The Sad Case of the Patient Protection and Affordable Care Act

[Rover]

We got slapped by the major metro areas. The rural US was solidly red.

But back to the gist of your post -- an OpEd in today's WaPo on why the fiscal cliff may not be a bad idea.

Nice to see yet another pundit ripping off my material! I said weeks ago that this is the most likely face saving scenario. Fiscal cliff hits Jan 1st; new law passed Jan 2nd. That way Dems get the tax rates they want while GOP can say they cut the existing rates that were in effect (for a day) at the time.

The author did miss a few important points though, which are 1) polls show the GOP is poised to take the blame for failure to resolve the crisis, and 2) Obama isn't up for re-election in two years. The GOP House is (as well as Dem senate, but not all of them). That leaves a lot more potential exposure on the Republican side for a party at record lows in popularity already.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Once again you are either drinking Drano or living in a conservative fantasyland world to make up for the humiliation your ideology suffered at the ballot box on Nov 6th. Governors refusing Medicare funding is irrelevant. Everybody needs to get health insurance. If said governors want their lower income residents to pay more for that by forgoing federal dollars, so be it. The law stays the same. My guess is those voters, particularly in Dem leaning states, will be wanting to have a chat with their elected officials come election day...

Second, its of no consequence whether the feds, the state, or a joint fed/state program is run. What we're seeing right now is a capitulation on the GOP side of Congress in regards to raising revenues via higher taxes and lower deductions. With Obama in the drivers seat, GOP has to either accept some tax hikes and cuts to defense spending, or do nothing and get ALL tax hikes and massive cuts to military spending. I'm not sure what reality you're living in, but if the GOP had the ability to defund the law, they would have done so over the past two years when they had some momentum. Not now after they've been publically b ! tch slapped by the voters.

We got slapped by the major metro areas. The rural US was solidly red.

But back to the gist of your post -- an OpEd in today's WaPo on why the fiscal cliff may not be a bad idea.

[Rover]

It is starting to look like governors can cause PPACA to topple under its own weight (a) by refusing to accept the Medicaid expansion (SCOTUS ruled 7 - 3 in favor of tossing out the provision of PPACA that required states to accept Medicaid expansion or lose all existing Medicaid funding; by overturning this section of the law, SCOTUS said states could keep existing Medicaid funding and also not participate in the expansion if they wanted), and more importantly, (b) by refusing to set up state-run exchanges for health insurance.

The law says that if a state doesn't set up a state-run exchange, the feds will step in and set one up and run it in that state; however, some people say that the actual language of the law says that if the feds set up an exchange in a state, residents of that state won't be eligible for the federal subsidies that are available for participants in state-run exchanges.

As of the original November 16 deadline for a decision, at least 30 states had not opted to develop state-run exchanges. HHS has extended the decision deadline to Dec 14.

If more than half the states decline to set up state-run exchanges, the burden of administration will squarely on the federal government, yet when Democrats controlled both Houses of Congress, they did not provide any funding to the government to run the programs. Now there are intensive negotiations on reducing the rate of growth in federal spending going forward: not quite the ideal time to be adding a huge new staffing requirement to a federal department, eh?


More details here.

It would be ironic indeed for the mandate to be found unconstitutional, for the law to be allowed to stand anyway under an alternate theory (the taxing power) and then for the law to fail anyway after all that because of how incredibly poorly it was drafted.

Once again you are either drinking Drano or living in a conservative fantasyland world to make up for the humiliation your ideology suffered at the ballot box on Nov 6th. Governors refusing Medicare funding is irrelevant. Everybody needs to get health insurance. If said governors want their lower income residents to pay more for that by forgoing federal dollars, so be it. The law stays the same. My guess is those voters, particularly in Dem leaning states, will be wanting to have a chat with their elected officials come election day...

Second, its of no consequence whether the feds, the state, or a joint fed/state program is run. What we're seeing right now is a capitulation on the GOP side of Congress in regards to raising revenues via higher taxes and lower deductions. With Obama in the drivers seat, GOP has to either accept some tax hikes and cuts to defense spending, or do nothing and get ALL tax hikes and massive cuts to military spending. I'm not sure what reality you're living in, but if the GOP had the ability to defund the law, they would have done so over the past two years when they had some momentum. Not now after they've been publically b ! tch slapped by the voters.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

It is starting to look like governors can cause PPACA to topple under its own weight (a) by refusing to accept the Medicaid expansion (SCOTUS ruled 7 - 3 in favor of tossing out the provision of PPACA that required states to accept Medicaid expansion or lose all existing Medicaid funding; by overturning this section of the law, SCOTUS said states could keep existing Medicaid funding and also not participate in the expansion if they wanted), and more importantly, (b) by refusing to set up state-run exchanges for health insurance.

The law says that if a state doesn't set up a state-run exchange, the feds will step in and set one up and run it in that state; however, some people say that the actual language of the law says that if the feds set up an exchange in a state, residents of that state won't be eligible for the federal subsidies that are available for participants in state-run exchanges.

As of the original November 16 deadline for a decision, at least 30 states had not opted to develop state-run exchanges. HHS has extended the decision deadline to Dec 14.

If more than half the states decline to set up state-run exchanges, the burden of administration will squarely on the federal government, yet when Democrats controlled both Houses of Congress, they did not provide any funding to the government to run the programs. Now there are intensive negotiations on reducing the rate of growth in federal spending going forward: not quite the ideal time to be adding a huge new staffing requirement to a federal department, eh?


More details here.

It would be ironic indeed for the mandate to be found unconstitutional, for the law to be allowed to stand anyway under an alternate theory (the taxing power) and then for the law to fail anyway after all that because of how incredibly poorly it was drafted.

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

That's one thing about the loony left: their policies may be stupid, but they themselves are not stupid. They know how to time their dumb ideas to have them collapse when they're out of power.

I better never hear you ever complain about other people blaming Dubya for anything if you're going to use that argument.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A tale of two states -- http://washingtonexaminer.com/virgin...2#.UKV1YYd9Kuk

As a Maryland taxpayer, I get used to statements like this....
Hint -- in 2014, the current MD administration gets changed due to term limits. Guess who gets stuck with the bill? The new gang (wonder if they can blame their troubles on the previous administration and make it stick)!

That's one thing about the loony left: their policies may be stupid, but they themselves are not stupid. They know how to time their dumb ideas to have them collapse when they're out of power.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The short of it- we do not actively do anything different based on insurance. We do not withhold treatment or not see someone because of their insurance. No one in my practice is treated different as far as getting better or quicker service per our choice. We see people as soon as we can get them in and make recommendations based on what we think is right. Unfortunately what happens after we make recommendations is dependent on what the person can afford/ what the insurance dictates. This means that we frequently spend time much more time discussing what the person can actually afford (see various rants in this and previous threads). We also may have to wait for the bubbleheads with no medical training to OK the prior authorization to pay for the tests we have tried to order.

The system is broken. Reeeeally broken.

All the reasons we stepped back from the practice Les. What we have is now terrible and getting worse rapidly. I truly fear for patients-and we are all patients at some point in time.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

a question for our in resident medical specialists.

my doc tells me he gets (numbers are rough - I cant remember exactly) 80 cents on the dollar from Blue Cross, 45 from TriCare (military coverage) and 20 cents from medicare. do doctors screen their patients by what insurance coverage they have? do patients with better insurance get better, quicker service?

as an aside, wow, this system is really broken.

The short of it- we do not actively do anything different based on insurance. We do not withhold treatment or not see someone because of their insurance. No one in my practice is treated different as far as getting better or quicker service per our choice. We see people as soon as we can get them in and make recommendations based on what we think is right. Unfortunately what happens after we make recommendations is dependent on what the person can afford/ what the insurance dictates. This means that we frequently spend time much more time discussing what the person can actually afford (see various rants in this and previous threads). We also may have to wait for the bubbleheads with no medical training to OK the prior authorization to pay for the tests we have tried to order.

The system is broken. Reeeeally broken.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

And keeps medicare costs down significantly if you do it at age 65. Pay in for 30-40 years and then drop dead-no longer will there be as big a shortage in the general fund.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A tale of two states -- http://washingtonexaminer.com/virgin...2#.UKV1YYd9Kuk

As a Maryland taxpayer, I get used to statements like this....

Maryland, meanwhile, plans to take advantage of the federal government's offer to fully fund the expansion for the first three years. However, the state must pick up 10 percent of the load after that, and it's unclear how the state will pay for it.

At $7,352, Maryland is 11th in the nation in Medicaid spending per enrollee. Virginia is 25th with $5,870 per enrollee.

"We recognize it's not forever, but it gets people under care, under coverage," said Maryland Lt. Gov. Anthony Brown.

"We certainly have a number of years to plan and prepare for the day when it's more like a 50-50 match. But we think it would be foolish for Maryland if we did not participate."

Hint -- in 2014, the current MD administration gets changed due to term limits. Guess who gets stuck with the bill? The new gang (wonder if they can blame their troubles on the previous administration and make it stick)!

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

You first.

Love to.

[goldy_331]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

You first.

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just remember. Dying solves your Health Care issues.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Emphasis added!

Emphasis accepted. I have spent virtually my entire adult life in medicine-several fields and several aspects of it. I have come to the conclusion that where we now reached is intolerable, but where we are going is even more so. Hopefully there is an answer but as of now I just do not see it.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Most important is that everyone has to realize that for every action there is a chain of reactions down the line. Some of the rules, laws, controls put into effect only create incredible problems later on.

Emphasis added!