Archive for the ‘Health Care Policy’ Category

Breaking News: Individuals May Opt-Out of Insurance Program in Health Care Reform

August 24, 2012 1 comment

Breaking News regarding health care reform.

Individuals are not  required to participate in health insurance programs under health care reform. Section 1555 of P.L. 111-148 (Patient Protection and Affordable Care Act) allows for individuals not to be required to participate in any health insurance program. They will not be penalized if they do not participate. Language from the provision is listed below and can also be read HERE


Section 1555 – Freedom Not To Participate in Health Insurance Programs
No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.

Stay tuned for more on this Breaking News story regarding health care reform. For more information on health care reform, please click  HERE


The Truth About Ron Wyden’s Medicare Plan

August 21, 2012 1 comment

What You Should Know About Ron Wyden‘s Medicare Plan

On August 11th, GOP Presidential Candidate Governor Mitt Romney introduced Representative Paul Ryan as his choice for Vice President. Once this was announced, media outlets “freaked out” over the Medicare plan Senator Ron Wyden (D-OR) wrote with Representative Paul Ryan (R-WI, Chairman of U.S. House Budget Committee). The plan is a bipartisan plan officially called “The Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future” and it is a roadmap for how to strengthen and fix or failing Medicare system. Senator Wyden and Representative Paul focus their plan on choice, affordability, and protecting seniors. You can read more about the plan by clicking HERE


Starting in 2022, a new Medicare program will begin offering seniors a choice among private plans and the traditional Medicare plan – much like plans Members of Congress have. Any senior at or above age 55 today will see no changes in their Medicare. (Page 2)


Coverage will be guaranteed through a new “premium support” system that encourages plans to provide high-quality care more efficiently. Private plans will compete directly with traditional Medicare based on their ability to provide quality coverage at an affordable lower cost. Low-income seniors shopping for coverage would be offered the same range of high-quality options offered to all other seniors. They would be guaranteed the ability to choose a traditional fee-for- service Medicare plan, or they could choose a private plan on the Medicare Exchange with a fully- funded account from which to pay premiums, co-pays and other out-of-pocket costs. (Page 2,9)

Protecting Seniors
To ensure ample protection from scam-artists and bad actors, the program will not only require insurance coverage protections such as guaranteed issue and risk adjustment, but it will also require the Centers for Medicare and Medicaid Services (CMS) to actively review marketing practices and benefit adequacy. Plans that fail to comply with established standards of participation would have their contracts terminated. Building upon Medicare’s current marketing rules, all plans would also be required to have their marketing materials approved annually by CMS. (Page 2, 10)

Above are the facts of Senator Ron Wyden’s Medicare Plan. Keep in mind that is only a proposal and it can not become reality without passing Congress first. You can read more about the plan by clicking HERE

U.S. House Votes to Repeal Healthcare Reform 244-185

July 11, 2012 1 comment

The U.S. House today voted to repeal the Affordable Care Act 244-185.  Five Democrats voted FOR repeal and they are:
Dan Boren (D-OK 02), Larry Kissell (D-NC 08), Jim Matheson (D-UT 02), Mike McIntyre (D-NC 07), Mike Ross (D-AR 04). You can see how each member of the House voted by going here: The bill the House approved (H.R. 6079) can be read here:

Keywords:  health care insurance, health care, health plan, health policy, U.S. Congress, health care reform

Student Loan Forgiveness for Primary Care Physicians Announced

July 2, 2012 Leave a comment

Dr. Tom Price, MD of Georgia has a bill in the U.S. House geared directly at replacing the infamous health care reform bill officially known as the affordable care act. This bill is called HR 3000 “Empowering Patients First Act”. Below are key provisions of the bill. You can read the bill for yourself here:

Key Provisions
Loan forgiveness for Primary Care Providers

Federally Supported Student Loans for Medical Students

Refundable Tax Credit for low-income families

Deduction for health care costs

Credit for small employers adopting auto-enrollment

Improve beneficiary choice in S-CHIP

Financial Incentives for Treatment Compliance

Freedom of Choice, Right of Contract with Providers

Reduction in Medicaid DSH


Keywords: physician, health care reform, primary care physician, student loan, health policy

States dropping For-Profit Health Insurance Companies from Medicaid Programs

June 11, 2012 2 comments

As of today, The great state of Ohio has taken the right step and has kicked out private for -profit health insurance company Aetna from insuring people in Ohio’s Medicaid program. This comes only 2 months after Aetna received the green light to manage 1.7 million recipients. The contracts were supposed to go into effect January 1 of next year. It is unknown as to why Aetna was dropped (source 1).

Ohio is not the only state to have recently stopped awarding state Medicaid contracts to Aetna and other large 4-profit companies. In December 0f 2011, the great state of Connecticut made a great decision and kicked out UnitedHealthcare and Aetna from managing its Medicaid recipients as well. State officials are reported as saying to USA Today that the companies were dropped for “not fulfilling their promise to lower costs and provide better care.” (source 2). This whole thing of “not fulfilling their promise to lower costs and provide better care” is unfortunately becoming an epidemic in this country to when it comes to insurers. This goes ditto for the 4-profit ones. These especially are getting caught more and more by the federal government for defrauding Medicare and Medicaid on purpose in order to get profits for their shareholders. Sadly, this situation is turning into the “plague”.

According to research that I have done, I have found out that Aetna and UnitedHealthcare collectively have paid out over $596 million in settlements over the past 5 years for having been caught defrauding Medicare and Medicaid (actual amount defrauded before settlement to be posted on blog soon). Total amount by insurers over same time period is nearly $3,000,000,000 (source 3). This situation is clearly getting worse. State governments have finally “smelled the Starbucks” and have realized that the best prescription for curing this problem is to simply kick out the 4-profit companies from state Medicaid programs. Hopefully more states will follow suit and drop for-profit health insurance companies from their Medicaid programs.



2. ttp://


Conservative Justice Scalia: Reform without Mandate would Bankrupt Health Insurance Companies!

June 7, 2012 Leave a comment

U.S. Supreme Court Justice Antonin Scalia has come out recently saying that if the individual mandate is ruled unconstitutional, it would bankrupt health insurance companies. According to Court transcripts of the hearing on severability of the Affordable Care Act, Justice Scalia argued: “There is going to be a deficit that used to be made up by the mandatory coverage provision. All that money, has to come from somewhere…So you’re just put to the choice of, I guess bankrupting insurance companies.” (Source 1).  Bankrupting the for-profit companies of Humana, Aetna, WellPoint, Cigna, and United Healthcare might not be a bad thing as they are again under indictment for defrauding the federal government on purpose in order to get profit for their shareholders. These companies have been caught in the past doing the same thing and they have managed to defraud the government by $5 billion over the past 5 years (Source 2).

The Supreme Court is due out with their final decision very soon. They are predicted to rule against the mandate and uphold the rest of the law.




U.S. Congress Working to Replace Physician Sustainable Growth Rate

May 17, 2012 Leave a comment

The U.S. Congress is currently working on legislation to replace the physician sustainable growth rate. Since 2002, this has become a highly debated topic in Congress that has resulted in 14 CRs (short-term measure) being passed that were aimed to delay a 30% cut to physician Medicare payments. H.R. 5707 introduced and aimed at replacing the SGR.

To get things started, The U.S. Senate Finance Committee held a roundtable discussion on the matter last week. You can view the discussion at In a statement, Chairman Max Baucus (D-MT) said : “Medicare’s sustainable growth rate (SGR) formula has not worked as planned. The annual cuts the formula calls for have snowballed the problem.” Ranking member Orrin Hatch (R-UT) said in a statement: “We must provide a stable foundation for paying physicians today, not five or 10 years from now.”

On May 9, a billed aimed at replacing the SGR was introduced. H.R. 5707: Medicare Physician Payment Innovation Act of 2012 was officially introduced in the House by members Allyson Schwartz (D-PA, former hospital CEO) and Dr. Joe Heck ,DO (R-NV, physician). The bill can be read here: In order for the bill to be successful, it will need to have FULL support by all of the physicians in Congress. The physicians that need to be encouraged to pass it are: John Barrasso (R-WY), Tom Coburn (R-OK), Rand Paul (R-KY), Dan Benishek (R-MI), John Boustany (R-LA), Paul Broun (R-GA), Michael Burgess (R-TX), Larry Buschon (R-IN), Bill Cassidy (R-LA), Scott DesJarlais (R-TN), John Fleming (R-LA), Phil Gingrey (R-GA), Paul Gosar (R-AZ), Andy Harris (R-MD), Nan Hayworth (R-NY), Ron Paul (R-TX), Tom Price (R-GA), Phil Roe (R-TN), Donna Christensen (D-VI), and Jim McDermott (D-WA).

Stay tuned to this blog for further updates on this story.



%d bloggers like this: