assisted suicide. One of the dissenters said she feared low-income people who have less access to health care would be pushed to end their lives early. Another felt this should be done through a ballot initiative to give voters their say.

 

And Why Do We Need Laws to Mandate Administrative Common Sense

On September 22, 2016, H.R. 5320, the Social Security Must Avert Identity Loss (MAIL) Act of 2016 passed the House by 414-0. This bill directs the Social Security Administration to ensure that no document it sends by mail includes a complete Social Security account number unless necessary.

Full text: https://www.govtrack.us/congress/bills/114/hr5320/text.

 

On July 14, 2016, H.R. 5880 was introduced by Rep. Cedric Richmond (D-LA) and referred to the House Ways and Means Committee. This bill directs the Department of Health and Human Services to establish cost-effective procedures to ensure that a Social Security account number (or a derivative) is not displayed, coded, or embedded on Medicare cards. If you remember, 20 years ago HIPAA mandated that insurance cards would not have Social Security numbers, but Medicare could not figure out how to do it.

Full text: https://www.govtrack.us/congress/bills/114/hr5880/text.

 

On September 13, 2016, H.R. 6011, the ACA Premium Verification Act, was introduced by Rep. Gus Bilirakis (R-FL) and referred to the House Energy and Commerce and Ways and Means Committees. To require that the Centers for Medicare & Medicaid Services has in place adequate verification procedures to ensure that advance payments under the Patient Protection and Affordable Care Act are made for only enrollees under qualified health plans who have paid their premiums

Full text: https://www.govtrack.us/congress/bills/114/hr6011/text.

Health Policy, Healthcare Reform, Medicare, Medicine, Op-eds, Socialized Medicine

The High Cost of Free Care

No Comments

By Marilyn M. Singleton, MD, JD.,

When I signed in for my yearly mammogram the receptionist announced with a wry smile, “No co-pay this time, it’s free!” We both knew that it really wasn’t free.

To understand whether free means free, let’s look at Medicare as an example. Medicare has four parts. Part A (“hospital”) covers hospital admissions, post-hospitalization short-term skilled nursing, and hospice. Part B (“medical”) covers outpatient medical services such as physician visits, lab tests, and outpatient surgery. Parts A and B are called traditional Medicare. Part C (“Medicare Advantage”) is private HMOs. Part D is prescription drug coverage. Technically, all parts are optional.

Medicare is costly before and after we enroll. We pay for Part A through a 2.9 percent tax on earnings, half of which is paid by employers. Thus, an average worker earning $43,500 per year generates $105 every month for the promise of hospital insurance benefits beginning up to 45 years in the future.

Importantly, Part A is mandatory for those eligible for Medicare who receive Social Security payments. If beneficiaries want to opt out of Part A, they must forfeit all of their Social Security payments.

Those ineligible for premium-free Part A because they did not pay the Medicare tax during their working years may purchase it (at a cost of $426/month in 2014), but if they do not do so immediately, they are penalized. Their monthly premium can increase 10 percent and they must pay the higher premium for twice the number of years they could have had Part A, but did not enroll.

Just as with most private insurance, Medicare Part A has out-of-pocket expenses. The 2014 Medicare Part A inpatient hospital deductible is $1,216 per hospitalization and the co-pay for hospitalizations over 60 days is $304 per day.  There is no out-of-pocket limit.

General tax revenues finance 72 percent of Part B; beneficiary premiums finance the remainder. The government deducts a minimum of $104.90 for Medicare Part B from the monthly Social Security payments of everyone enrolled in either Part B or Medicare Advantage.

High-income earners (greater than $85,000/individuals, $170,000/couples yearly) pay progressively higher Part B premiums up to $335.70 per month. Part B has an annual deductible of $147.00 and co-pays of 20 percent, and a lifetime penalty for late enrollment. There is no out-of-pocket limit.

Part C Advantage plans, started in 1997 as “Medicare+Choice”, are sold by private insurance companies and have at least the same Part A and B coverage as traditional Medicare. Their advantage is that the monthly private insurance premium covers prescription drugs and more services than traditional Medicare (e.g., optometry, hearing tests, dental plan options), with low or no co-pays.

They also have limits on out-of-pocket expenses.  With traditional Medicare, to avoid unlimited out-of-pocket expenses, beneficiaries must purchase a private government-approved supplemental insurance (“Medi-gap”) policy with an estimated annual cost of $6,200.

Part D is largely (74 percent) financed through general revenues. Beneficiary premiums and state payments through Medicaid make up the remainder. High-earning beneficiaries pay a larger share of the cost of Part D coverage.

The Affordable Care Act cut $156 billion from Medicare Advantage. My 2014 Advantage plan’s out-of-pocket maximum rose from $3,400 to $5,900. Lab and X-ray costs rose from $30 to $45. Was this to pay for the “free” tests for traditional Medicare?

The next time someone rails about evil insurers and the health exchanges’ surprisingly high premiums and co-pays, concluding that “Medicare for all” is the solution, enlighten them with facts. Traditional Medicare covers only 64 percent of healthcare expenses for noninstitutionalized beneficiaries, according to the MedPAC Data Book, 2013.

Medicare pays hospitals an average of 10 percent below their costs of caring for patients, states the American Hospital Association in its Underpayment by Medicare and Medicaid Fact Sheet, December, 2010.

If a physician accepts out-of-pocket payment from Medicare patients who want to pay, for example, for extra time with their doctor during a Medicare-covered visit, the physician is forced from the Medicare program for two years. Explain that ObamaCare’s individual mandate-tax is trivial compared to the government’s holding Social Security benefits hostage to participation in socialized medicine.

Free is never free. Medicare is a transfer system from younger generations’ incomes to older generations’ healthcare. “Medicare for all” would force our youth into the same costly and bankrupt system that is already denying care.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Medical Ethics, Medicine, Op-eds

I’m Sorry for Your Loss

No Comments

By Marilyn M. Singleton, MD, JD.,

In Law and Order re-runs after some tragedy has occurred, prior to grilling the victim’s family the police officer quickly states the obligatory phrase, “I’m sorry for your loss.” It is sterile, meaningless, and as heartfelt as the streaming digital “Thank you” at the automated gas pump.

Fortunately, genuine compassion has been given another reprieve. Pennsylvania recently became the 37th state to enact an “apology law.” When there is an unanticipated outcome of medical care, apology laws allow physicians to express sincere feelings without fear that such expressions will be used against them in court.

These statutes range from shielding all “statements, affirmations, gestures or conduct expressing apology, fault, sympathy, commiseration, condolence, compassion or a general sense of benevolence” (Connecticut) to expressions of sympathy or benevolent gestures, i.e., “actions which convey a sense of compassion or commiseration emanating from humane impulses” (California).

Psychologists teach us that an apology is an important way of “showing respect and empathy for the wronged person.” Apologies improve patient-doctor communication and reduce patient anger. A 2010 Annals of Internal Medicine study looked at University of Michigan and Boston’s Brigham and Women’s hospitals. The study found that malpractice claims decreased by almost one half where hospitals admit and apologize for mistakes.

In an age where physicians are increasingly engrossed in compliance paperwork and have their eyes glued to the computer screen with electronic medical records, any tool that injects humanity is more than welcome. The findings in a recent paper in Journal of Hospital Medicine were telling: only 4 percent of interns practiced “etiquette-based” medicine.

Such etiquette includes (1) introducing themselves; (2) explaining their role in patient care; (3) touching their patients with a handshake, reassuring gesture, or physical exam; (4) sitting and talking with patients; and (5) asking open-ended questions to get patients to relax and talk more about themselves.

These interns are busily learning algorithms, evidence-based guidelines, and fulfilling regulatory mandates. But they will soon discover that checklists will never replace thoughtful individualized care.

A Pennsylvania community hospital Emergency Department looked at physician time usage: direct patient contact, data and order entry, discussion with colleagues, and reviewing records and test results. A whopping 43 percent of their time was spent on data entry versus 28 percent on direct patient contact.

The depersonalization of medicine is disconcerting to be sure. But it is one band on the spectrum of disconnectedness. What is more troubling is the accepted disconnection between people and facts.

At least 80 percent of the comments to the newspaper article explaining the apology law were by people tethered to their hatred. The willfully uninformed railed about how letting incompetent doctors off the hook was what we can expect from a Republican governor.

Per usual, they had not read the article. The law does not shield the physician from malpractice lawsuits; it says that compassionate statements cannot be part of the collective evidence that he breached the standard of care.

The fact is that Pennsylvania’s Democratically controlled legislature unanimously passed the law and the Republican governor signed it. I suppose haters can blow off unjustified steam and begrudge physicians the ability to express spontaneous, unrehearsed, uncalculated empathy.

Of course people reinvent the truth. We have learned from our professor-in-chief: “If you like your doctor you can keep your doctor. Period.”

Well, I am sorry for our losses. I’m sorry for our loss of intelligent discussion of issues in the public forum. I’m sorry for our loss of time with patients when time is absorbed by bureaucratic red tape.

I’m sorry for our loss of patients’ full disclosure of private information for fear it will reach the government’s prying eyes. I’m sorry for your loss of choice of physicians and hospitals. I’m sorry for your loss of low-priced catastrophic insurance policies. I’m sorry for your loss of uncapped contributions to health flexible spending accounts.

I’m sorry for your loss of full-time work hours. I’m sorry that the 20 and 30-year olds who can least afford it are expected to finance healthcare. I’m sorry that the government thinks that having an insurance card equals access to care.

I’m sorry that ObamaCare true believers do not realize that there’s always free cheese in the mousetrap. Period.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Close Menu