Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[Lombardi's_kid_brother]

Because you don't have to "pay taxes" to get a credit. It's not a deduction - it's a credit, how much you get back or pay come tax time is irrelevant when it comes to a credit (unless the credit is written to specifically adjust based on that.)

 

It just requires that you file your taxes.

 

Depends on the tax credit.

 

I qualified for the adoption tax credit. It used to be fully refundable, meaning that if it reduced your tax liability to $0, you could receive any unclaimed portion as part of your refund. It is not fully refundable now. 

 

Basically, if you pile up tax credits, you just reduce a tax burder that is already $0 to $0.

[PeterMP]

Ok, you're right, there are nonrefundable tax credits (where your income matters) and nonrefundable tax credits (where it doesn't.)

 

But saying, in general, tax credits cannot help you if you don't pay taxes is incorrect. They can. Just because someone says they want to use a tax credit for something doesn't mean those who don't pay taxes can't get it. Unless they specify non-refundable tax credit, of course.

 

And the Earned Income Tax Credit isn't an exception... it's a refundable tax credit. It's not the only one. It's a type of tax credit that doesn't depend on income. It is not excluded from anything in terms of tax credits.

 

Sorry for my confusion on the matter

 

I guess I just assume that if somebody says tax credit, and they don't stipulate that it is a refundable tax credit that it isn't.

 

Otherwise, why wouldn't you say you were talking about a refundable tax credit?

[tshile]

I guess I just assume that if somebody says tax credit, and they don't stipulate that it is a refundable tax credit that it isn't.

 

Otherwise, why wouldn't you say you were talking about a refundable tax credit?

 

for the same reason when people say tax credit they don't say they're talking about non-refundable tax credits?

 

they absolutely should, politicians tend to avoid specifics whenever possible for obvious reasons.

 

to be fair, i'm not opposed to the idea that they would make it non-refundable making your entire point valid. that actually seems like something they would do, and i wouldn't even be shocked.

[Wrong Direction]

1. Sorry.  Right. Medicaid not Medicare.

 

2.  I'm still not sure how a tax credit help people that don't pay any taxes.

 

3.  Has the CBO scored it?  Scoring very general things like encouraging states to carry out tort reform is going to be hard (How encourage? What type of tort reform?), etc.

 

4.  Isn't the ACA being paid for by increased taxes on the "Cadillac" and the penalties for the uninsured primarily?

 

#2. I'm almost certain that the R plan is calling for fully refundable tax credits because it's being compared to Jindal's plan which is not refundable. To Hersh's question, yes, that's basically a direct subsidy. The theory behind a direct subsidy as opposed to just giving eligibility for things like Medicaid OR ACA subsidies is that it gives the poor person more of a choice of plan, which comes with more options for Dr. networks, etc.

 

#3. I'm going by memory here, but I think the R's refer to various scores that CBO has provided on provisions in the past. Those things change over time, but my understanding is that the R's think they're on solid CBO ground even w/o a direct score from CBO on this bill.

 

#4. The ACA is being paid for in many ways, but that includes big cuts to Medicare Advantage and Medicare Hospital payment. 

[PeterMP]

#2. I'm almost certain that the R plan is calling for fully refundable tax credits because it's being compared to Jindal's plan which is not refundable. To Hersh's question, yes, that's basically a direct subsidy. The theory behind a direct subsidy as opposed to just giving eligibility for things like Medicaid OR ACA subsidies is that it gives the poor person more of a choice of plan, which comes with more options for Dr. networks, etc.

 

#3. I'm going by memory here, but I think the R's refer to various scores that CBO has provided on provisions in the past. Those things change over time, but my understanding is that the R's think they're on solid CBO ground even w/o a direct score from CBO on this bill.

 

#4. The ACA is being paid for in many ways, but that includes big cuts to Medicare Advantage and Medicare Hospital payment. 

 

I believe Jindal's plan is for a tax deduction, which while also not doing people that currently pay no taxes any good, is also different than a non-refundable or refundable tax credit.

 

Isn't the hospital payments directly tied to (avoidable) readmissions?

 

The ACA is essentially working to make the hospitals more efficient where there was little incentive for them to be in the past.

 

Which should actually cut health care costs.

[tshile]

Isn't the hospital payments directly tied to (avoidable) readmissions?

Kind of.

First off - they're not avoidable. Not entirely. If you release a patient with medicine and instructions on how to get better, and they don't take their medicine or follow the instructions and wind up back in the hospital, is that an avoidable readmission? I wouldn't think so. This is a problem that exists right now. A big problem. The idea that readmissions are a completely avoidable thing (from the care-provider's side) is something that sounds good but just isn't true. People do not have the desire, or capacity, to follow directions even when their health is on the line. Just a sad fact of life.

Second - they're also tied to patient satisfaction scores which has a lot of issues itself.

I'm not quite sure what else their reimbursements are tied to, but I will ask my wife as she's up to her eye brows in this crap right now

Edited February 20, 2015 by tshile

[PeterMP]

Kind of.

First off - they're not avoidable. Not entirely. If you release a patient with medicine and instructions on how to get better, and they don't take their medicine or follow the instructions and wind up back in the hospital, is that an avoidable readmission? I wouldn't think so. This is a problem that exists right now. A big problem. The idea that readmissions are a completely avoidable thing (from the care-provider's side) is something that sounds good but just isn't true. People do not have the desire, or capacity, to follow directions even when their health is on the line. Just a sad fact of life.

Second - they're also tied to patient satisfaction scores which has a lot of issues itself.

I'm not quite sure what else their reimbursements are tied to, but I will ask my wife as she's up to her eye brows in this crap right now

 

But they've already cut re-admissions a lot, and a lot of time they are the elderly.

 

You send an elderly person away from the hospital who already has 3 pills they are taking with another 3 pills with 3 different schedules, is it really surprising if they mess them up?

 

The person is already probably stressed and probably not a 100% since they ended up in the hospital already.  Is it that hard to believe that they might have issues following the instructions they are given even if the want to?

 

And that even assumes the get good instructions.  I got my appendix out this summer.  The nurse printed me a bunch of information with "instructions" (looked like she'd gotten it from a web page), but some of it in terms of what activities I was allowed to do when directly contradicted what my surgeon had told my wife where I wasn't awake/alert at the time my wife and surgeon had the conversation.

 

My understanding is that one real simple thing hospitals have done is to contract out somebody to follow up with them a day or two later to go over the instructions again.

 

Certainly that's cheaper/better than people being readmitted to the hospital, no?

 

The government paying hospitals based on what kind of service they provide makes a lot of sense to me.

Edited February 20, 2015 by PeterMP

[tshile]

But they've already cut re-admissions a lot, and a lot of time they are the elderly.

 

You send an elderly person away from the hospital who already has 3 pills they are taking with another 3 pills with 3 different schedules, is it really surprising if they mess them up?

I think you're assuming that numerical change in how it's measured was caused by the results that the rule change was meant to create...

I, for a fact, know that's not (entirely) the case.

For example - Part of the rules apparently say that the hospital can go through a process which transitions the patient back to the primary care doctor. When this is done there is no "readmission" for this patient. The hospital is considered to have done its job, and it is now in the hands of the doctor.

So if the patient winds up back in the hospital, for the same issue, it doesn't count as a readmission because of a procedural issue. This is done so the hospital doesn't get its rates cut. The "stats" reflect it. Any reasonable person can look at the situation and say - this is a readmission.

They're skirting around the rule, the problem hasn't been fixed.

I'm sure some of the reasons the numbers have gone down is because people are making more of an effort to guard against it. But to attribute the entire decline to that is... well, I know it's just not true.

You can turn around and blame the hospitals, but I (and many that work in the field that I've talked to) would argue it was a stupid rule, based on numbers that don't capture the actual issue, that punished hospitals for something they had no control over to begin with, created by people that don't actually understand the system, and so there should be no surprise, shock, or outrage that they are trying to get around it (and being successful in some cases.)

The biggest problem with ACA (in my opinion) is that it put the ENTIRE onus of cost control on the hospitals. It's a flawed approach, and this is just one that shows it.

Lots of people have lost their jobs because of this. Hospitals have gone through complete restructures centered around reimbursements being cut for ridiculous reasons.

edit: I don't work in the field, and everything I'm posting is based on conversations I've had with people that do and (for the most part) I trust/value their opinions. I very well may have butchered a few things in the explanation because I'm regurgitating something I don't have a lot of experience with. I'm also only familiar with how things are working in my area.

Edited February 20, 2015 by tshile

[PeterMP]

I think you're assuming that numerical change in how it's measured was caused by the results that the rule change was meant to create...

I, for a fact, know that's not (entirely) the case.

For example - Part of the rules apparently say that the hospital can go through a process which transitions the patient back to the primary care doctor. When this is done there is no "readmission" for this patient. The hospital is considered to have done its job, and it is now in the hands of the doctor.

So if the patient winds up back in the hospital, for the same issue, it doesn't count as a readmission because of a procedural issue. This is done so the hospital doesn't get its rates cut. The "stats" reflect it. Any reasonable person can look at the situation and say - this is a readmission.

They're skirting around the rule, the problem hasn't been fixed.

I'm sure some of the reasons the numbers have gone down is because people are making more of an effort to guard against it. But to attribute the entire decline to that is... well, I know it's just not true.

You can turn around and blame the hospitals, but I (and many that work in the field that I've talked to) would argue it was a stupid rule, based on numbers that don't capture the actual issue, that punished hospitals for something they had no control over to begin with, created by people that don't actually understand the system, and so there should be no surprise, shock, or outrage that they are trying to get around it (and being successful in some cases.)

The biggest problem with ACA (in my opinion) is that it put the ENTIRE onus of cost control on the hospitals. It's a flawed approach, and this is just one that shows it.

Lots of people have lost their jobs because of this. Hospitals have gone through complete restructures centered around reimbursements being cut for ridiculous reasons.

edit: I don't work in the field, and everything I'm posting is based on conversations I've had with people that do and (for the most part) I trust/value their opinions. I very well may have butchered a few things in the explanation because I'm regurgitating something I don't have a lot of experience with. I'm also only familiar with how things are working in my area.

 

But you don't disagree that there has been some decrease in readmissions.

 

Right?

 

And that saves us money?

 

Right?

 

And realistically, hospitals are being compared to other hospitals.  It isn't like they are being compared to some unacheivable standard.

 

And all of the money goes out to hospitals.  The penalties are balanced by bonuses somewhere else.

 

http://kaiserhealthnews.org/news/value-based-purchasing-medicare/

 

And the hospitals have gained because of the expansion done by ACA in terms of their being less covered health care.

 

http://www.hhs.gov/news/press/2014pres/09/20140924a.html

 

But realistically, we need to bring some sort of quality measures and consequences back into health care.  Is there any reason why the government should pay equally for good care as bad care?

 

And yes people at hospitals that offer bad care are going to lose their jobs.

 

And a lot of times it isn't their fault, but that's the nature of our economic system, and it is true for most everybody working in the public sector.  If your boss makes bad decisions even if you do your job well, you can still end up losing your job.

 

Is that really an argument that the government should pay an equal amount for bad care?

Edited February 20, 2015 by PeterMP

[Wrong Direction]

I believe Jindal's plan is for a tax deduction, which while also not doing people that currently pay no taxes any good, is also different than a non-refundable or refundable tax credit.

 

Isn't the hospital payments directly tied to (avoidable) readmissions?

 

The ACA is essentially working to make the hospitals more efficient where there was little incentive for them to be in the past.

 

Which should actually cut health care costs.

 

re: Jindal - I see your point, but I think it's a matter or more explicit language versus intent. I'm pretty sure this particular bill has chosen the fully refundable version, but given the disagreement within the party, I'm sure that could change. Perhaps that's why the language isn't explicit?

 

re: Hospital payment, it isn't just about readmission and quality. Hospital payments are slated to decline relative to the previous baseline in 2016, I believe. The rationale for this was that more covered patients means less uncompensated care provided by Hospitals, so it was apparently a deal between the AHA and the administration back in 2010. Additionally, the MA cuts have already begun, but it seems like the administration is taking a very cautious approach to making those cuts, meaning they've used demonstration authority (and funds) to mute the effects of those cuts to date. There were some articles on this a year or two ago. However, I think the CR deal will further tighten the purse strings, so I'm guessing that'll begin to change next year. 

[tshile]

PeterMP:

My contention was with your use of the word avoidable, and saying that's how they get their reimbursements.

There are other things that affect their reimbursements. Furthermore not every readmission are avoidable. The only way to make them all avoidable is to keep the patient until they are 100% healthy, which is not feasible because of costs (and people wouldn't stay in the hospital that long.) So, you're at the mercy of the patient doing what they're supposed to do. I don't know if you have experience with the medicare/medicaid crowd, but if not - they're not exactly a population of people known for taking care of themselves/following direction... they're just not.

Lowering readmission saves us money? Sure, it sounds good, but I don't know. Again, numbers are being fudged. There's a cost associated with that fudging. I don't think it can accurately be measured due to various limitations. I would like to believe it's saving us money, but absent an adequate way to ACTUALLY measure readmission I don't honestly know.

I don't know about penalties balancing out of bonuses... I don't even understand what your claim there is.

But as for this:

"But realistically, we need to bring some sort of quality measures and consequences back into health care. Is there any reason why the government should pay equally for good care as bad care?"

I agree with you. My argument is that they're doing it wrong; or maybe to put it better - they're not doing it the best/most productive way. They are getting some of the results they want, and they'll surely tout that. And you're not going to catch hospital CEO's saying "Well, we just found ways around the new rules", they're obviously going to run around saying they have a renewed focus on patient care... let's not be naive here

I don't have a problem with what you're saying. I just don't think the results are what you seem to think they are, and I don't think the rule is having the impact you seem to think it's having, and I think this because people that work in the field are telling me the changes they've made because of this rule and why... and it's to get around it in various ways.

Here's some changes I know about:

Patient load has been increased

# of nurses on a floor at any given time has been decreased

acuity levels a nurse maxes out at has been raised

the follow up process has been completely redone and is a huge focus - part because they want to make sure they don't have a readmission from the patient, part is to transfer the patient to their doctor like I said earlier

middle management has been drastically cut and you very well may be appalled at the number of people any given manager is now responsible for. I'm not quite sure how any of them get any proactive work done.

There are still fundamental issues with the system. There are still changes that need to be made. The sooner both parties realize that and start working on it the better. As of right now, form where I sit, the Administration seems to think everything is all roses now and the GOP seems to think it's doom and gloom and repeal is the only option. Both are wrong and you and I and everyone else are screwed until they figure that out. (screwed in the sense that we're stuck with a system that won't be improved and needs to be improved)

Edited February 20, 2015 by tshile

[Wrong Direction]

 

The biggest problem with ACA (in my opinion) is that it put the ENTIRE onus of cost control on the hospitals. It's a flawed approach, and this is just one that shows it.

 

There's a long history hear that's worth knowing about.

 

In the 70's and early 80's, Medicare had a huge problem with hospital payment. They "solved" this payment by creating a bundled payment system (DRGs) for hospitals. The hospital response to this has been predictable. They maximize DRG payment and also any payments associated with outpatient hospital or ER care. Then they discharge people to post acute care settings and, in many cases, generate financial relationships with those entities. The result has been run-away costs in post acute care settings, SNF and Home Health in particular. One of the almost ancillary effects of this was patients are discharged sooner and thus more likely to be readmitted. Another effect is that by virtue of discharge from a hospital to a PAC setting, patients have seen less of their primary care Drs.

 

So now the government is sort of swinging the pendulum the other way. They want hospitals and physician networks to better manage patients post hospital discharge because they think better management (offering shared savings) will mean patients get the appropriate care but not the crazy overuse that Medicare sees. They also think it'll reduce readmissions.

 

These changes are good, but they're totally missing the point. The government is basically gathering a small share of savings out of a massively overused and overpriced payment system and then declaring victory.

 

The feeling from people on the left and on the right that I've spoken to is that there will need to be major changes to the way Medicare manages benefits because the current system is totally unsustainable. In the next 8-12 years, I think you'll see Medicare start acting like an insurance company rather than a big, dumb payer of any bill that comes in. They're going to have to start using tools like prior authorization and more bundled payments to prevent a ton of this care because this ACO (shared savings) model is very unlikely to achieve meaningful results.

 

If you follow the logic, the Ryan plan to move people to Medicare Advantage makes more and more sense. Why inefficiently make the government an insurance company over the next 20 years when you can reform basic MA payment and get the rest of the benefits much sooner and much more efficiently? 

 

 

But realistically, we need to bring some sort of quality measures and consequences back into health care.  Is there any reason why the government should pay equally for good care as bad care?

 

This is totally true, but it's also used by big lobbies to slow progress to a halt. The quality measurement process takes years per minor improvement. It's a perfect way for lobbies to give politicians talking points (quality) while knowing all along that the baseline spending will continue to rise even with quality payments. It's important work, but from a payment and budget perspective, it's a political tool to delay or totally forestall the payment reforms that are necessary to fix the budget issues of Medicare.

[PeterMP]

Lowering readmission saves us money? Sure, it sounds good, but I don't know. Again, numbers are being fudged. There's a cost associated with that fudging. I don't think it can accurately be measured due to various limitations. I would like to believe it's saving us money, but absent an adequate way to ACTUALLY measure readmission I don't honestly know.

I don't know about penalties balancing out of bonuses... I don't even understand what your claim there is.

But as for this:

"But realistically, we need to bring some sort of quality measures and consequences back into health care. Is there any reason why the government should pay equally for good care as bad care?"

I agree with you. My argument is that they're doing it wrong; or maybe to put it better - they're not doing it the best/most productive way. They are getting some of the results they want, and they'll surely tout that. And you're not going to catch hospital CEO's saying "Well, we just found ways around the new rules", they're obviously going to run around saying they have a renewed focus on patient care... let's not be naive here

I don't have a problem with what you're saying. I just don't think the results are what you seem to think they are, and I don't think the rule is having the impact you seem to think it's having, and I think this because people that work in the field are telling me the changes they've made because of this rule and why... and it's to get around it in various ways.

Here's some changes I know about:

Patient load has been increased

# of nurses on a floor at any given time has been decreased

acuity levels a nurse maxes out at has been raised

the follow up process has been completely redone and is a huge focus - part because they want to make sure they don't have a readmission from the patient, part is to transfer the patient to their doctor like I said earlier

middle management has been drastically cut and you very well may be appalled at the number of people any given manager is now responsible for. I'm not quite sure how any of them get any proactive work done.

There are still fundamental issues with the system. There are still changes that need to be made. The sooner both parties realize that and start working on it the better. As of right now, form where I sit, the Administration seems to think everything is all roses now and the GOP seems to think it's doom and gloom and repeal is the only option. Both are wrong and you and I and everyone else are screwed until they figure that out. (screwed in the sense that we're stuck with a system that won't be improved and needs to be improved)

1. Look no matter what you do, industry is going to bend/stretch things as much as possible.

The idea that there are a lot of avoidable readmissions is well established and that cutting down on them is well established in the health care literature.

Just as one example:

http://archsurg.jamanetwork.com/article.aspx?articleID=1879841

And the early results are that readmissions are down and the rate at which health care is increasing is down (though admittedly that's not all or even mostly due to changes in readmissions).

http://blog.cms.gov/2013/12/06/new-data-shows-affordable-care-act-reforms-are-leading-to-lower-hospital-readmission-rates-for-medicare-beneficiaries/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771544/

Now some of it might be cooked books and stretching the rules, but it seems unlikely it all is.

In terms of the other things that you are saying are happening, if hospitals can do those things while keeping patient care high (based on the surveys) and things like readmssions and fatalities down (which they are also starting to look at), don't we want them to do those things?

If I can cut the number of nurses on a floor and not lose my quality, have more deaths, or more readmissions, how is that a bad thing?

And if you think Obama (and many other Democrats) are happy with the status quo and don't want to go to something more akin to a single payer system, you are clueless.

Edited February 20, 2015 by PeterMP

[tshile]

Again, PeterMP, we're in 99% agreement and I think we're both picking at nits in each others posts I'm certainly not suggesting all the positive news is because of cooked books

The impression I get is that there is concern that patient care isn't being kept high. In addition nurses are more stressed out, more concerned, more overworked, and are afraid they are not being allowed to do their job (all of which were GOP talking points on ACA pre-implementation, btw.) This is what i hear them saying. These are concerns they voice, openly, to anyone willing to listen.

You can keep pointing to statistical numbers, I'm telling you what people I know in the field are telling me. And I'm not a "Repeal Obamacare" person...

But I'm only talking to people in a limited number of settings. These issues could be isolated, I realize that. But to me it seems like, nationally, we have two sets of hospitals: Those that have figured out how to adapt in a successful manner, and all the other ones still trying (of which some terrible decisions have been made.) None of that is to imply we're doomed - just that there are very real issues going on and that we shouldn't gloss over them.

 

And if you think Obama (and many other Democrats) are happy with the status quo and don't want to go to something more akin to a single payer system, you are clueless.

I'm not saying that.

What I am saying is that I haven't see either side propose any changes. I've seen one side constantly propose repeal, and another only fight against repeal.

The system still needs changes. It's not where it needs to be. There are still problems. The job is not done. Yet no one seems to be talking about the next round of changes... no one. (maybe i'm just not paying attention, always a possibility )

Edited February 20, 2015 by tshile

[PeterMP]

Again, PeterMP, we're in 99% agreement and I think we're both picking at nits in each others posts I'm certainly not suggesting all the positive news is because of cooked books

The impression I get is that there is concern that patient care isn't being kept high. In addition nurses are more stressed out, more concerned, more overworked, and are afraid they are not being allowed to do their job (all of which were GOP talking points on ACA pre-implementation, btw.) This is what i hear them saying. These are concerns they voice, openly, to anyone willing to listen.

You can keep pointing to statistical numbers, I'm telling you what people I know in the field are telling me. And I'm not a "Repeal Obamacare" person...

But I'm only talking to people in a limited number of settings. These issues could be isolated, I realize that. But to me it seems like, nationally, we have two sets of hospitals: Those that have figured out how to adapt in a successful manner, and all the other ones still trying (of which some terrible decisions have been made.) None of that is to imply we're doomed - just that there are very real issues going on and that we shouldn't gloss over them.

 

I'm not saying that.

What I am saying is that I haven't see either side propose any changes. I've seen one side constantly propose repeal, and another only fight against repeal.

The system still needs changes. It's not where it needs to be. There are still problems. The job is not done. Yet no one seems to be talking about the next round of changes... no one. (maybe i'm just not paying attention, always a possibility )

 

1.  You'll have to excuse me if I accept large scale peer reviewed statistical studies over anecdotal evidence.  This is especially true where the anecdotal evidence is coming from people that are being (negatively) affected by the process, had years to reform the system on their own and didn't and still aren't offering any reasonable solutions (have any of the people you are associated with offered a solution to the issue of unnecessary readmissions?).

 

And again, it isn't like they are being asked to achieve some unachievable goal.  They are being compared to other hospitals.

 

2.  Can you show me a link where the GOP claimed the ACA was going to result in more work for nurses when it was being debated or even shortly after it was passed?

 

And again, if they can do that while maintaining quality, low readmissions, and low moralities, why is that a bad thing?

 

3.  I don't think anybody thinks the system is broke.  The argument has essentially become which direction do we go  where the argument for keeping the ACA is essentially an argument for government.  As an example, Elizabeth Warren put forward a law that would penalize drug companies for misdeeds and force them to give (extra) money to the NIH, which potentially would cut down on health care costs (e.g. wasted spending on off label prescriptions) and help the federal government save money on funding the NIH.

 

I actually think things are even worse than many expect.  Much of the slow down for health care spending increases was due to the patent cliff.  However, this year FDA approvals of new drugs are up, including novel novel drugs so they aren't just reworked/recycled drugs with small changes.

[Wrong Direction]

 

The system still needs changes. It's not where it needs to be. There are still problems. The job is not done. Yet no one seems to be talking about the next round of changes... no one. (maybe i'm just not paying attention, always a possibility   )

 

Actually I think more people than ever are talking about reforms. This is an intellectual discussion amongst politicians and other think tank/industry types and it's a good thing. Many are just confusing the politics (which are intolerable now but will be somewhat reset with a new POTUS in 2017) with what's happening behind the scenes.

 

I actually think both parties are in a better intellectual position on healthcare issues than they were in 2008. 

[tshile]

1.  You'll have to excuse me if I accept large scale peer reviewed statistical studies over anecdotal evidence.  This is especially true where the anecdotal evidence is coming from people that are being (negatively) affected by the process, had years to reform the system on their own and didn't and still aren't offering any reasonable solutions (have any of the people you are associated with offered a solution to the issue of unnecessary readmissions?).

You're excused

No seriously, I get it. I already admitted its anecdotal - it's from a few systems in the same geographical area. I'm less trying to to argue with you here, more just trying to add to the conversation.

I knew that ACA dinged reimbursements based on readmission numbers and cold call surveys of patients. I didn't know that was because readmission was such a huge issue. So I never thought to ask - what would you do to lower readmission.

So I just asked my wife - her only real comment was: the problem is that we get penalized for any readmission within 30 days of discharge, even if it's unrelated to the original cause for being in the hospital.

She's watching a movie so I didn't get any more out of her I'll try again later.

 

2.  Can you show me a link where the GOP claimed the ACA was going to result in more work for nurses when it was being debated or even shortly after it was passed?

 

And again, if they can do that while maintaining quality, low readmissions, and low moralities, why is that a bad thing?

I really need to dig up a link of the GOP talking about ACA (or "socialized healthcare" in general) resulting in more patients, overworked and under compensated doctors and nurses, leading to doctors running out of the field?

Because for a good 2-3 months it was a huge talking point of the left to make fun of the right for saying those things. At least 2-3 months.

(to answer your question - i don't really want to put int he effort to find a link, but if you're going to call me stupid or a liar or something because i'm being lazy then sure, i'll go find one... )

 

<rest of post>

Hmm, I don't really know enough to comment either way other than to say it's something I'll look out for in my news feed

WrongDirection - I would love for what you say to be true, I hope it is. I'm probably blinded by the circus show and not looking behind the scenes, like you say.

Edited February 21, 2015 by tshile

[Gallen5862]

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/20/800000-healthcare-gov-users-received-wrong-tax-information/?hpid=z3

 

 

800,000 HealthCare.gov users received wrong tax information

 

About 800,000 people who purchased health insurance through HealthCare.gov last year received incorrect tax information and have been asked to delay filing their returns, Obama administration health officials said Friday, a misstep affecting a critical part of the president’s signature health-care law.

The mistake could slow down tax refunds for many Americans who depend on subsidies to afford coverage under the Affordable Care Act. It’s also drawn further criticism from Republican opponents, who say the error is just the latest evidence that the law is frustrating Americans and unworkable.

After a bumpy debut more than a year ago, HealthCare.gov appeared to be running smoothly in recent months. There were no major tech glitches. And just days ago, the administration was trumpeting the wrap-up of an enrollment period that surpassed the president’s goals.

But on Friday, administration officials said nearly one million customers had been notified and asked to delay filing their returns for two or three weeks. About 50,000 people who already filed their 2014 tax returns will likely have to resubmit information to the federal government.

The subsidies are a significant part of the Affordable Care Act’s design. For people earning too much to qualify for Medicaid in their states but who lack other sources for health insurance, the subsidies can make or break whether they can afford coverage.

On Friday, Republicans seized on the administration’s error and a separate announcement from officials that the government was extending enrollment for taxpayers who could be hit with a penalty for not being insured.

“Whether it’s providing taxpayers with incorrect subsidy information or having to create special enrollment periods so that taxpayers can avoid costly penalties, Obamacare continues to frustrate and confuse Americans,” said Senate Finance Committee chairman Orrin Hatch (R-Utah) in a statement. “The Administration’s latest attempt to unilaterally tweak their own law to avoid political fallout once again underscores the failed policies rooted in Obamacare’s DNA.”

The error is tied to the local “benchmark” premiums the government uses to calculate subsidy payments. The cost of the 2015 benchmark plan was listed on some forms, instead of 2014, HHS explained in a blog post. The administration isn’t sure how this error occurred, said Andy Slavitt, a top administration official overseeing the federal health insurance exchanges.

“We’re still investigating the cause,” Slavitt said on a press call Friday.

In 2014, the first year of exchange operations, enrollees had two options for receiving financial assistance.

The vast majority chose to receive the money up front based on their projected income. Now that it’s tax season, those consumers need to reconcile the credit if they received too little or too much during the year. The tax preparation firm H&R Block estimates that federal support was too generous for about half of subsidy recipients in 2014.

The rest of the enrollees elected to receive the money entirely during tax season through a refund.

Consumers Union health policy director Lynn Quincy said waiting another two or three weeks to file their return may be a challenge for low-income families that are counting on a refund.

“There are a lot of families who count on the refund to make large purchases,” she said. “To the extent that they’re still getting a refund — which we hope they are — it will be hard to wait these extra couple of weeks.”

Quincy’s group had been advising health-care shoppers to take as little as possible of the premium subsidy in advance to avoid a potentially painful process during tax season. However, she acknowledged that would make it difficult for many to afford monthly premiums.

People who received subsidies under the health-care law must fill out a 1095-A tax form, indicating each household member who got coverage and how much in subsidies the government provided each month. If someone received too much in subsidies, he or she will have to pay it back.

“It’s not easy to figure this thing out, even for someone who know what this is all about,” said Bob Williams of the nonpartisan Tax Policy Center.

 

[PeterMP]

So I just asked my wife - her only real comment was: the problem is that we get penalized for any readmission within 30 days of discharge, even if it's unrelated to the original cause for being in the hospital.

 

I really need to dig up a link of the GOP talking about ACA (or "socialized healthcare" in general) resulting in more patients, overworked and under compensated doctors and nurses, leading to doctors running out of the field?

 

1.  They are being compared to their previous results and other hospitals.  Unless there is some reason to believe that they are seeing a greater number of people readmitted for different reasons after 30 days than in the past and other hospitals, there really is no reason to believe that's an issue.  Right?  They get a certain number of unrelated readmissions, but so does every other hospital.  When I compare between hospitals, those things will cancel out.

 

2.  The mechanism is important.  Your previous comment was related to the idea it was because hospitals were trying to work the system related to the new readmission policies.

 

What you've said here can be explained by more people getting insurance and so getting health care.

 

For example, I found this:

 

"Doctor and nurse vacancies are approaching nearly 20 percent at hospitals as these facilities prepare to be inundated by millions of patients who have the ability to pay for medical care thanks to the Affordable Care Act."

 

http://www.forbes.com/sites/brucejapsen/2013/12/08/doctor-nurse-vacancies-soar-amid-obamacare-rollout/

 

Now, I guess if you are a nurse it might not be ideal, but that wasn't what your original point really was I don't think

 

And isn't that something that can be fixed by more nurses.  That supply and demand will kick in and there will be more nurses.

 

Are you really going to claim it is bad if more people have insurance because they might actually use it?

[Larry]

CNBC: Gov't sent 800,000 HealthCare.gov customers wrong tax info

 

The Obama administration says it sent about 800,000 HealthCare.gov customers the wrong tax information, and officials are asking those consumers to delay filing their 2014 taxes. 

 

The tax error disclosed Friday is a self-inflicted injury that comes on the heels of what President Barack Obama had touted as a successful enrollment season, with about 11.4 million people signed up. 

 

California, which is running its own insurance market, just announced a similar problem affecting about 100,000 people in that state.

 

 

 

[twa]

gonna be a fun tax season even with the exemptions from fines ect

[Mad Mike]

Obamacare Is Spurring Startups and Creating Jobs - Bloomberg Business

 

 

 

More than 90 new health-care companies employing as many as 6,200 people have been created in the U.S. since Obamacare became law, a level of entrepreneurial activity that participants say may be unprecedented for the industry.

[Larry]

And that's just the ones trying to fix the bugs.

[Larry]

Oh, goody.  What this thing really needs is another lawsuit. 

 

Intl Bus Times: Florida Medicaid Debate: Governor Rick Scott Plans To Sue Federal Government Over Withheld Funding

 

Florida Gov. Rick Scott said Thursday he would sue the federal government because it is withholding hospital funding as part of a dispute over the state's refusal to expand Medicaid, the Tampa Bay Times reported. Under the Affordable Care Act, the landmark health insurance legislation signed by President Barack Obama in 2010, states can receive federal dollars if they expand eligibility for Medicaid, a government health insurance program for people with low incomes. Florida is one of 21 states that has opted against expanding the program, although it has lately softened that stance while considering alternatives.

 

Scott's announcement comes after the Centers for Medicare and Medicaid Services, a federal agency, told Florida's Agency for Health Care Administration Tuesday that future funding for a $2.2 billion hospital program would be contingent upon whether Florida takes federal money to expand Medicaid. The state program in need of funding, known as the Low Income Pool, funds hospitals and healthcare facilities that treat low-income and uninsured patients and is due to expire June 30. 

 

Whether or not Florida expands Medicaid "is an important consideration in our approach regarding extending the LIP beyond June," Vikki Wachina, a Medicare and Medicaid official, wrote in a letter to the Florida agency, the News Service of Florida reported. "We believe that the future of the LIP, sufficient provider rates and Medicaid expansion are linked."

 

 

There's more at the link, but not much.  I think I quoted 3 of 5 paragraphs. 

 

And there's like 30 places that ran an AP story, pretty much word for word, that's considerably longer but IMO contains even less information. 

 

Part of me wants to go on a tear.  "Oh, you mean Florida is refusing to accept federal money that will pay poor citizens to get health insurance.  But you demand that the Feds give you money to pay the bills of low income people who don't have insurance?" 

 

But I'm not really certain, here, that one side is entirely villainous, and the other is purely righteous. 

 

For example, I observe that I don't see anybody claiming that there's a law that says this funding is tied to expanding Medicaid.  Rather, it seems to simply be a decision made by a bureaucrat in the agency that oversees Medicaid funds. 

[twa]

and the fruit ripens 

 

http://thehill.com/policy/healthcare/242142-study-businesses-affected-by-looming-obamacare-tax-are-trying-to-avoid-it

 

Nearly two-thirds of companies facing a new ObamaCare tax say they are changing their coverage to avoid the extra costs, according to a new survey.

The so-called Cadillac tax, which applies to healthcare plans above a certain expense threshold, is one of the most pressing changes still to come under ObamaCare, according to a survey of about 600 members of the International Foundation of Employee Benefit Plans.

Only 2.5 percent of companies that would be hit by the Cadillac tax starting in 2018 said they plan to pay the tax. A total of 62 percent of companies said they have already taken action or plan to take action to avoid it.

 

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Most say they are shifting toward higher deductible plans, while others said they are reducing benefits, shifting more costs to employees or dropping high-cost plans altogether