Evil Obamacare

[O Really]

Below are the most significant "Obamacare" requirements that take effect in 2013

If anyone would like to point out specific portions of this that will terrorize the population and send children crying into the streets, feel free. Comments about creeping socialism and people in black helicopters using no-cost vaccinations to kill grandma and turn kids into zombies will be ridiculed and/or ignored, as usual:

Cap on Employee Contributions to Flexible Spending Accounts. Effective for plan years beginning in 2013, employees' contributions to Flexible Spending Accounts (FSAs) will be limited to $2,500 per tax year with annual inflation increases. There is no limit on employer contributions.

Medicare Tax Increase. The Medicare tax will increase by 0.9% (from 1.45% to 2.35%) on wages above $200,000 ($250,000 if filing a joint tax return), effective January 1, 2013.

Coverage of Women's Preventive Care. Health insurers and group health plans will be required to cover women's preventive care services at 100%.

Notification Requirement: Beginning March 1, 2013, employers must notify all employees of:
- Information regarding the state Health Insurance Exchange; and
- Information on tax credits and reductions in cost-sharing if the employer share of the total cost of benefits under the employer's plan is less than 60%.

Health Care Exchanges: Last week, Health and Human Services Secretary Kathleen Sebelius announced that states now have until December 14, 2012 to submit a plan to federal regulators on how their state's health exchange would operate. States generally have until February 15, 2013 to decide if they will instead set up their health exchange in partnership with the federal government.

New Guidance is Imminent
The election is expected to fast-track new health care guidance and regulations that likely have been postponed until after the election. Expected guidance includes a transitional federal reinsurance program that partially reimburses commercial insurers underwriting coverage for high health cost individuals starting in 2014, which could cost as much as $90 per health care plan participant; the imposition of a $2000 per full-time employee penalty on employers that do not offer qualified coverage to employees; and subsidies to uninsured individuals earning less than 400% of the federal poverty level.

[Apache]

How are the uninsured being contacted about obtaining coverage?

[Dryer Vent]

We are looking forward to the closing of the Part D doughnut hole. I think that kicks in in 2014. A lot of seniors are paying full boat for their drugs in November and December OR not taking them during those months when they have hit the year's limit.

[O Really]

Below are the most significant "Obamacare" requirements that take effect in 2013

If anyone would like to point out specific portions of this that will terrorize the population and send children crying into the streets, feel free...

...Medicare Tax Increase. The Medicare tax will increase by 0.9% (from 1.45% to 2.35%) on wages above $200,000 ($250,000 if filing a joint tax return), effective January 1, 2013...

Should be more!!!

The current Medicare tax (for individuals) is 1.45%, the same as was established in......1986! So let's see, what else hasn't increased since 1986? There's computers and other electronics, maybe, but certainly not health care services.

[O Really]

How are the uninsured being contacted about obtaining coverage?

Good question - I'll see if I can find out. Probably hasn't been determined yet, though.

[Supsalemgr]

We are looking forward to the closing of the Part D doughnut hole. I think that kicks in in 2014. A lot of seniors are paying full boat for their drugs in November and December OR not taking them during those months when they have hit the year's limit.

Does anyone have any idea how much more in premiums will it cost to close the donut hole?

[O Really]

Does anyone have any idea how much more in premiums will it cost to close the donut hole?

"premiums"? It's paid by the Medicare tax. Why am I schooling you on insurance terminology?

The CBO has estimated that Obamacare will cost less than repealing it. So, by one measure, zero.

The donut hole is in the Part D prescription plan. It requires an affirmative enrollment, and does have a participant premium, currently averaging around $30-something.

As to Super-S's question, it is what it is. Talk to big Pharma about costs.,

[Supsalemgr]

I appreciate the apology Vrede. I agree with you about Bush introducing Part D. Because of it I lost my retirement prescription drug benefit. Had it not been available, the Obama administration would not have removed the ability of corporations to deduct retiree drug cost from their taxes because Part D was available. My former employer dropped this coverage and now I have to participate in Part D. This move also drives up the Part D deficit because of more participants in an underfunded program.

[Dryer Vent]

Does anyone have any idea how much more in premiums will it cost to close the donut hole?

"premiums"? It's paid by the Medicare tax. Why am I schooling you on insurance terminology?

The CBO has estimated that Obamacare will cost less than repealing it. So, by one measure, zero.

The donut hole is in the Part D prescription plan. It requires an affirmative enrollment, and does have a participant premium, currently averaging around $30-something.

As to Super-S's question, it is what it is. Talk to big Pharma about costs.,

It depends on what you buy in the way of health insurance. My Medicare PPO with prescriptions is $28/month. My husband's is $91/month because he has more issues. I had a $50,000 bill for an operation with 5 day hospital stay and my total out of pocket was $60 including all doctors and hospital. A CT scan last week was totally covered. It depends on your program. My prescription coverage is $8 for a generic and sliding scale for non generics. The doughnut hole is around $2800. However, my total prescriptions for 2012 has been $46. My husband hit the $2800 in October.

So, all in all we pay $200 for both Medicare Part B's and $28 plus $91 in supplemental and we are well taken care of. It looks like the insurance companies are going to be competitive once the mandate kicks in. The more people paying for insurance, the lower the premium.

[Supsalemgr]

Sounds good in theory, but many will not engage because all the new mandates will make coverage too expensive and they will pay the fine.

[O Really]

Sounds good in theory, but many will not engage because all the new mandates will make coverage too expensive and they will pay the fine.

Undoubtedly true for some, but why let the outliers become an impediment to a worthwhile goal. No law has 100% compliance. Point being that sure, 100% healthcare coverage is a goal; the current system hasn't provided close to that; Obamacare will get closer. But if at least everybody who wants and needs coverage can get it at an affordable rate, then I'm not too worried about the relatively few who foolishly opt out.

[O Really]

The vast majority of under-65 people get, and will continue to get employment-based coverage as long as the employer can continue to take a tax deduction for the insurance. Nobody has proposed ending that, and aren't likely to unless or until we get a single-payer system. But when medical expenses are the primary cause of personal bankruptcy in the US, it would seem apparent to even the most dense that something needs to be done differently. Back when "Maddawg" was posting, he argued vociferously and continuously against mandatory medical insurance - or medical insurance in general, actually - from the standpoint of one who keeps himself healthy and if he is ill, goes to the village witch doctor or whatever. But the question he never answered is how does he pay for cancer the witch doctor can't cure and that isn't necessarily related to his healthy living habits? How does he pay for multiple surgeries to repair his back broken when he falls off his high horse? The real value of insurance isn't to pay a few hundred dollars for minor problems - it's to make sure you'll be able to get the treatment you need for serious stuff.

What's the average cost of a course of radiation, Doc? How about chemotherapy? Isn't each infusion in the tens of thousands of dollars?

Republicans scoffed at the idea that people die for lack of insurance, but they do. They may have to take you in the ER, but once you're stabilized, you're on your own.

There are many other alternatives other than Obamacare - a lot of them are better IMNVHO. But that was the one that could get past the Republicans. And it's way better than nothing. Hopefully now that the election is over, we don't have to deal with chicken-little-shit about death panels, bureaucrats choosing your doctors, plumbers doing dental work, yada.

[Wneglia]

The vast majority of under-65 people get, and will continue to get employment-based coverage as long as the employer can continue to take a tax deduction for the insurance. Nobody has proposed ending that, and aren't likely to unless or until we get a single-payer system. But when medical expenses are the primary cause of personal bankruptcy in the US, it would seem apparent to even the most dense that something needs to be done differently. Back when "Maddawg" was posting, he argued vociferously and continuously against mandatory medical insurance - or medical insurance in general, actually - from the standpoint of one who keeps himself healthy and if he is ill, goes to the village witch doctor or whatever. But the question he never answered is how does he pay for cancer the witch doctor can't cure and that isn't necessarily related to his healthy living habits? How does he pay for multiple surgeries to repair his back broken when he falls off his high horse? The real value of insurance isn't to pay a few hundred dollars for minor problems - it's to make sure you'll be able to get the treatment you need for serious stuff.

What's the average cost of a course of radiation, Doc? How about chemotherapy? Isn't each infusion in the tens of thousands of dollars?

Republicans scoffed at the idea that people die for lack of insurance, but they do. They may have to take you in the ER, but once you're stabilized, you're on your own.

There are many other alternatives other than Obamacare - a lot of them are better IMNVHO. But that was the one that could get past the Republicans. And it's way better than nothing. Hopefully now that the election is over, we don't have to deal with chicken-little-shit about death panels, bureaucrats choosing your doctors, plumbers doing dental work, yada.

Your question about the cost of radiation and chemotherapy is difficult to answer. Radiation is charged by the number and complexity of treatments, and can range from 3 treatments to ease the pain of cancer in a bone, to 45 treatments for a prostate cancer. Here is a list of radiation codes and Medicare Reimbursements

Chemotherapy likewise depends upon the drugs used. A full course of chemo for breast cancer in a poor-prognosis Her-2 positive patient can easily run in excess of $100k.

[O Really]

Thanks, Doc - So, if one isn't eligible for Medicare and doesn't have private insurance, are there any other alternatives for paying for the treatment?

And on a related note, one could say that if the prognosis is "poor" maybe ones money could be better spent elsewhere, say by "living like you're dying." But isn't it true that trying to save those with a poor prognosis advances the science overall and can result in long term improvements? I seem to remember that when St. Jude was started, they were treating kids with little or no chance, so their innovative protocol was tested.

[Wneglia]

Thanks, Doc - So, if one isn't eligible for Medicare and doesn't have private insurance, are there any other alternatives for paying for the treatment?

And on a related note, one could say that if the prognosis is "poor" maybe ones money could be better spent elsewhere, say by "living like you're dying." But isn't it true that trying to save those with a poor prognosis advances the science overall and can result in long term improvements? I seem to remember that when St. Jude was started, they were treating kids with little or no chance, so their innovative protocol was tested.

As I have said many times before, most radiation oncologists will treat everybody regardless of their ability to pay. For chemotherapy, most of the pharmaceutical companies have indigent programs that will provide the chemo- we provide the remainder (space, nurses, our services, etc.) I should have clarified the "poor prognosis" statement- I meant historically poor, before genetic markers and targeted drugs like Herceptin were available. With state of art chemo, the former "poor prognosis" patients are now survivors.

My first clinical rotation in medical school was inpatient pediatrics, most of which were oncology, with little or no hope for survival. I was so depressed after that rotation, I wondered whether I had made the right choice going into medicine. Now, the most common pediatric malignancies (leukemias and lymphomas) are routinely curable. The survival rate for acute lymphoblastic leukemia 50 years ago was 4%. Today it is 94%.

Clinical trials through either cooperative NCI sponsored grants, or through pharmaceutical companies have greatly changed the way oncology is practiced. We have an active research department in our practice with over 20 clinical trials available through the Sarah Cannon Reasearch Institute Unfortunately, running these trials is costly for our practice because of the research nurses salaries, record keeping, forms to be filled out, etc.

[O Really]

As I have said many times before, most radiation oncologists will treat everybody regardless of their ability to pay. For chemotherapy, most of the pharmaceutical companies have indigent programs that will provide the chemo- we provide the remainder (space, nurses, our services, etc.)

That's good, but obviously nothing is truly "free" so is it fair to say that those treatment costs are reflected in the charges made to those who can pay? NTTAWWT, but isn't that exactly what a lot of the uninformed Obamacare-bashers (not you) screech about the loudest? "Why do I have to pay for someone else's medical care?"

[Wneglia]

As I have said many times before, most radiation oncologists will treat everybody regardless of their ability to pay. For chemotherapy, most of the pharmaceutical companies have indigent programs that will provide the chemo- we provide the remainder (space, nurses, our services, etc.)

That's good, but obviously nothing is truly "free" so is it fair to say that those treatment costs are reflected in the charges made to those who can pay? NTTAWWT, but isn't that exactly what a lot of the uninformed Obamacare-bashers (not you) screech about the loudest? "Why do I have to pay for someone else's medical care?"

Actually, it doesn't matter whether you charge $500 or $5000 for any given procedure. The reality is that insurance companies will only pay a certain amount of your charge, so the concept of passing along charges to those who can pay is a myth. The insurance companies are like the Mafia-they make a deal you can't refuse; They also ratchet down reimbursement every time the government reduces Medicare/Medicaid. BTW if there is not a "doctor fix" passed by congress by the end of the year, there will be an automatic 27% cut in addition to a 9% cut in radiation center reimbursement. Even the few patients we have in our practice who have no insurance, but have the ability to pay, get significant discounts so they basically pay the equivalent of Medicare allowable amounts. In light of these cuts, we may need to re-evaluate this.

[Colonel Taylor]

Good day Doc.
I used to go to a Cardiologist who one day just decided he would take no insurance. My problem was my ins. co. would not reimburse patients and if they did it took forever and many many calls and letters. If he knew you had no ins. he would charge what he would have received from medicare I think it was(Cash). I have a relative now who goes to an eye Dr who did the same thing and she has been waiting for over 6 months to get reimbursed from her ins. co. He would fill out the paper work but that's where it ended and payment was due before you seen him. He was much happier afterward and was down to one secretary and one nurse. He used to have one full time person just doing billing I remember because she was a nasty unhappy person.
Could your business ever take this path in the future?

As I have said many times before, most radiation oncologists will treat everybody regardless of their ability to pay. For chemotherapy, most of the pharmaceutical companies have indigent programs that will provide the chemo- we provide the remainder (space, nurses, our services, etc.)

That's good, but obviously nothing is truly "free" so is it fair to say that those treatment costs are reflected in the charges made to those who can pay? NTTAWWT, but isn't that exactly what a lot of the uninformed Obamacare-bashers (not you) screech about the loudest? "Why do I have to pay for someone else's medical care?"

Actually, it doesn't matter whether you charge $500 or $5000 for any given procedure. The reality is that insurance companies will only pay a certain amount of your charge, so the concept of passing along charges to those who can pay is a myth. The insurance companies are like the Mafia-they make a deal you can't refuse; They also ratchet down reimbursement every time the government reduces Medicare/Medicaid. BTW if there is not a "doctor fix" passed by congress by the end of the year, there will be an automatic 27% cut in addition to a 9% cut in radiation center reimbursement. Even the few patients we have in our practice who have no insurance, but have the ability to pay, get significant discounts so they basically pay the equivalent of Medicare allowable amounts. In light of these cuts, we may need to re-evaluate this.

[Wneglia]

Good day Doc.
I used to go to a Cardiologist who one day just decided he would take no insurance. My problem was my ins. co. would not reimburse patients and if they did it took forever and many many calls and letters. If he knew you had no ins. he would charge what he would have received from medicare I think it was(Cash). I have a relative now who goes to an eye Dr who did the same thing and she has been waiting for over 6 months to get reimbursed from her ins. co. He would fill out the paper work but that's where it ended and payment was due before you seen him. He was much happier afterward and was down to one secretary and one nurse. He used to have one full time person just doing billing I remember because she was a nasty unhappy person.
Could your business ever take this path in the future?

It would be difficult with a practice as large and expensive as ours. No one can afford to pay for chemo up front, then wait to be reimbursed by the insurance companies.

[Supsalemgr]

I went to my internist this morning and he told me he was retiring at the end of the year. He shared the hassle and red tape is bad enough now. Then with the cuts in Medicare payments to doctors and what he would to deal with Obamacare made it almost impossible to continue his practice. Being in Hendersonville, it is clear he has a large senior patient load. He also said the days are numbered where we will have internists. A sad state of affairs and we have not begun to see the ultimate effects of this program.