Thread: Do you support Obama Care ?

WITH OBAMACARE, GET READY FOR "GROUP APPOINTMENTS" OF YOU AND AS MANY AS A DOZEN OTHER PATIENTS SEEING THE DOCTOR AT ONE TIME.

http://www.everydayhealth.com/health...t-a-crowd.aspx


More doctors are holding appointments with multiple patients, a trend some say may help ease a forecasted shortage of physicians.
By Michelle Andrews, Kaiser Health News
TUESDAY, March 19, 2013

(Kaiser Health News) — When visiting the doctor, there may be strength in numbers.

In recent years, a growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.

Some see group appointments as a way to ease looming physician shortages. According to a study published in December, meeting the country's health-care needs will require nearly 52,000 additional primary-care physicians by 2025. More than 8,000 of that total will be needed for the more than 27 million people newly insured under the Affordable Care Act.

"With Obamacare, we're going to get a lot of previously uninsured people coming into the system, and the question will be 'How are we going to service these people well?' " says Edward Noffsinger, who has developed group-visit models and consults with providers on their implementation. With that approach, "doctors can be more efficient and patients can have more time with their doctors."

Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.

Insurance typically covers a group appointment just as it would an individual appointment; there is no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it's provided or how many people are in the room, Noffsinger says.

Some patients say there are advantages to the group setting. "Patients like the diversity of issues discussed," Noffsinger says. "And they like getting 2 hours with their doctor."

Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.

"We tell people, 'You don't have to say anything,' " says Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville. Shahady trains medical residents and physicians to conduct group visits with diabetes patients. "But give them 10 minutes, and they're talking about their sex lives."

Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they're used to taking a more authoritative approach with patients rather than facilitating a discussion with them.

According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.

Some studies have found that group visits can improve health outcomes. In an Italian trial that randomly assigned more than 800 Type 2 diabetes patients to either group or individual care, the group patients had lower blood glucose, blood pressure, cholesterol and BMI levels after four years than the patients receiving individual care.

Doctors say patients may learn more from each other than they do from physicians. "Patients really want to hear what others patients are experiencing, " Shahady says.

Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.

Padilla, now 67, continued to attend group appointments geared to primary-care patients' concerns for years after that at the Kaiser Permanente outpatient clinic near his home. (Kaiser Health News is not affiliated with Kaiser Permanente.) He usually went once a month or so, and the members of the group constantly changed.

One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.

But group visits aren't for everyone. Padilla's wife, Tedi, went to one meeting with him and never went back. "She said she didn't have time to sit there and listen to all those patients," he says.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

I like the idea of a support group like weight watchers has. This may be/could be beneficial to patients with diabetes, hypertension, etc. if the discussions were guided and clarified by a nurse, doctor, etc. I really could see the benefit of that. However, I don't think it should take the place of a doctor's visit.

3/20/2013
The New York Times on How One Business Will Deal with ObamaCare
Patterico @ 7:36 pm

Rachel Shein and Steve Pilarski have a problem. That problem is ObamaCare. http://www.nytimes.com/2013/03/21/bu...pagewanted=all

THE CHALLENGE The company is one of thousands of small businesses that employ more than 50 full-time employees and thus will be required to offer health insurance to their workers — or pay into a government fund — beginning Jan. 1. Rachel Shein and Steve Pilarski, the married owners of the bakery, which employs 95 people, estimate this could cost their business up to $108,000, and they are weighing their options as the date approaches.

The article takes us through three options that Shein and Pilarski have to meet . . . THE CHALLENGE.

One is to buy the insurance. That’s $108,000 a year.

A second option is to pay the penalty, er, tax, er, “employer shared responsibility payment.” That, apparently, is about $120,000 a year, net ($130,000 minus $10,000 saved in not having to manage the plans).

And the third option?

Ms. Shein is considering a third option: outsourcing certain jobs to reduce the staff, because businesses with 50 or fewer employees will be exempt from the penalty. “We can outsource the cleaning and make the drivers independent contractors,” she said, “and we can cut the least profitable delivery routes, least profitable accounts or reduce the variety of items we create.”

A related idea not mentioned in the article: she could have 49 full-time employees and 50-60 part-time employees working under 30 hours per week, I suppose. It may well be that some employees are going to become exployees.

(In totally unrelated news, looks like unemployment is going to skyrocket next year. Damn those Republicans and their damn sequestration!)

Shein and Pilarski say prices may be going up about 4 per cent at their bakery. That’s probably the only business in the country that will raise prices significantly to defray the extra costs of ObamaCare. Yes, my eyes are rolling — rolling like bowling balls.

(In totally unrelated news, looks like inflation is going to take off next year. Damn those Republicans and their damn sequestration!)

The article does not mention whether these two voted for Obama. I’d be curious to know. Heck, I *am* curious to know!

Apparently we’ll find out in about a week how Shein and Pilarski plan to meet THE CHALLENGE. I’ll stay tuned for that! Don’t change that channel!!!

http://patterico.com/2013/03/20/the-...ith-obamacare/

Questions Abound in Learning to Adjust to Health Care Overhaul
By JULIE WEED
Published: March 20, 2013

Baked in the Sun is a wholesale baker and distributor of freshly baked pastries near San Diego.

THE CHALLENGE : The company is one of thousands of small businesses that employ more than 50 full-time employees and thus will be required to offer health insurance to their workers — or pay into a government fund — beginning Jan. 1. Rachel Shein and Steve Pilarski, the married owners of the bakery, which employs 95 people, estimate this could cost their business up to $108,000, and they are weighing their options as the date approaches. “Our revenues are about $8 million, but the food business is a low-margin industry so cutting $108,000 out of our profits, which are just over $200,000, is a big deal,” said Ms. Shein, who is the chief executive. They are evaluating different ways to comply with the new law and finance the expense.

THE BACKGROUND : Ms. Shein and Mr. Pilarski bought their first bakery, a maker of scones, 16 years ago. Their business grew along with the popularity of coffee shops, and they expanded their product line to include other pastries.

During the recession, the coffee shop business contracted, so they found new customers among hotels and hospitals, but the cost of servicing different types of businesses and developing new products to meet their needs eroded profits. At the same time, gasoline and ingredient prices went up and vendors tightened payment terms. Still, the couple persevered by providing an array of freshly baked goods and offering product variety and consolidated delivery, simplifying things for their customers.

With the recession behind them, Ms. Shein and Mr. Pilarski are trying to rebuild their profitability. Baked in the Sun produces nearly 200,000 items a day — almost 200 different products, including brownies, coffee cakes, muffins and cookies — in an 18,500-square-foot baking facility in San Marcos, Calif. The goods are delivered to coffee shops, schools, hotels and hospitals in the San Diego area.

THE OPTIONS : Ms. Shein is contemplating several options to comply with the Affordable Care Act’s business mandate.

Option One is to provide the insurance. According to the law, Ms. Shein will have to offer health insurance or, most likely, pay a penalty, and she estimates the insurance will cost up to $108,000 a year for 90 employees (managers have insurance already).

This is just an estimate, she said, because the insurance companies have not yet created and set a price on plans that meet the law’s requirement for minimum care. She estimates a cost of $200 per employee a month, of which the bakery would pay half and the employee would pay half. Employees can choose not to participate in the plan if they are covered elsewhere or for other reasons, so it is unlikely they will all sign up.

Option Two is to not offer health insurance and let employees find coverage elsewhere, perhaps on one of the new government exchanges. Under this option, the company will probably have to pay the mandated “employer shared responsibility payment” to the government.

The cost to the business would be $2,000 per employee a year, but the law exempts the first 30 employees, so the total would be $130,000 per year for a 95-person company. One benefit of this option is that the company would not have to take on the burden or expense of managing the insurance plan, which Ms. Shein estimates would take $10,000 of staff time.

One way to cover the costs associated with the new law would be to raise the price of each item sold about 4 percent and pass the costs along to buyers. “It’s ironic that our success meant we could grow,” Ms. Shein said, “and now we will be competing against smaller companies, with 50 employees or fewer, who will be able to charge less per item because they don’t have the financial burden of health insurance.” Prices are currently similar among local competitors, Ms. Shein said, and she says she believes the increase in her prices could affect her sales, possibly significantly.

Ms. Shein is considering a third option: outsourcing certain jobs to reduce the staff, because businesses with 50 or fewer employees will be exempt from the penalty. “We can outsource the cleaning and make the drivers independent contractors,” she said, “and we can cut the least profitable delivery routes, least profitable accounts or reduce the variety of items we create.”

It is important for Ms. Shein to make a decision soon on staff levels because the number of full-time employees a business has in 2013 will determine its status in 2014. If the business has 50 or more full-time, or full-time equivalent, employees, it has to provide insurance to any staff members who work 30 hours or more a week. Companies can average their number of employees across the full 12 months in 2013 to see whether they meet the threshold, or they can instead calculate the number of full-time employees by using any six-consecutive-month period in 2013.

Ms. Shein said she believed all workers should have health insurance, and she and her husband had wrestled with the problem for years. “We have offered health insurance to our employees in the past,” she said, “for preventive care, for financial protection, and because it doesn’t make sense for taxpayers when they end up in the emergency room.”

However, she has found many of her employees resistant to coverage that requires an employee contribution. “They are mostly young and healthy,” she said. “They don’t have a lot of extra money, and they would rather have a bit more in their paycheck than health insurance.” Also, she said, some of her Mexican employees prefer to go south of the border for inexpensive health care when they need it.

John G. Ebenger, an accountant with Berkowitz Pollack Brant Advisors and Accountants in Miami: “It is a challenging situation, especially since the details have not been fully worked out. The bakery could opt to bite the bullet and pay the penalty next year with plans to revisit the types of insurance that become available in 2014. With a year to plan, insurance companies will come up with more options for employers.”

Jonathan Gruber, an economics professor at M.I.T. who advised the Obama administration on health care reform: “Rachel and Steve face a difficult decision, but it seems that the third option, to reorganize production and outsource functions to end up with fewer than 50 workers, will be too expensive to make much sense. Offering insurance won’t cost much more than the penalty, and in an industry where many of their competitors don’t offer insurance, they could advertise themselves as a better place to work.”

Jody Hall, owner of Cupcake Royale, with 80 employees in Seattle, and a leader of the Main Street Alliance, a national network of small-business groups: “I’d recommend offering health care insurance for full-time employees, like we do at Cupcake Royale, as part of our responsibility to help strengthen the health of our employees, our community, and our business.

“Ms. Shein is probably overestimating her costs because not all employees will use the health insurance she offers. At our bakery only about half our employees use the health insurance we provide. Some are under 26 and covered by parents, others have spouses with coverage, and some just choose not to take it. Small businesses like mine who have been offering health care will be better off when all businesses are paying into the system because the cost increases will slow down.”

THE RESULTS : Offer your thoughts on the You’re the Boss blog at nytimes.com/boss. Next week, on the blog and on this page, we will give an update on what Ms. Shein is planning to do.

http://www.nytimes.com/2013/03/21/bu...nted=all&_r=2&

When I was growing up, there was insurance and if you didn't have insurance, you went to the clinic. It was a sliding scale fee according to your income and if you couldn't pay for it then, they billed it to you over time. I don't recall there being a problem with that and no one being treated.

Then it morphed into insurance with a deductible and HMO's......with an option to go in network or out of network.

So sick of Obamacare further messing it all up. Could it have been tweaked, probably...but this is crap.

Sebelius: Yep, ObamaCare is raising insurance costs
By: John Hayward 3/27/2013 07:46 AM

A watershed moment in the ongoing disaster of ObamaCare, as Health and Human Services Secretary Kathleen Sebelius finally admits that health insurance premiums are rising because of the President’s health insurance takeover, per the Wall Street Journal: http://blogs.wsj.com/washwire/2013/0...bile_uber_feed

Ms. Sebelius’s remarks come weeks before insurers are expected to begin releasing rates for plans that start on Jan. 1, 2014, when key provisions of the health law kick in. Premiums have been a sensitive subject for the Obama administration, which is counting on elements in the health law designed to increase competition among insurers to keep rates in check. The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

The secretary’s remarks are among the first direct statements from federal officials that people who have skimpy health plans right now could face higher premiums for plans that are more generous. She noted that the law requires plans to provide better benefits and treat all customers equally regardless of their medical claims.

“These folks will be moving into a really fully insured product for the first time, and so there may be a higher cost associated with getting into that market,” she said. “But we feel pretty strongly that with subsidies available to a lot of that population that they are really going to see much better benefit for the money that they’re spending.”

Ms. Sebelius added that those customers currently pay more for their health care if their plans have high out-of-pocket costs, high deductibles or exclude particular types of coverage, such as mental health treatment. She also said that some men and younger customers could see their rates increase while women and older customers could see their rates drop because the law restricts insurers’ ability to set rates based on age and gender.

Don’t worry, folks, ObamaCare is blowing premiums through the roof, but there will be subsidies available for lower-income Americans! That means the rest of us will get screwed twice - once when we pay our higher insurance premiums, then again when we pay for all those lovely subsidies.

On the political front, Obama’s cherished young voters are getting rooked, but luckily they tend to be low-information types who don’t hold him accountable for anything – they keep saying jobs and economic growth are their top concern, but they voted to re-elect him, didn’t they? And Sebelius is doing her best to mitigate political fallout from sticker-shocked young people by keeping that “War on Women” narrative going. Those brutish misogynist ObamaCare opponents just want to repeal the President’s magical program because they want insurance companies to be able to discriminate against women!

Sebelius also put some effort into attacking a Society of Actuaries study that predicted an average 32 percent increase in the cost of claims paid out by insurance companies, thanks to the new regulations requiring them to cover people with pre-existing conditions. The effect will be felt unevenly by various states, with the “overwhelming majority” on track for “double-digit increases in their individual health insurance markets,” while a few are expected to see cost reductions. Sebelius tried the same tactic of hiding the corresponding increase in premiums by folding them into the immense red inkblot of general federal taxation and spending:

The Obama administration challenged the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law, such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick.
The study also doesn’t take into account the potential price-cutting effect of competition in new state insurance markets that will go live Oct. 1, administration officials said.

At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can’t be compared to the comprehensive coverage available under the law. “Some of these folks have very high catastrophic plans that don’t pay for anything unless you get hit by a bus,” she said. “They’re really mortgage protection, not health insurance.”

Sebelius said the picture on premiums won’t start coming into focus until insurers submit their bids. Those results may not be publicly known until late summer.

It’s cute when these people pretend to care about the deficit in order to beat tax increases out of us, isn’t it? But when multi-trillion-dollar government programs need even more taxpayer subsidies to function, we’re not supposed to bat an eye. How many “sequesters” will these subsidies be worth over the next decade? Because when the government is asked to spend $80 billion less in the coming year, it’s a world-ending crisis that causes the entire federal system to tremble on the verge of collapse.

Remember back when Barack Obama was lying through his teeth and promising you could keep your plan, if you liked your plan? Well, his Health and Human Services commissar thinks your skimpy high-catastrophic hit-by-a-bus plan sucks, so it’s dead. Welcome to socialist reality, suckers. Just wait until you find out what other promises won’t be kept, like maybe those promises of huge federal subsidies for state Medicaid expansion.

There could be even more taxpayer subsidies on the way, because the Financial Times reported on Tuesday that the US Chamber of Commerce is “appealing to the Obama Administration to grant special relief to employers in states that are rejecting federal aid promised under the President’s health reform program.”

In states that are not expanding Medicaid, employers will have to pay $3,000 for each employee who joins a state exchange programme to buy health insurance.

In a filing this month, the US Chamber of Commerce urged the administration to exempt employers in those states from the tax penalties.

In doing so, the chamber pointed to a decision by the Obama administration to exempt poor people in states that do not expand Medicaid from the “individual mandate”, which requires people to get health insurance or face an individual tax penalty. The chamber said the same approach should be used for employers.

“If an employer penalty is only triggered by a would-be Medicaid eligible employee, that trigger should be exempted or excused,” the Chamber of Commerce said.

The additional cost to employers in states that do not expand Medicaid has been estimated as $1.3 billion a year. Of course, if Medicaid is expanded, that’s another fleecing for we, the taxpaying sheep. If we’re going to get our pockets picked anyway, subsidizing businesses sounds like it would be cheaper. And that’s what waiving the notorious “individual mandate” or business mandates amounts to, because the purpose of those mandates is to force every American to buy health insurance right away, rather than waiting until they get sick and invoking that “must cover pre-existing conditions” mandate.

Governor Rick Perry of Texas, which is resisting Medicaid expansion, made this point through a spokeswoman: “This is not free money from the federal government – it’s either being borrowed from China or taken out of taxpayers’ pockets. The state and federal government can’t afford the current Medicaid program as is, and it’s financially irresponsible to continue expanding a program that we know to be broken.”

Who knew all these mandates would be so expensive? Oh, that’s right: ObamaCare critics, the most thoroughly vindicated group in modern American political history.

http://www.humanevents.com/2013/03/2...surance-costs/

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Sebelius also put some effort into attacking a Society of Actuaries study that predicted an average 32 percent increase in the cost of claims paid out by insurance companies

http://news.yahoo.com/study-health-l...--finance.html