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FIrst Day of ACA: Realizing the Promise of the Affordable Care Act—1/1/2014

FIrst Day of ACA: Realizing the Promise of the Affordable Care Act—1/1/2014 | Heart and Vascular Health | Scoop.it

First, this is the first day of fundamental reform of the business and regulation of health insurance in all 50 states: 

Banning the practice of "medical underwriting" by which insurance companies rate enrollees based on their health status and medical history, Banning pre-existing condition exclusions from US health insurance everywhere, Establishing "guaranteed issue" as the new operating paradigm for individual health insurance, Completely eliminating lifetime limits on all health insurance, and Establishing "minimum essential benefits" that must be included in nearly all licensed health insurance policies everywhere.

Second, Medicaid coverage begins for close to five million uninsured low-income Americans in participating states, with many more millions to follow. This will happen more slowly than the Affordable Care Act's designers expected because of the Supreme Court ruling that made the Medicaid expansions optional for states. But come they will.

Third, private health insurance coverage starts for about one million Americans purchasing coverage through the federal/state health insurance marketplaces with many more to follow.

Fourth, the principle of personal responsibility -- aka the "individual mandate" -- to obtain health insurance coverage takes effect, with the Supreme Court's stamp of approval.

From Boston.com by same author

Seth Bilazarian, MD's insight:

The ACA has many laudable aspects, especially its potential to increase the coverage of the uninsured with improved access to care.  The rollout however has been anxiety provoking because of implementation SANFUs and this violates a chief tenet of insurance.  Having insurance is supposed to reduce anxiety and uncertainty and this program has increased uncertainty fro all participants: hosptials, doctors and patients..

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Clinicians Remain Reluctant to Allow Negative Findings to Influence Practice

Clinicians Remain Reluctant to Allow Negative Findings to Influence Practice | Heart and Vascular Health | Scoop.it

My comment: The American physician - patient interaction is complex. It is apparent to me that many in policy positions don't understand simple aspects of care that will have huge implications as the ACA is adopted and ACOs become more prevalent.

It is MUCH harder and more time consuming for a physician to counsel a patient NOT to have a procedure than it is to persuade a patient to have a procedure.  Many pundits have estimated there will be a glut of physicians as procedures are ratcheted down with greater adoption of appropriate use guideleines and evidence based medicine.  Unfortunately this will not be the case.  American patients generally are suspicious when physicians counsel against evaluation or treatment.  And this is occurring in the current fee for service environment.  We are in for a significant transitional storm for the next several years as physicians become incentivized (in ACOs) to limit care.

This JAMA essay speaks about physician adoption of new guidelines, but says litle about patients willingness to limit care.

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Tweeting for Student Health Care Coverage

Tweeting for Student Health Care Coverage | Heart and Vascular Health | Scoop.it
An Arizona graduate student with advanced colon cancer turned to Twitter when his insurance company stopped covering his medical bills. Surprisingly, the insurance company's chief executive tweeted back.

Ultimately the student with colon cancer who uses the Twitter handle @poop_strong engaged Aetna & the Aetna CEO, Mark Bertolini in twitterverse and won changes in coverage limits for himself and other students at his school.

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Massachusetts Health care consumes 43% of planned state budget

Massachusetts Health care consumes 43% of planned state budget | Heart and Vascular Health | Scoop.it

Massachusetts health care policy makers goal was to first provide universal coverage and THEN to rein in costs.  The first goal has been achieved. The second goal will be difficult, painful, uncertain and consequential

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Between the Medicaid program, subsidized insurance under the 2006 health care access reform law, and investments in state employee health insurance and public health programs, health care spending this fiscal year is on pace to rise to 43% of the overall state budget.

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HBS Faculty on Supreme Court Health Care Ruling

HBS Faculty on Supreme Court Health Care Ruling | Heart and Vascular Health | Scoop.it

Three Harvard Business School faculty members, all experts in the health care field provide their views on various facets of one of this country's most important and complex problems.

 

Best line: "Americans must take greater responsibility for maintaining their health. In the future they will have a health score, much like their credit score, that is based on well-established metrics that will motivate them to improve their health & will also have to assume greater financial responsibility for cost of their care, abandoning the myth that "health care is free." This will be accomplished through incentives for those who maintain their health, enabling them to pay less, while people who cost the system more will pay a larger proportion of their expenses."

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More Health-Law Changes Coming in 2013

More Health-Law Changes Coming in 2013 | Heart and Vascular Health | Scoop.it

My comment: regardless of your support or opposition to ACA (Obamacare) these first set of changes due at the beginning of 2013 are mostly good.  Higher premiums can't really be blamed on the ACA since the graph shows this rate of increase over the last several years is steady.

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Next year will see some of the many significant changes brought on by the Affordable Care Act, including easy-to-read plan summaries and caps on flexible spending accounts.

FIVE changes:

1. Higher Premiums

2. Straightforward Summaries

3. Flexible Spending Account  Limit

4. Dependent Coverage

5. Higher Spending Cap - cap rises to $2 million, from $1.25 million

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Counterpoint to Cheesecake Factory Medicine

Counterpoint to Cheesecake Factory Medicine | Heart and Vascular Health | Scoop.it

Political counterpoint to the Big Medicine piece of Dr Atul Gawande in the New Yorker.,  (See my scoop).

The highlighted aspects are the corporatization of medical practices and the Payment advisory Board.

 

'The "most important institutional change" after ObamaCare passed in 2010: the Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care."

 

The unknown aspects of who, what and why and perceived hazards of this decision making process are discussed.

 

"The longer-run danger is ... cost board starts to decide what types of care "work" for society at large and thus what individual patients are allowed to receive.     '

 

"The Cheesecake Factory is a great place to eat but you probably wouldn't want to be operated on there—especially if it's run by the government."

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If You Don’t Buy Health Insurance, Will You Really Pay the Tax?

If You Don’t Buy Health Insurance, Will You Really Pay the Tax? | Heart and Vascular Health | Scoop.it

Here's why not:

1.  Tax is small $95 in 2014

2.  Law requires filers to sel-disclose that they are not covered

3.  Difficult enforcement - IRS must match insurance data with tax retuns.  It could take years.

4.  If owed, IRS has no mechanism to force payment. Law prohibits criminal penalties

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44,000 uninsured Massachusetts residents paid penalty in 2010

44,000 uninsured Massachusetts residents paid penalty in 2010 | Heart and Vascular Health | Scoop.it
Take Home Message: Since Massachusetts is the state laboratory for the national health insurance program (ACA) and its pesonal mandate for insurance, its encouraging to see that the small penalty ($406/yr) MAY play a role as an incentive to encourage more citizens to become insured through the state insurance exchanges ***************************************** About 67,000 people were fined for not having coverage in 2007, the first year of the penalty. That figure dropped to 44,000 in 2010, according to a state report. Since the recession, the state has waived the fine for more people on the grounds that they could not afford health plans available to them, accounting for ome of the decline.
More than half of those who paid the tax penalty were uninsured for the full year, the ­report said. Most were under age 40.
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Declining Payments for Seniors: drug costs in "donut hole" set to decline

Declining Payments for Seniors: drug costs in "donut hole" set to decline | Heart and Vascular Health | Scoop.it

The court's ruling preserves discounts consumers get on the Medicare drug plan doughnut hole. Drug makers worry Medicare might be able to lower prices it pays the companies even more. The closing of the coverage gap has been a tangible selling point for the health overhaul.

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