Second federal judge strikes down Trump ‘conscience protection’ rule for health care providers – The Hill

The Hill reports that Washington State has again triumphed over Trump for now on the administrations attempts to allow bigotry in healthcare.

“The court agreed that all Washingtonians deserve to receive the full range of health care services,” Ferguson said in a statement. “This rule would have disproportionately harmed rural and working poor Washington families, who have no alternatives to their local health care providers, as well as LGBTQ individuals, who already face discrimination when they seek medical care.”

Read the whole story here.

https://thehill.com/policy/healthcare/469498-second-federal-judge-rules-against-trump-conscience-protection-rule

Trump order to force hospitals to reveal information behind negotiated rates – Healthcare Dive

So as the article states, this is yet another federal idea that will help large hospitals and insurance companies, and likely to hurt smaller more expensive hospitals. (like Jefferson Healthcare). However, in general pricing transparency is a good thing.

“In our view, the pricing transparency is likely to result in contract rates converging to the mean while the largest hospitals with local market power will see less impact,” they wrote.

https://www.healthcaredive.com/news/trump-order-to-force-hospitals-to-reveal-information-behind-negotiated-rate/557454/

Many Hospitals Charge Double or Even Triple What Medicare would pay – NY Times

While our PT hospital is not named in this study, this article is relevant because Jefferson Healthcare is *allowed* to charge much higher rates that competing hospitals, since we are deemed “rural”. Yes, it’s strange that a hospital only 60 miles from a gigantic urban center could be considered rural, but that is what it is. And given the experiences that myself and others I’ve interviewed have shown, JHC is significantly overcharging for many of it’s procedures. The medical staff (doctors, PAs etc) are not aware of the pricing, as it’s all done by the billing department. But the watchword is that if you are going to go in for any kind of procedure that allows you the time to shop around, do so. I have been quoted $500 for a three view x-ray, and Sequim quoted me $250 while Poulsbo quoted me $150 and I ended up paying less than $50.

It is important to note that Medicare does *NOT* pay enough to make many hospitals profitable, or even break even. There is a very real threat to JHC if the Medicare For All proposals of Bernie Sanders and others are actually put into law, without government funding for hospitals that care for high Medicare/Medicaid populations, such as Jefferson County. We could lose our hospital under a badly implemented M4A.

We don’t need government-run healthcare to get affordable, universal coverage – Washington Post

A very interesting opinion piece (that dovetails with the last post of mine discussing that a large amount of lobbyists are out to kill the idea of Medicare for All). I don’t think that Third Way is a lobbying arm of the healthcare industry, but I would love to get some feedback by my readers as to what they think of this proposal. It does merit a good debate, I believe. It might even be possible to get a great many Americans on board with this, since they get to keep their doctor, it doesn’t put every medical professional into having to accept the uneconomic reimbursal rates of Medicare/medicaid, it eliminates medical bankruptcies, and it covers everyone in a way that is easy to implement. Thoughts? Am I missing something here?

From the article:

America can insure everyone without changing anyone’s existing health coverage. It won’t require replacing Obamacare with a single-payer, government-run system. Instead, we can build upon Obamacare with two simple, game-changing features: a universal cap on premiums and out-of-pocket expenses, and an automatic coverage system that places the uninsured in a plan they can depend on and afford.

UPDATE: After thinking about it, here’s my, and a medical friend’s thoughts:

A missing element in this is that it doesn’t change the issue that not everyone with insurance gets the coverage they need. Some providers don’t take more than one or two of the ACA options. Some don’t take any. Many things docs want to do arent covered by Obamacare, Medicare or independent insurers. If your doc says you need an MRI, and the ACA people say no, what then? Why is an insurance bureaucrat more knowledgeable about your care than your doctor? The devil is in the details in the current ACA & in this one too. In Canada, everyone who walks in the clinics or hospitals gets the same care. This proposal at least in the article, does not achieve that. Reimbursements in the ACA often barely cover the cost of treatment. That’s why some docs won’t take them. What about the caps? Meaning some programs only allow you to see a doc 4 or 5 times a year, then you are out of luck and out of pocket. Will it cover all needed coverage? So much missing in this article. Would love to have the authors point us to more indepth overviews of this. Interesting to read some of the comments, which seem to say that Third Way is a tool of the Right, some say it’s a tool of the Left. Wonder what the reality is? 

https://www.washingtonpost.com/opinions/2019/02/19/we-dont-need-government-run-health-care-get-affordable-universal-coverage/

Hospital Lobbying in 2018 By the Numbers

It’s always interesting to review where the big money is spent on lobbying. Today’s article in the Healthcare Dive (link at bottom of page) covered the an overview of hospital lobbying efforts highlight a few interesting issues (facts?):

  • The last lines point out that political rhetoric for “Medicare for All” seems to die after elections. Gavin Newsome in CA and the Illinois legislature has had a bill under study for two years without movement. The Medicare for All sounds like it’s not much more than a political ploy to help get politicians elected. We’ll have to see what becomes of the bills in the Washingon State legislature before putting the final nails in the coffin of this idea of Bernie Sanders. A question could be asked that if it’s that’s important to Sanders, is he involved in lobbying these states to implement it?
  • The 340B program, which has been a political hot potato, continues to be lobbied for by hospitals. There is much to criticize in this program, which supposedly provides direct subsidies to low income patients, but has been manipulated by both big Pharma (which wants to kill it) and hospitals (which has found ways to use it to make money for their bottom line). Yes, low income patients are getting drugs at a lower cost through this program but it leads one wondering if they could get even lower prices if the money was actually given to them directly, which was the original intent of the bill. We’re a long ways from that original intent, and even our hospital is profiting from the program, and finding further ways to incorporate it into future hospital planning.
  • It’s not all cynical lobbying though, as the hospital lobby fought hard against efforts to kill the ACA, helped support more funds for mental health care and much more.
  • Read the whole story at the following link.

https://www.healthcaredive.com/news/hospital-lobbying-in-2018-by-the-numbers/548262/

Democrats prepare to introduce “Medicare 50” – Washington Examiner

Whether or not this bill will get anywhere other than through the House, remains to be seen, but it will certainly help them heading into the elections next year. I’m sure it will be very popular with the base, while it angers and brings out the big guns of the AMA. Most physicians are not happy with Medicare reimbursement rates. I have been told by a number of providers that they cannot run an independent business on Medicare reimbursals. That’s one of the reasons the hospital has taken over almost all of our local providers. Not clear yet whether this will help those who can’t afford Obamacare, but are above Medicaid eligibility. But look for a program like this to reduce independent providers and force you into larger and larger hospital run facilities, for better or worse.

Read more here: https://www.washingtonexaminer.com/daily-on-healthcare-democrats-prepare-to-introduce-medicare-50

Democrats are set a noon today to unveil a bill that would allow people to buy into Medicare beginning at age 50, even as the majority of the caucus in the House is onboard with rolling everyone into a government-run system. The bill signals that Democratic leaders are prepared to move forward more gradually on extending the government’s role in healthcare. Under the proposal, people would have the option of buying into Medicare instead of having private health insurance. The Medicare Buy In and Health Care Stabilization Act is being introduced by Sen. Debbie Stabenow, D-Mich., Sen. Tammy Baldwin, D-Wis., Rep. Brian Higgins, D-N.Y., Rep. Joe Courtney, D-Conn. View livestream.


Hospital lobby ramps up ‘Medicare for all’ opposition – Healthcare Dive

We had an inkling that the Medicare for All would find heavy opposition quickly. Was debating a supporter on FB just yesterday saying essentially exactly what this article states. A day later, here we are. Want to state clearly here and now that I support getting the U.S. to a universal healthcare place, but I’m very dubious that Medicare for All is a way that will garner enough support. Why? Because the government has done a terrible job of reimbursing front line providers for their time. Many front line providers are not accepting Medicare patients, or new Medicare patients. Hospitals are subsidizing this cost by higher costs elsewhere. This has to be fixed before this idea will gain ground with providers. While it would be great to tear down the whole system and start fresh, that just is political rhetoric to get the base motivated to vote next year, a non starter in this current climate with Republicans controlling two branches of government. And we haven’t yet seen the money from the special interest groups show up in any large scale way.

The article points out that the AMA, PHrMa, American Health Insurance Plans, and the Federation of American Hospitals have come out against it, asking Congress to “fix what’s broken and improve what’s working, don’t start over”. My guess is that for a start, raising reimbursals for Primary Care would be a good place for Congress to begin, to slow the bleeding of funds from hospitals etc. In fact, the article points this out, from a document from the coalition of these providers, showing that “66% of hospitals received Medicare payments less than the cost of care, for an industry wide shortfall of $53.9 Billion dollars. Locally, I know that Jefferson Healthcare would be considered part of that amount. While the nurses union claims that hospital coffers have ‘swelled’ there is no truth in that here locally. Of course, we are a public hospital, but the ACA has helped our bottom line, allowing for JCH to better support primary care by hiring more providers, for example. While proponents are arguing that the reduction in administrative costs would help, there is no real understanding of whether these costs would be offset here locally.

Read the whole article for a better understanding. It brings the Koch Brothers into the picture for their efforts, along with the Nurses Union, etc.

Hospital lobbies are mounting a coordinated effort to dissuade legislators from supporting Medicare for all, a policy health systems argue would cut into profits and ultimately force facilities to shutter.

https://www.healthcaredive.com/news/hospital-lobby-ramps-up-medicare-for-all-opposition/547678/