An interesting twist is that the court has “also signaled that it could punt a decision on the individual mandate until 2014. In accepting the challenges to the law, the court said it would devote an hour of the arguments to the effect of the Anti-Injunction Act – a law that, in the view of some courts, could prohibit a ruling on the individual mandate until the mandate goes into effect in 2014. That could provide an escape clause if the court wants it.”

Erwin Chemerinsky, dean of the UC Irvine School of Law, writes that “what complicates the decision and makes the result unpredictable is whether the justices will see the issue in terms of precedent or through the partisanship that has so dominated the public debate and most of the court decisions so far.”

Over the past year, opinions were evenly split on the new health care reform. The Kaiser Family Foundation survey showed last month was the worst results for the new law, 34% in favor, 51% against. This month actually showed an uptick with 37% in favor, 44% against. Even if the law is not upheld, health care in America has changed in ways that will not be easily undone.

Virginia Gov. Bob McDonnell issued a scathing rebuke of how President Obama’s staff has handled its own health care law, accusing the administration of dragging its feet and preventing states from preparing to comply with the overhaul, having “missed deadlines for producing an outline of what the federal exchange would look like, leaving states at a loss for how to proceed with important deadlines fast approaching.” In addition, for the third time in a year, Congress is squeezing the health care law in favor of other priorities. Specifically, “some $50 billion earmarked to pay for benefits and programs in the health care overhaul in future years to fund more-immediate spending needs.” Oh well, it’s only $50 billion.

Some realities of the market are coming to pass, leaving many without coverage even before most provisions of the law take effect. American Enterprise Group “‘announced in October 2011 that it would stop offering non-group health insurance in more than 20 states,’ affecting 35,000 people. Sited are regulatory burdens that have also caused Empire BlueCross Blue Shield to soon eliminate plans that currently cover 20,000 businesses.
Democrats “are worried that the Supreme Court will rule against President Obama’s healthcare reform law. While the lawmakers are not second-guessing the administration’s legal strategy, some are clearly bracing for defeat.”
At the heart of the legal challenge to healthcare reform “is ‘the mandate’ — a provision requiring nearly all Americans to buy coverage or pay a penalty” one that President Obama vigorously opposed as a candidate. The mandate, the most unpopular provision of the law, could be its undoing. I would not envy the President if he is forced to defend something he once rejected. Insurance carriers note that they can offer coverage to the previously uninsurable with substantial influx from the hundreds of thousands mandated to buy coverage. Without the mandate, everyone’s premiums would increase disproportionately to cover the high risk population that will surely apply.
The Cato Institute notes a legal mistake in the hastily drafted bill provides that only a state run exchange (a co-op for individuals and businesses can offer the much touted federal subsidies. Thus far, less than 20 states have created said exchanges, leaving at least 30 preferring to allow the feds to create one for them. 60% of the states with plans missing subsidies? Should be interesting.

Fraud prosecutions reached an astounding high last year, increasing 69 percent from the year earlier!

Medicare will pay for screening and counseling services to help obese patients lose weight has opened an old debate about who can best help people slim down. Seen a “lap band” billboard lately? Think there’s any money there?

Some better news is that 74% of hospitals have responded to surveys saying they are planning on investing in health information exchange services. This is long overdue to streamline health care systems, making them more efficient and cost effective. In addition, Medicare has proposed rules to create more transparency about financial relationships between doctors and more than 1,150 drugmakers, device manufacturers and other private interests would have to report ‘transfers of value’ made to physicians and teaching hospitals.”

An inordinate portion of our health care is delivered in the last few months of our lives. Physicians “overwhelmingly support the type of end-of-life care that sparked charges of ‘death panels’ in the healthcare reform bill, according to a new poll”. The poll “found that 96 percent of doctors believe it’s more important to improve dying patients’ quality of life than to prolong their lives as long as possible.” The poll also found that “seventy-nine percent of the doctors surveyed said the US ‘spends far too much trying to extend lives,’ compared with just 37 percent of the general public.” We can’t continue to beef about health care costs and place pressure on the system to provide unproductive care.

On the other end of the scale, 3,500 “concierge” medical practices are charging patients annual fees to be a part of their practice, shunning any relationships with insurance carriers, while providing very personal service. In other news, healthcare solutions using IBM Watson technology are continue to develop at Cedars-Sinai Medical Center. Mentioned in a previous column, you can see a clip on how “Watson” works. Check out this 30 second video, spotlighting how Watson technology can help doctors find answers quicker and treat patients much faster.

High deductible, consumer driven health plans continue to attract the attention of the public sector as a Mercer survey shows 32% of companies with 500 or more employees offering them, up from 23% in 2010, lowering costs by 20%. Wells Fargo’s Iowa employees will no longer have traditional health insurance but, instead a choice between high-deductible insurance plans tied to health reimbursement accounts or health savings accounts. Engaging the consumer is a must if costs are to be controlled.

Client day 2011

Our 4th Annual Client Day, October 19, is just weeks away. Steve Sell, President of Health Net California, will give us an insurer’s perspective on health care reform, answering key questions:
• Is there an upside to health care reform?
• What can you do to curb costs?
• Will there be better, new options for small business?
• What should employers be concerned about?

If you haven’t registered, please contact Lisa immediately as last year sold out!

With much greater subtlety, anyone applying for coverage through the mandated state exchanges must complete an exhaustive questionnaire that will press themselves and their EMPLOYERS into state and federal programs, fines and penalties as unforeseen (?) consequences.

Effective September 1, 2011, for the first time in history, the feds will be reviewing health insurance companies’ rate increases above 10% for individual and small group plans in those 10 states where it determines state officials have not adequately regulated premiums, In future years, states will be allowed to move that % up or down, depending on their state’s trend. For now, California is not one of them.

For example, Washington Post notes that Medicare payments would be reduced to hospitals with higher than average readmission rates. While hospitals generally see their job as done once a patient is released, this recently released rule would change that paradigm, prompting them to have to follow up to assure patients are obtaining and taking medications and seeing their doctors for follow up care.

Try to reconcile this – about half the American public believes tax increases on the wealthy and reducing government spending should play a role in reducing the federal deficit, according to Kaiser Family Foundation. However, “in that same survey, 59 percent said do not cut Medicare and 48 percent do not want reductions in Medicaid.” Not in my backyard?

Almost in the same breath, The Hill reports “The federal government wasted almost $48 billion in improper payments in Medicare last year, the most of any government program, federal officials testified” concluding that the “Health and Human Services Department has been making progress in cutting back on improper payments, but has a long way to go.” The blog entry pointed out that fraud is partly responsible for improper payments. And insurance company profits are personified as “the dark side”?

A number, approaching majority, of both the House and Senate have written Medicare administrator Dr. Donald Berwick to not go to hard on payments to hospitals, citing a 7% NEGATIVE margin for hospitals in 2011.