Bad Day at Black Rock

Below is a guest post by Raynor James, an eastern North Carolina resident who has followed the debate on North Carolina House Bill 184 very closely:

Tuesday, April 3rd was a sad day in the North Carolina House of Representatives.

Let me tell you about it. Dale Folwell is North Carolina’s Treasurer. He’s a very popular fellow for all the right reasons. He did a good job when he served in the North Carolina General Assembly. He got North Carolina’s unemployment insurance out of debt to the Federal Government when he served in Governor McCrory’s administration, an accomplishment that continues to save North Carolina’s employers significant sums annually. He’s known as a problem solver.

North Carolina’s State Health Plan (which pays for medical expenses of current and retired state employees) is seriously underfunded and is projected to be bankrupt by the year 2023.When Dale Folwell was elected Treasurer, many who voted for him expected him to solve the Plan’s problems as its administration was in the Treasurer’s portfolio.

Enter HB-184 which if implemented will tie the Treasurer’s hands and not allow corrective action to be taken while a committee studies the situation.

HB-184 was debated on the floor of the House April 3rd. Let’s look in on how some conservative House members tried to kill the bill.

First, Representative Michael Speciale offered two amendments to the bill. Representative Speciale’s first amendment would give the Treasurer a vote on the study committee and would make it impossible to expand the size of the committee (something that is sometimes done when the “powers that be”don’t like the direction a committee seems to be taking).

That amendment passed by a vote of 106 to 5.

Representative Speciale’s second amendment would remove Section 2 from the bill. Section 2 requires that Blue Cross-Blue Shield continue to be used during the study period.

It also prevents the Treasurer from switching the Plan to using referenced based pricing for medical services to the Plan during the study period.That amendment failed by a vote of 88 to 23.

During debate on HB-184 itself, Representative Larry Pittman cited a memo from the Plan’s Board of Trustees that projects that the plan will be out of money in 2023, and said that we can’t wait on a two year study. He talked about how hospital groups were groaning about how burdensome the Treasurer’s planed payment changes would be on them [tie pricing of medical services to 172% of the average Medicare pays for the same service], and pointed out how well funded many hospitals are. In support of his assertion, Representative Pittman mentioned that the hospital at East Carolina has given $10 million dollars to fund a stadium.

Representative Pittman asked that members not pass the bill and added that when Treasurer Folwell had requested info from the hospital groups, they had sent him the schedules he asked for with page after page blacked out. “They might as well have slapped him in the face and spit on him,” Representative Pittman said.

He continued by saying passage of the bill would hurt both members of the Plan and taxpayers who pay the freight and pointed out that members of the Plan are also taxpayers, so they get hit two ways.

He stated that Dale Folwell is “competent” and “honest” and renewed his request by saying, “Defeat this bill.” Representative Michael Speciale said, “We’re told that if we don’t pass this bill, the sky will fall; we’ll lose our rural hospitals.” He went on to say that they’d heard the same thing when he was trying to get rid of the CON [Certificate of Need] laws [which did not pass] and shortly thereafter they closed one of the hospitals in my district.”

“I hear fake news ads” [on the topic of rural hospitals closing if HB-184 doesn’t pass] when I drive in my district.”

Representative Speciale went on to say that Dale Folwell got the people together who are opposing him [mainly large hospital groups] and asked how much waste, fraud, and abuse there is in the system. The answers they give him ran from 12% to 25%, so he took a middle number and asked them to figure out how they could reduce costs by 15% and said that they needed to get together again as soon as that was done.

After that meeting, Treasurer Folwell tried to set follow up meetings, and time after time he was stonewalled.

Representative Speciale continued, “Now we’re faced with $33 to $36 billion dollars in unfunded liabilities. If we don’t allow him to cut costs, how are we going to cut costs because it’ll be on us!”

“Dale Folwell has increased what would be going into rural hospitals. He’s compromised, but they won’t budge an inch.If we do not pass this bill, then the hospital lobby will sit down and talk to him. Let the state Treasurer do what he was elected to do. Throw the politics aside and vote NO!

Representative Keith Kidwell said, “For the last 10 years, health care costs have gone up and up. We asked Treasurer Folwell to handle it. Let’s not bobble him,or we’ll be faced with taking $235 million to $509 million [dollars] from the general fund to deal with the problem AND $1.1 billion will be added to the unfunded liability.”

“HB-184 will cost us a ton of money!” “Cut through partisanship and look at the numbers! We HAVE to block this bill!’

In spite of those eloquent pleas and others, too, HB-184 passed 75 to 36, and it will now be sent to the North Carolina Senate where it is hoped that wiser voices will prevail.

If you’d like to hear the whole debate, you can go to the NC General Assembly website at which NC House sessions are archived.

Thank you, Raynor. This is a picture of what is going on in the North Carolina state legislature. President Eisenhower warned about the military-industrial complex. What we see here is the result of intense lobbying by the healthcare-industrial complex. We need to stop this bill.

Medical Care For America’s Aging Population Just Took A Step Backwards

As America‘s population has aged, we have been blessed by some of the best medical care in the world. We have had cataract surgery, hip replacements, knee replacements, etc. We have essentially become bionic as we have had failing parts replaced. Unfortunately, that is changing with ObamaCare–simply as a matter of economics.

Accuracy in Media is reporting today that due to ObamaCare, seniors will not get the care they need:

On Oct. 1, 2012 the Obama administration started awarding bonus points to hospitals that spend the least on elderly patients. It will result in fewer knee replacements, hip replacements, angioplasty, bypass surgery and cataract operations.

These are the five procedures that have transformed aging for older Americans. They used to languish in wheelchairs and nursing homes due to arthritis, cataracts and heart disease. Now they lead active lives.

But the Obama administration is undoing that progress. By cutting $716 billion from future Medicare funding over the next decade and rewarding the hospitals that spend the least on seniors, the Obama health law will make these procedures hard to get and less safe.

The Obama health law creates two new entitlements for people under age 65 – subsidies to buy private health plans and a vast expansion of Medicaid. More than half the cost of these entitlements is paid for by cutting what hospitals, doctors, hospice care, home care and Advantage plans are paid to care for seniors.

ObamaCare may provide all Americans with insurance (assuming that they sign up for ObamaCare), but unfortunately it does not provide Americans with quality health care or access to the doctors and care that they need.

The article concludes:

In addition to the across-the-board cuts, the Obama administration will now impose a new measure on hospitals: “Medicare spending per beneficiary.” Hospitals that spend the least on seniors get bonus points, and higher-spending hospitals get demerits.

Hospitals will even be penalized for care consumed up to 30 days after patients are discharged, for example, for outpatient physical therapy following a hip or knee replacement.

There are ways to control Medicare spending, such as inching up the eligibility age or asking well-off seniors to pay more. Forcing hospitals to skimp on care is deadly.

Research sponsored by the National Institute on Aging (Annals of Internal Medicine, February 2011) shows that heart attack patients at the lowest-spending hospitals are 19% more likely to die than patients of the same age at higher-spending hospitals. Yet the Obama health law pushes all hospitals to imitate the lowest spending ones.

Ignore the political rhetoric and look at the scientific evidence. The Medicare cuts in the Obama health law will end Medicare as we’ve known it and doom seniors to painful aging and shorter lives.

Is this what the Democrats in Congress who passed ObamaCare wanted?

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Using The Internal Revenue Service As A Weapon Against Charitable Hospitals

Under President Obama, the Internal Revenue Service (IRS) is becoming a political weapon. This is not the first time a President has attempted to use the IRS for political purposes, but President Obama has succeeded in this to an amazing extent.

Now, under ObamaCare, the IRS will be used as a weapon against charitable hospitals who treat the uninsured.

On Thursday, the Daily Caller reported:

A new provision in Section 501 of the Internal Revenue Code, which takes effect under Obamacare, sets new standards of review and installs new financial penalties for tax-exempt charitable hospitals, which devote a minimum amount of their expenses to treat uninsured poor people. Approximately 60 percent of American hospitals are currently nonprofit.

Charity for the uninsured is one of the factors that could discourage enrollment in Obamacare, which requires all Americans to purchase health insurance or else face new taxes themselves from the IRS.

The article further reports:

Healthcare experts warn that the Obamacare’s new requirements make it almost impossible for charitable hospitals to navigate treacherous new waters.

Nonprofit hospitals should be advised that the new PPACA requirements will play a significant role in how they operate and report, specifically when it comes to billing and collections for services provided to the uninsured. The new law leaves many gray areas and hospitals themselves will have to establish eligibility criteria for financial assistance. Following the new procedures as best they can will ensure the best chance of maintaining their tax exempt status,” wrote D. Douglas Metcalf, partner at the law firm Lewis and Roca, in a 2013 op-ed entitled “Will nonprofit hospitals disappear under Obamacare?”

The White House did not return a request for comment.

The more we learn about ObamaCare, the worse it gets. I hate the idea of shutting down the government to defund ObamaCare, but I really am beginning to wonder if it would be worth it.

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The Impact Of Obamacare On Your Doctor

On Thursday, the Wall Street Journal posted an article by Scott Gottlieb discussing the impact of Obamacare on doctors. The article points out that the regulations in Obamacare will move doctors toward being 40-hour week employees rather than being in charge of their own offices.

The article reports:

…Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks.

The irony is that in the name of lowering costs, ObamaCare will almost certainly make the practice of medicine more expensive. It turns out that when doctors become salaried hospital employees, their overall productivity falls.

This is another result of government by special interest groups. In this particular case, the special interest group is the unions.

The article explains:

All of this reduced productivity translates into the loss of what should be a critical factor in the effort to offer more health care while containing costs. Yet hospitals aren’t buying doctors’ practices because they want to reform the delivery of medical care. They are making these purchases to gain local market share and develop monopolies. They are also exploiting an arbitrage opportunity presented by Medicare‘s billing schemes, which pay more for many services when they are delivered at a hospital instead of an outpatient doctor’s office.

This billing structure exists because hospitals are politically favored in Washington. Their mostly unionized workforces give them political power, as does their status as big employers in congressional districts.

This is another example of a law regulating health care that was written without concern for the impact it would have on medical care for individuals in this country. The law was written with special interest groups and government control in mind. It needs to be repealed and rewritten with the needs of American citizens in mind.

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Statement By The U.S. Conference of Catholic Bishops

This is the statement regarding last night’s Vice-Presidential debate issued by the U.S. Conference of Catholic Bishops (USCCB) on October 12:

Last night, the following statement was made during the Vice Presidential debate regarding the decision of the U.S. Department of Health and Human Services (HHS) to force virtually all employers to include sterilization and contraception, including drugs that may cause abortion, in the health insurance coverage they provide their employees:

“With regard to the assault on the Catholic Church, let me make it absolutely clear. No religious institution—Catholic or otherwise, including Catholic social services, Georgetown hospital, Mercy hospital, any hospital—none has to either refer contraception, none has to pay for contraception, none has to be a vehicle to get contraception in any insurance policy they provide. That is a fact. That is a fact.”

This is not a fact. The HHS mandate contains a narrow, four-part exemption for certain “religious employers.” That exemption was made final in February and does not extend to “Catholic social services, Georgetown hospital, Mercy hospital, any hospital,” or any other religious charity that offers its services to all, regardless of the faith of those served.

HHS has proposed an additional “accommodation” for religious organizations like these, which HHS itself describes as “non-exempt.” That proposal does not even potentially relieve these organizations from the obligation “to pay for contraception” and “to be a vehicle to get contraception.” They will have to serve as a vehicle, because they will still be forced to provide their employees with health coverage, and that coverage will still have to include sterilization, contraception, and abortifacients. They will have to pay for these things, because the premiums that the organizations (and their employees) are required to pay will still be applied, along with other funds, to cover the cost of these drugs and surgeries.

USCCB continues to urge HHS, in the strongest possible terms, actually to eliminate the various infringements on religious freedom imposed by the mandate.

For more details, please see USCCB’s regulatory comments filed on May 15 regarding the proposed “accommodation”: www.usccb.org/about/general-counsel/rulemaking/upload/comments-on-advance-notice-of-proposed-rulemaking-on-preventive-services-12-05-15.pdf

 

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A New Dimension In Meddling

Mayor Bloomberg is at it again. The New York Post reported yesterday that the Mayor is asking New York City hospitals to lock up the baby formula so that more mothers will breast-feed their babies.

The article reports:

Starting Sept. 3, the city will keep tabs on the number of bottles that participating hospitals stock and use — the most restrictive pro-breast-milk program in the nation.

I support breast-feeding. I think it is a good idea. All my children were breast-fed and all my grandchildren were breast-fed. There is a history of milk allergies in my family and that seemed like a logical preventative measure. It seems to have worked. However, forcing women to do something they may not want to do because the Mayor thinks it’s healthy is a horrible idea. What if Mayor Bloomberg wakes up one morning and decides we should all eat seaweed for a week? Where will he draw the line?

I have no problem encouraging new mothers to breast-feed their babies. In 1970, when my first daughter was born, I was the only breast-feeding mother in the hospital. By 1974, when my third daughter was born, there were more babies breast-fed than formula-fed. I think the way to get mothers to breast-feed their children is to give them as much information as possible about the benefits. The new mothers are the ones who need to make the choice–not the government.

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Medical Expenses Of The Elderly

Friday’s Wall Street Journal (I am not linking to the article because it is subscribers only) contained an article entitled, “Commonly Used Medicines Send Seniors to Hospitals.”  The article reports on a study done by the Centers for Disease Control and Prevention that found that an estimated 99,628 hospitalizations every year of people 65 years and older are linked to adverse drug events such as allergies and unintentional overdoses. It further reports that nearly half of those hospitalized were age 80 or older. The drugs responsible were not high-risk medications–they were commonly used diabetes pills and blood thinners.

Maybe we need to rethink the way we handle medical care for seniors. Is there a way to make the commonly used drugs safer, for example bottles that somehow remind the person to take their medicine and let them know if they have already taken their dose for the day? I have no idea if that is possible or already in existence, but certainly drug safety might be one way to seriously cut medical expenses for everyone.

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