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quite correct. I was speaking to the original design of the US republic, not the ACA.
Not with regard to Medicaid expansion. SCOTUS enabled that.
quite correct. I was speaking to the original design of the US republic, not the ACA.
"states rights" has always meant racism, discrimination, still does.
The Cons ution greatly strengthened Federal govt as a remedy for the hapless Articles of Confederation.
speaking loosely, again: I meant the 1789 Cons ution, which the Articles of Confederation of course preceded.
While he is going to most likely disregard the truth in that, I see it.
there is a smaller part of the ACA that has potentially far-reaching effects on all of primary care, and I've hardly heard a thing about it in the media. It is helping primary care physicians transform how we deliver care to our population of patients and it is actually kind of exciting.
I am a family practice physician in a multi-specialty group of about 60 doctors, mostly primary care.
...
So enough background. Here's the good stuff. The ACA provides funding and guidance for a new way to approach health care. The Comprehensive Primary Care initiative is a program that involves about 500 practices across the country, in several geographic areas. Southwest Ohio/N. KY, New Jersey, Arkansas, Colorado, New York, Oregon, and Oklahoma have participating practices.
Practices were selected based on a number of factors, including past willingness to participate in such things as NCQA quality recognition, and patient-centered medical home (PCMH) certification. You can read more here: http://innovation.cms.gov/...
Basically, CMS (center for Medicare and Medicaid services) provides funding outside of the fee-for-service environment for practices to do a better job of chronic disease management. There is/was a detailed application process, and multiple milestones you have to meet, but a lot of it boils down to CMS providing additional monies for practices to use as they see fit in order to help improve the care for their patients, particularly (although not exclusively) those with higher risk chronic illness.
The whole thing is actually really interesting. While there are quite a lot of specifics, there are also a lot of areas open to interpretation. CMS is partnering with multiple private insurance carriers to provide a monthly fee (outside of any appointment or fee-for-service interaction) to physician practices in order to help those practices invest in infrastructure which will help improve patient care. The amount per patient per month is based on risk assessment. Basically, the more diagnoses, and the more complicated a patient is, the higher the monthly fee. A well-controlled diabetic would have a lower fee than a diabetic with chronic kidney disease, heart disease, and neuropathy. So right off the bat, you can see how this is a paradigm shift from the traditional fee-for-service environment. You may actually be paid more to take care of a more complicated person and try to keep them out of the hospital.
However, and this is a BIG part, the money from this CPC initiative can NOT be paid to physicians as compensation. It is to be used to improve infrastructure. This is actually pretty cool because instead of just paying doctors more and saying, "hey, if we pay you more, you'll do a better job, right?", CMS is saying, "we will give you money to use as you see fit (within the structure of our program and its milestones) to improve patient care which should improve outcomes, decrease severe complication rates, improve patient satisfaction, and eventually decrease overall costs through an investment up front."
If you hadn't already guessed, my group has several practices involved in the CPCI program and we are excited about it. I don't know what the other 490-some practices across the country are doing, but we have used the money to hire more staff, including what we call Care Coordinators for each office, an RN who can reach out to patients before, during and after appointments to see how we can better coordinate care. We try to have labs drawn before folks come for appointments, so we can have already reviewed the results before walking in the room. This allows for more efficient care. If someone's cholesterol is not to goal, for example, we can increase the dose of their cholesterol medication while sitting with them and explaining why an LDL goal of under 70 is the target. This works a lot better than a medical assistant calling someone and playing phone tag three days after their appointment to try to make sure they know that the new dose is 40 mg instead of 20.
Anyway, the Care Coordinator can help reach out to people who might need help paying for meds and see what assistance programs might help someone. She can help someone who was recently in the hospital understand their new medication regimen and help set up their follow up. If someone doesn't go for the colonoscopy or mammogram that we ordered, she can call them and find out why and/or encourage them to go (and maybe mention that preventative care is covered 100% now!). She can review their chart ahead of time and put in a reminder for the doctor that the patient is due for a pneumonia vaccine or a shingles vaccine. This is all part of the team-based approach to care which is helping to improve patient outcomes.
Our practice would not really been able to afford a Care Coordinator without the CPCI monies. Our group has also decided to hire a diabetes educator. Insurance is often squirrelly about paying for diabetes education, despite study after study clearly showing the benefits. Now we will be able to offer diabetes education free of charge to all of our patients.
This is pretty great all around. The doctors get more help, the patients get more individualized attention and care, outcomes improve, which specifically means someone didn't have a stroke. Someone didn't lose their vision because of diabetes. Someone had a precancerous colon polyp removed instead of being diagnosed with metastatic cancer a couple years later. Someone's grandmother didn't lose her foot. Oh, and all that stuff also saves money.
http://www.dailykos.com/story/2013/1...?detail=email#
Last edited by boutons_deux; 10-28-2013 at 04:30 PM.
tbh
I'm glad this was done. 0bama acted lawlessly in delaying the employer mandate.
AAPS Sues to Stop the Unlawful Revisions to ObamaCare
Published: October 30, 2013
By Association of American Physicians and Surgeons (AAPS)
TUCSON, ARIZ., OCT. 30, 2013 — /PRNewswire-USNewswire/ -- The Association of American Physicians & Surgeons (AAPS) has filed a lawsuit today in federal court to halt the unlawful revisions to ObamaCare (the Patient Protection and Affordable Care Act).
The separation of powers required by the Cons ution prohibits the executive branch—the Obama Administration—from rewriting laws passed by Congress. Yet that is what Obama has done by changing key parts of ObamaCare in order to implement it.
The AAPS lawsuit, which was filed today in the Eastern District of Wisconsin, asks the Court to enjoin the Obama Administration from imposing its "individual mandate" while delaying the "employer mandate." The law that was passed by Congress in 2010 requires that the employer mandate go into effect at the same time as the individual mandate: Jan 1, 2014.
"The U.S. Cons ution requires a strict separation of powers between the three branches of government, such that the executive branch cannot change laws passed by Congress," AAPS's lawsuit explains. By imposing the individual mandate in 2014 without the protection of the employer mandate, the Obama Administration has changed the legislation passed by Congress.
The delay in the employer mandate means that many Americans who might have had the protection of employer-purchased insurance will either have to purchase costly individual insurance for themselves, or else pay a tax. This unlawful change will force many Americans, more than Congress intended, to purchase expensive, unwanted health insurance. They will then have less income to use for things they do want, such as medical services purchased directly from private physicians without bureaucratic interference.
Unless Americans stand up now to stop Obama's rewriting of the laws, then there is no end to the harm that will result. The Obama Administration could begin to impose still more laws on Americans, such as single payer, without congressional approval, if legal action is not taken now to stop these violations of the Cons ution. AAPS's lawsuit today seeks an end to the practice of legislating from the White House.
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.
SOURCE Association of American Physicians and Surgeons (AAPS)
http://www.heraldonline.com/2013/10/...-unlawful.html
what bull . The REPUGS have been screaming, agitating for Obama to delay, "UNLAWFULLY", the individual mandate, also.
========================
The Association of American Physicians and Surgeons (AAPS) is a politically conservative non-profit association founded in 1943 to "fight socialized medicine and to fight the government takeover of medicine."[1][2] The group was reported to have approximately 4,000 members in 2005, and 3,000 in 2011.[1][3] Notable members include Ron Paul
While it describes itself as "non-partisan",[8] AAPS is generally recognized as politically conservative.[7][9][10][11] According to Mother Jones, "despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD."[11]
The organization opposes mandatory vaccination,[12] a single-payer healthcare system[13] and government intervention in healthcare.[11][14] The AAPS has characterized the effects of theSocial Security Act of 1965, which established Medicare and Medicaid, as "evil" and "immoral",[15] and encouraged member physicians to boycott Medicare and Medicaid.[16] AAPS argues that individuals should purchase medical care directly from doctors, and that there is no right to medical care.[17] The organization requires its members to sign a "declaration of independence" pledging that they will not work with Medicare, Medicaid, or even private insurance companies.[11]
AAPS opposes mandated evidence-based medicine and practice guidelines, criticizing them as a usurpation of physician autonomy and a fascist merger of state and corporate power where the biggest stakeholder is the pharmaceutical industry.[18] Other procedures that AAPS opposes include abortion[19] and over-the-counter access to emergency contraception.[20]AAPS also opposes electronic medical records[11] as well as any "direct or de facto supervision or control over the practice of medicine by federal officers or employees."[21]
On Oct 25, 2008 the AAPS website published an editorial implying that Barack Obama was using Neuro-linguistic Programming, "a covert form of hypnosis", to coerce people to vote for him in his 2008 presidential campaign.[22]
http://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
Last edited by boutons_deux; 10-30-2013 at 11:07 AM.
Who in their right mind thought the insurance companies could survive if they were required to accept people with pre-existing conditions?
It's all part of the plan. Destroy the insurance companies and then tell the American people that the only way we're going to survive is if we go to a single-payer system. In other words,.. FULL GOVERNMENT CONTROL.
“Why can’t I keep my insurance?” Because you’re stupid, sweetie.
Okay. This all goes to my screaming rants that people are responsible for their government. I’m getting really sick of people acting all indignant and acting like they’re being ambushed by this whole ObamaCare thing.
“Er my gawsh, y’all! My insurance bill just quadrupled. I’m serious you guys!”
Well, no kidding. What in the blue firey blazes did you expect? Let’s see. Insurance is risk pooling. A bunch of people get together and pay a small amount of money into a pool, and then when one of the people has an adverse event happen to them, the frequency of which can be broadly statistically predicted, then the pool pays out to the unlucky person who had the adverse event happen to them.
Now let’s see. From DAY FLIPPING ONE the Obama regime has been saying that mean old insurance companies will not be able to turn away customers with pre-existing conditions – in other words, insurance companies will have to let people JOIN THE RISK POOL … AFTER THE RISK EVENT HAS ALREADY HAPPENED.
Um, yeah. That is the total, complete destruction of the entire insurance paradigm. This isn’t my opinion. This is a mathematical fact … an extremely simple and elementary mathematical fact. If people who have already had the adverse risk event happen to them must be allowed into the risk pool, then it is no longer a risk pool. It is a wealth redistribution scam that victimizes the TOTAL, COMPLETE MORONS who enter and pay into the “pool” without already having had the risk event happen to them.
How can a nation of 330 million people, iniquitous gutter republic though it may be, not understand this? How can a nation of 330 million people have their tyrannical regime tell them in no uncertain terms that the entire insurance paradigm is going to be destroyed by said regime, and then when it happens everyone acts all shocked?
Oh, and then add onto that the fact that ObamaCare requires insurance to cover all kinds of bee-ess “preventative” and “elective” services. Well, if every single person in a risk pool is guaranteed to have a claim because the coverage is no longer for catastrophes, but also for purely non-emergent, elective pseudomedicine and outright quackery, then what do you expect? The “pool” has to collect more than it pays out. Period.
http://www.barnhardt.biz/2013/10/28/...tupid-sweetie/
That's it, try and divert attention away from the fact 0bama acted lawlessly.
========================
The Association of American Physicians and Surgeons (AAPS) is a politically conservative non-profit association founded in 1943 to "fight socialized medicine and to fight the government takeover of medicine."[1][2] The group was reported to have approximately 4,000 members in 2005, and 3,000 in 2011.[1][3] Notable members include Ron Paul
While it describes itself as "non-partisan",[8] AAPS is generally recognized as politically conservative.[7][9][10][11] According to Mother Jones, "despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD."[11]
The organization opposes mandatory vaccination,[12] a single-payer healthcare system[13] and government intervention in healthcare.[11][14] The AAPS has characterized the effects of theSocial Security Act of 1965, which established Medicare and Medicaid, as "evil" and "immoral",[15] and encouraged member physicians to boycott Medicare and Medicaid.[16] AAPS argues that individuals should purchase medical care directly from doctors, and that there is no right to medical care.[17] The organization requires its members to sign a "declaration of independence" pledging that they will not work with Medicare, Medicaid, or even private insurance companies.[11]
AAPS opposes mandated evidence-based medicine and practice guidelines, criticizing them as a usurpation of physician autonomy and a fascist merger of state and corporate power where the biggest stakeholder is the pharmaceutical industry.[18] Other procedures that AAPS opposes include abortion[19] and over-the-counter access to emergency contraception.[20]AAPS also opposes electronic medical records[11] as well as any "direct or de facto supervision or control over the practice of medicine by federal officers or employees."[21]
On Oct 25, 2008 the AAPS website published an editorial implying that Barack Obama was using Neuro-linguistic Programming, "a covert form of hypnosis", to coerce people to vote for him in his 2008 presidential campaign.[22]
http://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
that's it, Repugs try to SABOTAGE a federal law.
I haven't heard of any lawsuits targeting Repubs. I have though seen one targeting 0bama....See above.
AAPS is an old, extreme, right wiing POLITICAL organization, has no cred as disinterested medical professionals, and is participating in SABOTAGING ACA for purely political reasons, not because the company mandate was ILLEGALLY delayed.
So you agree that it was illegal correct?
ILLEGALLY
"ILLEGALLY"
aka BULL ING
ACA is a success, and will get even better, so you right-wingers can go suck it, and keep driving your Medicaid-denied red-state Repug-state neighbors to the ER with advanced disease and NO INSURANCE.
An unfortunate split screen on CNN while Kathleen Sebelius was testifying about the train wreck, a.k.a. Obamacare website
Lol, this video
At issue is the president's claim when selling health care reform that if you like your current health plan, you can keep it. That point in turn was based on the provision that grandfathered existing plans in the individual market (neither employer-based or government provided) by granting exemptions from various standards and consumer protections that came into effect when the law was signed in 2010.
However, as clearly stated at the time, if such a plan were to significantly change in ways that are inconsistent with consumer protections under the ACA, that it would lose its grandfathered status.
Like I said, this has been known since the law was written. In fact, go here to see a 2010 publication by my CBPP colleague Sarah Lueck that lists the ways plans can lose its grandfathered status, like eliminating benefits to treat certain conditions or significantly raising co-pays beyond what's implied by the rate of medical price inflation.
So, yeah -- if a plan changes such that a) it's not the same plan, and b) those changes, as Volsky notes, "significantly burden enrollees with lower benefits and increased costs, [then] they have to come into compliance with all consumer protections."
It's also the case that:
-- The administration knew there would be lots of plans in the individual market that would change like this and lose their grandfathered status, and said so back in 2010.
-- Despite rumors to the contrary, it's still a free country and private insurers can discontinue plans whenever they want. That plan may or may not have been grandfathered in 2010, but now needs to improve to come into compliance with the ACA.
-- The vast majority of Americans with health coverage will face few or no changes to their coverage, including the 171 million with employer-based coverage and the 100 million with Medicare and Medicaid. And any changes they will face will be improvements in benefits.
So, did the president misspeak? In a way, sure. He should have said: "If you like your plan and it doesn't get significantly worse such that it's out of sync with what we're trying to do here, you can keep it."
And, in fact, such nuances were clear at the time and not buried in the weeds but discussed in the open. Not much to see here folks... move along.
http://www.huffingtonpost.com/jared-...b_4175019.html
aka, if your individual insurance plan is junk, is garbage, it will have to change or die.
the assholes grillig Sebelius are just engaging in further SABOTAGE, eg:
The Republicans Grilling Sebelius Prevented Uninsured From Enrolling In Obamacare In Other Ways
But last month, fifteen Republican members of the Committee, including Chairman Fred Upton (R-MI), requested detailed responses and thousands of pages of do ents from approximately 60 percent of the so-called “Navigator” organizations — more than 100 hospitals, universities, Indian tribes, patient advocacy groups and local food banks — tasked with helping uninsured people connect to coverage. The lawmakers gave the groups just two weeks to provide detailed written descriptions of their employees and activities, interactions with the Department of Health and Human Services, and “all do entation and communication related to your grant.”
Several Republicans on the Committee cheered the news. “If this ended up resulting in a delay, I wouldn’t be unhappy about it,” Rep. Renee Ellmers (R-NC) said. Rep. Tim Huelskamp (R-KS) added that his office wouldn’t help cons uents enroll in Obamacare. “Our position is, if you want to sign up, you got to call HHS,” he said. “So we will say, ‘Call [HHS Secretary] Kathleen Sebelius’ office if you want to figure that out.’ ”
The effort is just the latest attempt by Republicans to undermine enrollment. Republicans on the Energy and Commerce Committee have previously sent letters seeking information from en ies tasked with educating the public about the law, opened investigations into public relations companies that had been contracted to promote the law on popular television shows, and warned the National Football League (NFL) and National Basketball Association (NBA) against encouraging enrollment in the law.
Update:
The National Journal’s Alex Seitz-Wald adds that “Republican legislatures and officials in at least 17 states across the country have thrown up all manner of bureaucratic roadblocks in front of the program.”
http://thinkprogress.org/health/2013...bamacare-ways/
Bishop Gecko chimes in:
Mitt Romney Would Like To Remind You That He’s Still Bitter
In a post on his infrequently updated Facebook page, Romney posted a rebuke to Obamacare on Wednesday, much the way Sarah Palin often does:
"In the years since the Massachusetts health care law went into effect nothing has changed my view that a plan crafted to fit the unique cir stances of a single state should not be grafted onto the entire country. Beyond that, had President Obama actually learned the lessons of Massachusetts health care,
millions of Americans would not lose the insurance they were promised they could keep, millions more would not see their premiums skyrocket, and the installation of the program would not have been a frustrating embarrassment.
Health reform is best crafted by states with bipartisan support and input from its employers, as we did, without raising taxes, and by carefully phasing it in to avoid the type of disruptions we are seeing nationally."
Romney’s bitterness is understandable, having watched his signature legislative accomplishment co-opted by the president who defeated him. He’s seized on the moment of health care reform’s worst moment of despair to give it a little kick.
http://www.nationalmemo.com/mitt-rom...-still-bitter/
Bishop Gecko must be thrilled that red-states, with no bipartisan support, are "crafting" the sabotage of their own state's Romneycare.
Last edited by boutons_deux; 10-30-2013 at 01:43 PM.
Leave Obama Alone!
Boutons have you signed up for Obamacare?
I have free, excellent employer insurance
I hope you receive a letter from them.
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