From Reform to Fraud and Abuse Prevention

Posted on August 29, 2011 by Danyell Jones

We would like to thank everyone who has visited our blog this month and joined us for our online series about some of the more particular aspects of healthcare reform, particularly our HIPAA 5010 posts.

We understand that this topic is extremely expansive, and will come back to visit it again in the future through some of our other posts. Indeed healthcare reform has already began to impact the industry, and will continue to do so in the future. Compliance in healthcare will be impacted, relationships with payers will be affected, and, as we have shown previously, there will be more of an emphasis on fraud and abuse prevention. September is just around the corner and has been designated by the Centers for Medicare and Medicaid Services(CMS) as Healthcare Fraud Prevention and Awareness Month. We think that this is an excellent time to shift gears and look at the topic of fraud and abuse prevention and awareness. We hope that you will join us again this week as we continue to explore relevant healthcare topics, and engage in conversations with you, our viewers.

In the meantime please feel free to check out this video to become acquainted with the basics of what healthcare fraud is: What is Healthcare Fraud

And watch this campaign for fraud and abuse prevention for some interesting statistics on how fraud is impacting healthcare costs:

Until next time!

HIPAA 5010 Resources

Posted on August 26, 2011 by Danyell Jones

As promised, today we are providing you with some of our favorite HIPAA 5010 resources from around the web. We hope that you enjoy these posts, and that they help you with your individual preparations and healthcare compliance initiatives.

My favorite HIPAA 5010 Blog Information:

MelissaData

The following post has a fantastic HIPAA 5010 timeline:

Relayhealth

Blog Posts About HIPAA 5010 Testing Week:

FCP

Government Health IT

AAFP Informational Page on HIPAA 5010 Testing

HIPAA 5010 Questions and Answers from CMS

We hope that everyone will take advantage of some of the resources that we have found, and that all organizations will begin to examine how prepared they are for HIPAA 5010 implementation and other healthcare reform issues. The key to preparation is to stay current with the new changes, and begin to prepare now before the changes are implemented. BHM strongly recommends that all organizations begin constructing a HIPAA 5010 preparedness strategy which will include testing, training, and educational components.

Best of luck, until next time!

HIPAA 5010 Will Pack a Punch- National Testing Week

Posted on August 25, 2011 by Danyell Jones

Reform, reform, reform…we hear about it all the time, but few organizations know to what extent it will impact their organizations, and

HIPAA 5010 Readiness

even fewer are adequately prepared for changes which are coming down the pike. HIPAA 5010 is one of those changes which promises to pack a big punch as far as organizations and providers are concerned. HIPAA 5010 will constitute a large change in the way that providers submit claims, as well as the processes for billing procedures….and its implementation is slated to take effect on Jan. 1, 2012.

What is HIPAA

HIPAA, generally speaking, provides federal protections for personal health information held by health plans, health care clearinghouses, and health care providers. HIPAA also gives rights to patients/consumers with respect to that protected information. The U.S. Dept. of Health and Human Services (HHS) also specifies a number of regulations regarding confidentiality, integrity, and availability of this personal health information with regard to electronic medical records

HIPAA 5010- What is the Difference

HIPAA 5010 is more specific in terms of data requirements collected and transmitted with personal health information. Many of the new requirements deal with a patients location of residence, or address issues. The mandate will impact how companies, billing providers, and facilities treat postal addresses (for instance PO Boxes are prohibited as a valid billing address, and ZIP codes will be required in their entirety meaning 9 digits, rather than 5).

Who Needs to Be Prepared

As stated, all healthcare organizations will need to be HIPAA 5010 compliant by Jan. 2010, however IT vendors and Data Quality Software Vendors who sell programs to healthcare organizations will also need to be compliant with these changes. In fact initial surveys point to the fact that healthcare providers are largely leaving the compliance issue up to their outside vendors, counting on them to ensure that all software is able to be updated and ready for the healthcare compliance changes to come, but relying on these vendors could mean potential problems for organizations down the road.

Troubling Statistics

The following information is courtesy of a recent HIMSS survey conducted in Summer 2011

35% of providers stated that they had NO Plans in place to implement a HIPAA 5010 readiness project

How to Prepare

To avoid rejected claims and cash flow interruptions, physicians should prepare for the transition by working with their vendors, clearinghouses, billing services, and payors or upgrade and test their systems and ensure that they are able to successfully implement the new standards prior to the compliance date.

To help practices prepare for the transition, the Centers for Medicare & Medicaid Services (CMS) has announced that Monday, August 22, through Friday, August 26, is National 5010 Testing Week. This is an opportunity for physicians, including their clearinghouse and/or billing service, to test the Version 5010 transactions with the added benefit of real-time help desk support and immediate access to the Medicare Administrative Contractors (MACs). For more information on National 5010 Testing Week, please visit the following link: 5010 Testing Week

For more information on how your organization can be prepared please come back tomorrow, when we will be posting a directory of links for free webinars, HIPAA 5010 blog information, and valuable CMS/HIMSS information.

We look forward to seeing you tomorrow!

BHM Launches Physician Peer Review Portal

Posted on August 23, 2011 by Danyell Jones

BHM Healthcare Solutions, a nationwide consulting firm, has long been recognized for their expertise in providing physician advisor

BHM Launches PA Portal for Clients

services to their client base. The firm was built on a strong foundation of providing quality physician advisory services, which go beyond the typical quantitative review services and offer a qualitative experience through the utilization of in-depth guidance and ongoing improvement strategies. Now BHM has taken this process one step further with the development and launch of a new PA Portal which will drive efficiency, and accessibility. Brian Johnson, Chief Technology Officer at BHM was instrumental in driving the development of this new product and recently stated that “It has been our goal in designing this product to make the peer review process more streamlined, which will translate into better accessibility, affordability, and ease of use for client organizations and our physicians.”

The PA Portal, which was officially launched in August 2011, is a scalable solution for peer reviews. The product has undergone testing and has been found to have the capacity to meet larger volume demands while simultaneously increasing speed and decreasing manual duplication which can be problematic for organizations participation in the physician peer review process. This new tool will be used in tandem with BHMs unique physician advisor approach which incorporates expertise, training, and education allowing for the provision of exceptional review services that provide clinical leadership modeling opportunities for client organizations. All of this is backed by a broad base of physician advisors who are able to conduct utilization management review, complex file reviews, appeal reviews, and provide physician advisor consultations. Mark Rosenberg, President and CEO of BHM has stated that “PA services are the foundation that our consulting firm was built upon, and many of our associates have more than 15 years experience providing PA services to hospitals and managed care organizations.”

BHM looks toward the future of providing superior physician consulting services which bring value, innovation, and cutting edge technology to our clients and the PA Portal is a giant advancement to that end. Annette Marie, Director of Administrative Operations at BHM, was another member of BHMs highly trained team who was pivotal in the development and creation process of the PA Portal. Ms. Marie has stated that “BHM is exceptionally pleased to bring this new product to our existing and future clients. The PA Portal is a secure, automated, and efficient solution to meeting physician advisor needs in a standardized way which will provide the benefit of faster turn-around times, lower cost, and improved documentation.”

To learn more about BHM Healthcare Solutions and their full range of innovative products and services related to physician advisor services please visit: http://www.bhmpc.com/physician-advisor/

Bracing for Reform Impact- Encounter Data and Claims (2)

Posted on August 17, 2011 by Danyell Jones

healthcare reform, encounter data and claims

Proper Data + Reform = Payment Impact

In our last blog post we began to go over the potential impact that new ways of utilizing Encounter Data and Claims could have on healthcare. Following up on that discussion we though we would share some interesting statistics that were recently released by the Office of Inspector General and CMS.

Currently 39 States and Washington D.C. are running Capitated Manged Care Plans
All 39 states with capitated Medicaid Managed Care are responsible for the collection of Encounter Data, and the utilization of this information for purposes of rate setting, detection of fraud and abuse, and monitoring of program expenditures
Only 28 of these states were able to successfully submit the required data per CMS specifications, the other states experienced “significant difficulty” according to the OIG, and not all of the states submitted their data on time; in fact
15 of the 40 states were unable to submit data at the time of the OIGs review

In response to these poor performance numbers the OIG is now beginning to push for monetary sanctions against states who do not adequately supply the adequate information. Furthermore, the Affordable Care Act has authorized the withholding of federal matching funds for states that fail to properly report encounter data in a timely manner. All of this means that plans that do not comply correctly could lose valuable revenue.

So, what can your organization do to gauge how prepared you are for the new CMS requirements? We have put together a quick checklist of questions that your organization should consider

1. What is the potential CMS encounter data impact on your organization?

2. Does your organization currently have any issues with data integrity or timely reporting?

3. Are you familiar with the changing regulations, and do you have a proactive plan to address potential concerns?

4. What is your current encounter data submission process? Are there any tools or additional training that your organization will need to employ to ensure healthcare compliance?

5. What are the CMS deadlines for encounter data as it relates to your state and your organization?

BHM strongly recommends that in order to maintain profitability and mitigate the risk of lost revenue all organizations check that they are properly certified in healthcare compliance or working with an organization that is, and that they are fully aware of the changes. Developing a strong proactive plan to address any areas of risk or need in your organization will ensure that when Jan. 2012 hits, and the new requirements go into effect, that your organization is not left out in the cold.

Bracing for Reform Impact- Encounter Data and Claims (1)

Posted on August 15, 2011 by Danyell Jones

As we gear up to hit on some hot healthcare reform topics this month we will begin with the monumental changes which will be taking place with regard to Encounter Data and Claims under a new Center for Medicare and Medicaid Services (CMS) requirement. Though few organizations seem to have this requirement on their radar, the impact could prove to be very costly for any organization which finds itself unprepared once the new requirement goes into effect in Jan. 2012.

What is Encounter Data and Claims

Before we dig into the topic at hand, we will begin with a brief overview of what Encounter Data and Claims is. Encounter Data and Claims is all information related to the services provided by a States capitated Medicaid Managed Care Program, and the primary record of services for enrolled beneficiaries. This information allows CMS to know which medicaid services enrolled beneficiaries in managed care are receiving, what services Medicaid is paying for via capitated rates, and whether or not capitated rates paid to Managed Care Organizations and Local Management Entities are fair and set accordingly.

Why is Encounter Data and Claims Information Important

According to the Office of Inspector General:

Enrollment in Medicaid managed care is increasing

71% of Medicaid beneficiaries receive managed care services
45% of Medicaid beneficiaries are enrolled in comprehensive managed care programs

Expenditures for Medicaid managed care are increasing

2000-2006 State and Federal expenditures increased form $207 to $322 Billion
2008 Total Medicaid spending reached $330 billion
2009-2010 Federal Medicaid budget request increased by $36 billion

What is changing under Healthcare Reform

Historically, Medicaid program evaluations have been based on fee-for-service claims- providers would submit a claim and upon approval be paid for services rendered, however Medicaid is not longer a fee-for-service world and the move has been made toward capitated payments.

Plans will not need to be more focused on submitting patient encounter data to CMS for risk-adjustment purposes. According to AIS Health “this is not only a system-change issue, although many plans seem to be way behind on making those needed modifications. It also affects revenue cycles since plans not collecting and supplying high-quality data reflecting patient ‘encounters’ with providers could receive lower payments from CMS.”

Organizations should begin to make concrete determinations as to whether or not they are prepared for the impending Jan. 2012 changes, and what potential impact this could have on their organization. In our next post we will be looking at some statistics that show how successful, or unsuccessful states have been thus far in regard to Encounter Data Collection and Use. We will also be posting a list of questions that organizations should ask themselves to gauge their current level of preparedness.

We hope you will join us!

If you believe that your organization could benefit from a financial analysis which examines the intricacies of how Encounter Data and Claims is utilized in your business please visit our Financial Improvement page, or contact us at results@bhmpc.com for a free consultation.

BHM Healthcare Solutions Launches Executive Healthcare Job Search Tool

Posted on August 11, 2011 by Danyell Jones

Though the economy may still be rebounding, those in the healthcare field can now benefit from a new job search and listing board recently released by BHM Healthcare Solutions on their website. This interactive web feature allows users to search for high level healthcare jobs online, submit their applications virtually, and schedule appointments for interviews. Full access to the job opportunities board may be found here. Unlike many other job search boards which offer high level executive and clinical positions BHM provides its listings to the public, and there is no membership fee to submit applications online. All of these services are offered via BHMs revamped, and recently re-launched Executive Recruitment division headed by Jeanette Baker.

Ms. Baker, former CEO of Executive Search Consultants, brings more than 15 years of senior executive recruitment and entrepreneurial experience to the position. Additionally, Ms. Baker has been recognized as one of the top executive recruiters nationwide, and formerly worked with Rice Cohen International, a top ranked recruiting firm. “I plan to bring my expertise in the field of recruiting to BHM Healthcare Solutions, and utilize that expertise to bring top level candidates and employers together in the healthcare field,” stated Ms. Baker.

The difference found in BHM Healthcare Solutions is in their unique approach to finding qualified applicants, screening them through each stage of the process, and pairing prospective associates with employers in a way which will guarantee a long term match. Robert Pezzoli, MPH FACHE, Vice President of Administration for Baltimore Healthcare Access states that “I have worked with nearly every Executive Search firm in my career, as both a client and a candidate, and I can say without reservation that my experience with BHM has been one of the best I have ever had.”

Not only is BHM experienced in healthcare executive recruitment , but the consulting firm is one of a few select firms nationwide that also specializes in behavioral health executive recruitment, a niche market in the healthcare field that will become increasingly important as the nation moves towards healthcare reform, and primary care/behavioral health integration. Danyell Jones, Director of Customer Solutions for BHM stated that “as BHM continues to grow we will continue to strive to make our services and tools more accessible for both candidates and employers by utilizing technology in association with expertise and a unique approach to provide our clients with a positive experience for a competitive price.”

MCEG Top 10 Healthcare Reform Issues

Posted on August 9, 2011 by Danyell Jones

TOP TEN Healthcare Reform Issues

This summer the Managed Care Executive Group (MCEG) met in Florida, and released a “TOP TEN” list of relevant healthcare reform issues. Here is a copy of that list fresh off of the internet presses. Over the course of the month we will look into some of these issues in more detail, including encounter data and claims changes, HITECH Act, HIPAA 5010, and other healthcare compliance issues which will be front and center moving forward.

The 2010 MCEG Top Ten Issues:

The Role of State and Federal Government in Health Care: Government support, intervention and regulation are having increasing impact on payer’s operations, costs and even marketplace strategies. In 2010 MCEG will look closer at Legislative and Compliance Demands from the Government. The implementation of the HITECH Act, ICD-10, HIPAA 5010, and Health Care Reform will be among the top investments in 2010.
Health Care Reform: Reform legislation, whether comprehensive or piece-meal, and whether at the Federal level or State level, will result in dozens of new agencies and grant programs, in addition to adjustments to the insurance market and payment.
ICD-10: The impact of changing to ICD-10 for medical record coding and billing is underestimated. It will likely be as significant a project across the industry as Y2K or HIPAA 5010 and when undertaken, will push many other HIT projects to lower priority.
Data analytics and informatics: Disease management, real-time decision support, case management, customer segmentation and protocol development will continue to drive investment in analytics. Clinical information will be broad and deep, enabling caregivers to more precisely identify diagnoses and target treatment.
HIPAA 5010: New HIPAA requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries. The implementation will require changes to the software, systems, and perhaps procedures that are used for billing Medicare and other payers.
Consumer Response to Health Care Changes: In 2010 we will see a wave of consumers voicing their opinion on product offerings, costs, networks and reform. Consumers will demand integration between Web-based technology and administrative services to improve their customer experience.
Health Data Exchanges: HIOs (Health Information Organizations) are a key component of the HITECH Act. States level HIE efforts are addressing 5 critical domains identified by the office of the national coordinator (ONC): governance, finance, legal/privacy, technical infrastructure and business /technical operations. Finding the sustainable financial model is a core issue.
Automated Member Acquisition and Retention: As participation in employer-sponsored plans decrease and the need for individual and family health insurance grows, health plans are looking to connect directly with potential members to enable them to search and select plans right for them and then purchase them on-line. Health plans will need enterprise application integration techniques and processes to connect their Web portal to their underwriting systems, their enrollment systems, their sales systems, their customer service systems and their billing and payment systems.
Providing transparency to health plan data and operations: The ability to allow providers and health plans to utilize secure shared-data continues to expand. The need to improve patient outcomes and operational efficiency is leading to investments in quality measurement, peer grouping, provider report cards and predictive modeling.
Collaboration with Providers as a Business Partnership: Prior authorization and utilization reviews are fading and in their place, is a more collaborative model based on real- time eligibility, benefit verification, access, quality, safety, effectiveness and patient centeredness. P4P is holding providers accountable, as stressed by Bridges To Excellence (BTE), Leapfrog and other initiatives.

We would love to know what you think of this list, and look forward to discussing it with you more in our upcoming August posts. In the meantime please feel free to contact us at results@bhmpc.com with any questions.

Healthcare Reform- The Basics

Posted on August 8, 2011 by Danyell Jones

Hello everyone,

I recently found this great video that gives a very broad overview of healthcare reform, and a fairly….(mind you I say fairly), unbiased look at healthcare reform in a “big picture” sense. I hope that you enjoy it as a bit of an intro into our healthcare reform series, and as a means to get acquainted with the topic before we look at it from the granular level!

For questions on healthcare reform, healthcare compliance, accreditation, or financial improvement please email us at results@bhmpc.com.

Its a scorcher- Healthcare Reform

Posted on August 5, 2011 by Danyell Jones

I am not talking about the heat index, but how the debate over health care reform is heating up. Due to this we have decided to do a multi-part blog series on healthcare reform beginning this month. We will examine some of the recently passed healthcare bills, how they will impact healthcare compliance, business, practices, and government entities. We will try to shed some light on what organizations can do to be proactive, and what some of the reactions to reform have been so far. To become more acquainted with this sizzling topic, we will begin with a broad overview of the pros and cons of healthcare reform courtesy of ProCon.org

PRO Health Care Reform Laws

CON Health Care Reform Laws

1. Keeping Insurance Coverage

PRO:“No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”

Barack H. Obama, JD
44th President of the United States
Address to the annual meeting of the American Medical Association,
June 15, 2009

CON: “According to experts, more than 87 million American could lose access to their current health care plan under the new law. Workers at a majority of the nation’s employers – including as many as four out of every five small businesses – would lose their current coverage, thus providing further evidence that ObamaCare is doing exactly the opposite of what Democrats promised it would do.”

John Boehner
Minority Leader of the United States House of Representatives (R-OH)
“Obamacare, Three Months of Broken Promises,” www.gopleader.gov,
June 23, 2010

2. Quality of Care Improvements

PRO: “Patient care under Medicare will improve as pilot programs to improve efficiencies are implemented. Doctors and hospitals are encouraged to coordinate care through payment incentives. For the first time, Medicare will reward quality, not quantity; thus, bonus payments will be given to those doctors and hospitals that provide good quality care.”

Alliance for Retired Americans (ARA)
“Medicare Benefits and Changes,” www.retiredamericans.org,
Apr. 2010

CON:“…[O]ur care will suffer. If the Democrats’ plans become law, fewer than 700,000 physicians would be available to treat a patient population growing in size, aging in years, shunning medical education and receiving ‘free’ health care or insurance coverage from the government in increasing numbers.The result will be longer wait times to see a doctor and a decline in the high quality of care Americans are accustomed to as overworked physicians try to keep up.”

Investor’s Business Daily
“The Doctor Shortage,” www.investors.com,
Mar. 4, 2010

3. Private Health Insurance VS. Socialism

PRO: “Opponents of health insurance reform continue to spread myths, including peddling the bogus notion that the health reform bill is ‘socialism’ and a ‘government takeover of health care.’ The fact is the reform legislation builds on our existing private health insurance system…[H]ealth insurance reform legislation expands private health insurance in America, and is based on increasing choice and competition… among a variety of private insurance plans.”

Nancy Pelosi
Speaker of the US House of Representatives (D-CA)
“Health Insurance Reform Mythbuster – ‘Democrats’ Health Insurance Refrom Is Socialism and a Government Takeover,” www.speaker.gov,
Mar. 19, 2010

CON:“Obama is a socialist. If you take over banks, if you take over car companies, if you take over financial institutions, the way that he has – now the health care system. If you’re going to use every crooked deal that you can come up with to get a bill like that passed – most recently the health care bill – that is by definition, if you look up the dictionary definition of socialism, this is it.”

Sean Hannity
Host of Fox News Channel’s Hannity show
Interview with CNSnews.com,
Mar. 25, 2010

4. Constitutionality

PRO: “The Constitution gives Congress the power to tax and spend money for the general welfare. This tax [PPACA] promotes the general welfare because it makes health care more widely available and affordable. Under existing law, therefore, the tax is clearly constitutional…Many important and popular government programs are based [on] Congress’s ability to give incentives through taxation and redistribute tax revenues for public purposes. To strike down the individual mandate the Supreme Court would have to undermine many years of precedents justifying these programs that stretch back to the New Deal (and in the case of the rules for direct taxes, to the very founding of the country).

Opponents of the individual mandate insist that they are only defending individual freedom, but they are actually taking a far more radical position. They are really claiming that it is unconstitutional to make Americans pay taxes.”

Jack M. Balkin, JD, PhD
Knight Professor of Constitutional Law and the First Amendment at Yale Law School
“Is the Health Care Law Unconstitutional?,” New York Times,
Mar. 28, 2010

CON: “Can Congress really require that every person purchase health insurance from a private company or face a penalty? The answer lies in the commerce clause of the Constitution, which grants Congress the power ‘to regulate commerce… among the several states.’…[T]he individual mandate extends the commerce clause’s power beyond economic activity, to economic inactivity. That is unprecedented. While Congress has used its taxing power to fund Social Security and Medicare, never before has it used its commerce power to mandate that an individual person engage in an economic transaction with a private company. Regulating the auto industry or paying ‘cash for clunkers’ is one thing; making everyone buy a Chevy is quite another. Even during World War II, the federal government did not mandate that individual citizens purchase war bonds.”

Randy E. Barnett, JD
Carmack Waterhouse Professor of Legal Theory at the Georgetown University Law Center
“Is Health-Care Reform Constitutional?,” Washington Post,
Mar. 21, 2010

5. Insurance Premium Reductions

PRO: “We estimate that, on net, the combination of provisions in the new law will… lower premiums by nearly $2,000 per family…Without reform, premiums are expected to increase from $13,305 in 2010 to $21,458 in 2019. Relative to this increase, premiums under reform increase only threequarters as much. By 2019, family premiums are nearly $2,000 lower. Adding reductions in out-of-pocket costs and lower taxes for Medicare and Medicaid will result in estimated savings for the typical family of over $2,500 that year.”

Center for American Progress (CAP)
“The Impact of Health Reform on Health System Spending,” www.americanprogress.org,
May 2010

CON: “Throughout the year-long debate over health care reform, President Obama promised that the legislation would reduce the spiraling cost of health care… But a couple of new government reports confirm what many of us who opposed a federal takeover of the health care system feared all along – higher costs…CMS [Centers for Medicare and Medicaid Services] says that the health care law will impose billions of dollars in annual fees on manufacturers and importers of brand-name prescription drugs and on health insurance plans, and new taxes on medical device sales. CMS said it anticipates that these new fees and taxes will be passed down to consumers in the form of higher drug and device prices and higher insurance premiums, raising health care costs from $2.1 billion in 2011 to $18.2 billion in 2018.

Throughout the health care debate, Americans were told the Democrats’ health care reform measure would make premiums more affordable; instead, as the President’s own actuary at CMS confirms, Americans will face higher premiums…”

Lisa Murkowski, JD
US Senator (R-AK),
New Health Care Law Will Increase Costs, Reduce Benefits,” murkowski.senate.gov,
May 18, 2010

6. Medical Bankruptcy Prevention

PRO: “The Senate plan limits how much even the wealthiest family buying insurance in the Exchange can be expected to pay, out-of-pocket, in a given year to a total of $11,900 for a family, and $5,950 for an individual. Again, lower-income households are expected to pay less…These caps should virtually eliminate medical bankruptcy. The total amount that a family can possibly owe is low enough that providers will be willing to give them time to pay it off, and in many cases, to negotiate discounts.

When providers know that there is no way that you can ever pay a $50,000 bill, you wind up in bankruptcy court. When the amounts are smaller, and doable over time, negotiations are possible.”

Maggie Mahar, PhD
Fellow at the Century Foundation
Response to Paul Starr’s article “What Is in the Health Care Bill,” www.talkingpointsmemo.com,
Dec. 17, 2009

CON: “Most people with medical bankruptcies already have insurance, and out-of-pocket expenses will continue to be a burden on the middle class.

In 2009, 1.5 million Americans declared bankruptcy
Of those, 62% were medically related
Three-quarters of those had health insurance
The Obama bill leaves 24 million without insurance
The maximum yearly out-of-pocket limit for a family will be $11,900 on top of premiums
A family with serious medical problems that last for a few years could easily be financially crushed by medical cost

Real health care reform is needed. But this bill falls short of that on many levels.”

Jane Hamsher, MFA
Founder and Publisher of Firedoglake
“Fact Sheet: The Truth About the Health Care Bill,” www.huffingtonpost.com,
Mar. 19, 2010

7. Federal Deficit Reduction

PRO:“CBO [Congressional Budget Office] and JCT [Joint Committee on Taxation] estimate that enacting both pieces of legislation—H.R. 3590 and the reconciliation proposal—would produce a net reduction in federal deficits of $143 billion over the 2010–2019 period as result of changes in direct spending and revenues. That figure comprises $124 billion in net reductions deriving from the health care and revenue provisions and $19 billion in net reductions deriving from the education provisions.”

Congressional Budget Office (CBO)
Report (untitled) on the estimated budgetary effects of the March 2010 health care reform laws, www.cbo.gov,
Mar. 20, 2010

CON: “In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion…”

Douglas Holtz-Eakin, PhD
President of the American Action Forum and former Director of the Congressional Budget Office
“The Real Arithmetic of Health Care Reform,” New York Times,
Mar. 20, 2010

8. Tax Reductions

PRO:“The health reform legislation signed into law by President Obama includes the largest health care tax cut in history for middle class families, helping to make insurance much more affordable for millions of families…The Small Business Health Care Tax Credit can cover up to 35 percent of the premiums a small business pays to cover its workers. In 2014, the rate will increase to 50 percent…”

Dan Pfeiffer
White House Communications Director
“Health Reform and the Recovery Act: Unprecedented Tax Cuts for the Middle Class,” www.whitehouse.gov,
Apr. 13, 2010

CON: “The Senate bill would: impose job-killing mandates and penalties on businesses, [and] increase taxes and burdens on small businesses… H.R. 4872 is no ‘fix’ for the Senate-passed bill. It includes a long term hidden tax by deferring the ‘Cadillac tax’ on certain high cost health plans until 2018. The number of Americans that will ultimately suffer from this hidden tax will mushroom each year because the tax is indexed to inflation…This bill would also impose a new 3.8 percent ‘Medicare tax’ on non-wage income that would target high income earners, income from interest, dividends, capital gains, and some profits from investments in partnerships and S-corporations. If this tax and other tax increases included in the President’s FY 2011 budget become law, certain taxpayers could expect a marginal tax rate on capital gains and qualified dividends of 23.8 percent, and a marginal tax rate on nonqualified dividends of 43.4 percent.”

US Chamber of Commerce
“H.R. 3590, the ‘Patient Protection and Affordable Care Act,’ and the Related Budget Reconciliation Legislation, H.R. 4872, the ‘Student Aid and Fiscal Responsibility Act of 2009,’” www.library.uschamber.com,
Mar. 19, 2010

9. Fixing the Physician Shortage

PRO: “The recently enacted PPACA (H.R. 3590) includes numerous policies to train more primary care physicians and increase the supply of primary care physicians. These policies include: mandatory and increased discretionary funding for the National Health Service Corp (NHSC), reauthorization of Section 747 of Title VII, Training in Family Medicine, General Internal Medicine, General Pediatrics, and Physician Assistantship; creation of a Primary Care Training Extension Program and increased faculty scholarship loans, redistribution of 65% of the current unused Graduate Medical Education slots to primary care and general surgery and allowing residents to count their time spent in ambulatory settings to count towards their residency requirements, such as physician offices and community health centers; and the establishment of Teaching Health Centers, creating primary care residency programs in non-hospital settings.”

American College of Physicians (ACP)
“Ensuring an Adequate Supply of Primary Care Internists and Other Specialties Facing Shortages,” www.acponline.org,
Apr. 7, 2010

CON:“Questions have been raised as to whether there will be a sufficient supply of physicians and other health professionals to serve the nation, especially in light of concerns that the nation was facing potentially significant shortages even before health care reform…[W]e project an overall shortage of 91,500 and 130,600 active patient care physicians in 2020 and 2025 respectively, and a primary care shortage of 45,400 and 65,800 physicians in 2020 and 2025…

These revised estimates are consistent with earlier estimates: they indicate the health care system is likely to be facing severe pressure as demand rises more rapidly than the supply.”

Association of American Medical Colleges (AAMC)
“The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025,” www.aamc.org,
June 2010

10. Medical Malpractice Lawsuits

PRO:“As part of a ‘grand bargain’ to create a bipartisan health care bill, some have said tort reform should be included…Look at what the actual data says: 98,000 people dead every year from preventable medical errors, at a cost of $29 billion. Countless more are seriously injured with astronomical costs. The Congressional Budget Office and Government Accountability Office have looked at tort reform multiple times, and said it will save practically no money. They also found no evidence of so-called ‘defensive medicine,’ finding that doctors run more tests because of the fee-for-service structure, or because of the benefits extra tests have on patient care.

Additionally, a 2006 study from Harvard found that 97% of cases were meritorious, totally debunking the idea that frivolous lawsuits plague our courts. And while 46 states have enacted some kind of tort reform, health care costs have continued to skyrocket, while injured patients or their families often can’t seek justice…

Forty-six states have tort reform, and American families still shoulder exorbitant health care costs. All the facts and data say it doesn’t work. There’s still 98,000 people dead every year from medical errors. But when political gamesmanship and backroom deals take over, the facts fly out the window.

This health care bill has a long way to go. But let’s be perfectly clear: patients’ rights aren’t negotiable. Tort law changes won’t fix health care, but only make it more difficult for injured patients to seek justice. Instead of bargaining away patients’ rights, Congress should [put] their safety first.”

Anthony Tarricone, JD
Former President of the American Association of Justice
“Tort Reform: A Bad Bargain That Won’t Fix Health Care,” www.huffingtonpost.com,
Sep. 22, 2009

CON:“You would think that any effort to reform our health care system would include tort reform, especially if the stated purpose for Obama’s plan to nationalize our health care industry is the current high costs…Many states, including my own state of Alaska, have enacted caps on lawsuit awards against health care providers. Texas enacted caps and found that one county’s medical malpractice claims dropped 41 percent, and another study found a ’55 percent decline’ after reform measures were passed.

Texas Gov. Rick Perry noted that, after his state enacted tort reform measures, the number of doctors applying to practice medicine in Texas ‘skyrocketed by 57 percent’ and that the tort reforms ‘brought critical specialties to underserved areas.’ These are real reforms that actually improve access to health care.

…[R]esearch shows that around $200 billion per year could be saved with legal reform. That’s real savings.

If you want to save health care, let’s listen to our doctors. There should be no health care reform without legal reform. There can be no true health care reform without legal reform.”

Sarah Palin
Former Governor of Alaska
“No Health Care Reform Without Legal Reform,” www.realclearpolitics.com,
Aug. 21, 2009

PRO Health Care Reform Laws

CON Health Care Reform Laws

We think that it will be a hot month for healthcare, and hope that you will join us as we explore these topics!