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The Republican Alternative to ObamaCare explained!

2016-09-17 12:26:45 edwardbriggs
Text: HEALTH CARE REFORM from wooden letters on wooden background

Text: HEALTH CARE REFORM OUR NATIONAL DYSFUNCTION

As the 2016 election looms many irrelevant issues are monopolizing the news media and blogosphere.  A direct result of this is important issues that truly impact our nation are rarely discussed.  And when issues are discussed they are frequently in generalizations and rarely in specifics or with any details. From immigration to international affairs both Presidential candidates are providing broad sweeping solutions without precise details.

One vital issue that will effect every American that will be decided in the coming election is the fate of the Affordable Care Act.  It is clear that if Hillary Clinton is elected the Affordable Care Act (ACA) will likely remain. She has proposed several changes to the law including creating the ability of individuals to buy Medicare before they turn 65.  (This is commonly referred to as the “Public Option”.)

If Donald Trump wins the White House there is a strong likelihood that the ACA will be repealed.  The resulting legislative vacuum would require the passage of legislation to govern healthcare delivery.

Since 2010 the Republican Majorities in the US House and Senate have attempted to repeal the Affordable Care Act on multiple occasions with the intention to replace it with an alternative healthcare law.  In June 2016 Senator Richard Burr (R-NC), Senator Orrin Hatch (R-Utah) and Representative Fred Upton (R-Mich) released a comprehensive Republican proposal to replace the ACA.  Their proposal, called the Patient Choice, Affordability, Responsibility and Empowerment Act (CARE), if passed and signed by the President, could replace the ACA.

Listed below are a summary of the changes that would be brought about with the implementation of the CARE Act.

AFFORDABLE CARE ACT CARE ACT
INIDIVIDUAL MARKET REFORMS
-Requires individuals, with certain exceptions, have health insurance

-Requires health insurers to offer coverage regardless of pre-existing conditions.  Annual open enrollment period. Rates are limited to considering age, place of residence and smoking status

-Older adults can be charged no more than 3 times as much as younger adults (3 to 1 banding)

-Eliminates annual and lifetime limits within health insurance policies.

-Mandates preventative care is covered

-Mandates that health insurance covers the diagnosis and treatment of certain conditions and illnesses

-Allows families to keep children on insurance until they are 26 years of age.

-Limits out of pocket expenses for health insurance policy holders

-Does not require individuals have health insurance

-Requires health insurers to offer to coverage to buyers at standard rates based on age and place of residence so long as they maintain continuous coverage for at least 18 months.  If individuals lose coverage for any period they are no longer guaranteed insurance accessibility.

-One-time enrollment period for all without health insurance.

-Older adults can be charged no more than 5 times as much as younger adults (5 to 1 banding)

-After the onetime open enrollment period insurers may refuse to offer health insurance to individuals with pre-existing conditions or adjust rates based on prior health conditions if they have interrupted health insurance coverage

-Eliminates lifetime health insurance limits but allows annual limits

-Eliminates the requirement that preventative care is covered.

-Eliminates mandate of what insurance covers

-Eliminates out of pocket limits.

INSURANCE ASSISTANCE
-ACA offers tax credits paid directly to health insurers to individuals between 100 and 400% of the federal poverty level who do not have Medicaid, VA Care or employer based insurance.

-ACA offers tax credits to small businesses who offer health insurance to employees.

-To receive tax credits individuals are required to pay a percentage of their insurance premium based on income and insurance plan chosen (varies between 2% and 9.5%).

-The amount individuals receive is based on the cost of the insurance premium, income and family status.

-Individuals between 100% and 250% of federal poverty level also qualify for assistance to pay copays and share of cost.

-CARE Act offers tax credits to small businesses and individuals who do not work for a large business or who do not have other access to health insurance.

-Fixed Tax credit varies with age, income and family status.   See below*:

Age          Individual         Family

18-34              $1970             $4290

35-49             $3190             $8330

50-64             $4690             $11,110

-Those at 200% of FPL would qualify for 100% of tax credit.

-Tax credit would adjust between 200 and 300% of FPL (0% tax credit at 300% of FPL)

-Medicaid recipients could opt to receive tax credit in lieu of Medicaid

-Tax credits increase annually fixed to Consumer Price Index

MEDICAID
• Allows states to expand Medicaid to individuals making 138% of less of FPL.

• Share of cost between federal government and the states

• Federal government sets conditions for how Medicaid is provided and what services must be covered under Medicaid

• Converts Medicaid to a capped allotment to the state based on pre-2014 spending in each state adjusted for inflation and demographic change

• Eliminates funding for Medicaid expansion to individuals making between 100-138% of FPL but allows these individuals to access tax credits

• Eliminates federal mandates for services and coverage of Medicaid and allows states more flexibility in what services would be covered under Medicaid.

HIGH RISK POOLS
• Not necessary as insurers must accept all individuals desiring health insurance •  Would create funds for state run high risk insurance pools.  These pools would move the most expensive individuals out of the individual market place thereby reducing premium for the remaining population.  **
MALPRACTICE INSURANCE
• Provides for funds for states to try “Demonstration Projects” to experiment with malpractice reform to see what works. •  Does not provide specific plan but refers to implementing caps on non-economic damages (pain and suffering), limiting attorney’s fees, dispute resolution committees and payment
TAX EXCLUSION FOR EMPLOYER INSURANCE
•  Imposes a 40% excise tax on employer provided health insurance plans in excess of $10,200 for the individual or $27,500 for a family.  (Not expected to take effect until 2020) •  Imposes a 40% excise tax on employer provided health insurance plans in excess of $12,000 for the individual or $30,000 for a family.

ASPECTS OF THE AFFORDABLE CARE ACT NOT INCLUDED IN THE CARE ACT

•Penalties on hospitals for excessive readmission rates and hospital insurance tax on individuals with high income.  (Congressional budget office estimates these changes will reduce deficit by $802 million between 2016 and 2025.)

•Funding for nursing and medical education.

•Funding for community health clinics and health centers.

REFERENCES

*Average National Annual Health Insurance Premiums for lowest level Bronze Plan 2014 (Source: https://spe.hhs.gov/report/health-insurance-marketplace-premiums-2014-september-2013) and E-health Insurance.

Note: Health insurance premiums are very variable based on location.  These are national averages only for comparison

25-34 year old Single adult: $2652 ($221/month) Family: $5112

35-44 year old Single adult:    $3312 ($276/month) Family: $6834

45-54 year old Single adult: $4308 Family: $9804

55-64 year old Single adult: $6228 Family  $12,688

**Analysis has found that high risk insurance pools are prohibitively expensive to administer, are prohibitively expensive for consumers to purchase and provide less than optimal coverage.

 

So as you consider your vote this coming November consider the real and significant impact that vote will have on the health of you and your family!

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Facts v. slander....and the winner is?

2014-03-11 18:03:35 edwardbriggs

That’s the best you got?

Really?

I thought better of organized medicine in Florida, but clearly they are not beneath slander and maligning of an individuals character.  It is unfortunate that they have allowed the debate to be reduced to such a pubescent level, and telling because they have no factual argument that they can make!

(See the hatchet job at:http://www.saintpetersblog.com/why-is-rep-cary-pigman-being-such-a-jerk-to-florida-doctors. )

For those of you who are unaware the Florida House of Representatives have advanced a piece of legislation that would remove unnecessary and costly rules that limits the scope of practice for advanced practice nurses and removes the economic shackling of nurse practitioners to physicians.  This legislation would increase the number of professionals who are able to provide primary care services, particularly to underserved communities.  It would allow nurse practitioners to practice to the full scope of their education and training.

To support this effort there is evidence from 49 other states and hundreds of independent studies that demonstrate that nurse practitioners can safely and effectively provide these services.  Some studies have even demonstrated that nurse practitioners have similar, or better,  healthcare outcomes to their physician colleagues.  (Published in the JOURAL OF THE AMERICAN MEDICAL ASSOCIATION!)

This legislation is strongly opposed by the Florida Medical Association and other physicians groups.  They are exceptionally vexed because the effort to advance the legislation is being headed up by Dr. Cary Pigman, a Florida emergency medical physician.  Dr. Pigman has consistently referred to data, evidence and facts to support his position.  He has consistently argued that the removal of the unnecessary regulations would improve access to care and save money!   He has steadfastly asserted that his rural constituents would benefit directly from the removal of these barriers.

And the facts support his position!

The assorted medical groups have tried to fight the legislation through anecdotal stories, push polling, fear mongering and outright lies!  (One physician testified he had more than 20,000 hours of clinical experience during his three year residency!  This would mean he worked 128 hours a week, 52 weeks  year?  At the same time he claimed nurse practitioners have only a few hundred hours of clinical experience.  I personally had over 2000 hours of clinical advanced practice experience after nearly 20 years experience as a registered nurse!)

And when these tactics have seemed to have failed they resort to maligning the character of Dr. Pigman.  They insinuate his motivations are uninformed, uneducated or self serving.   Through proxies like Peter Schorsch they further impugn Dr. Pigman’s character.

I have personally had the privilege of meeting and speaking with Dr. Pigman.  I can sincerely say he was intelligent, articulate and passionate about meeting the healthcare needs of Florida.  He consistently spoke of ensuring that all Floridians, particularly those in rural communities where he served, had access to primary care services.  He also demonstrated to me his remarkable grasp of data and statistics, particularly those associated with this issue.

The personal attacks against Dr. Pigman clearly goes beyond the pale and is the base at every level!

The question everyone should ask is why isn’t the associated medical groups fighting this legislation citing data and literature. Why the necessity to turn to such scurrilous tactics and personal attacks.  Why the need to utilize manipulative polling and proxies?

And the answer is quite simple…they don’t have the data to support their arguments.   The overwhelming evidence supports Dr. Pigman and the efforts of the Florida House!

So they are forced to utilizing such tactics in the hope to sway public opinion.

I regret Dr. Pigman has to suffer such abuse for standing behind his convictions and supporting advanced practice nurses.  I hope the citizens of Florida, particularly those in Dr. Pigman’s district, recognize the actions of organized medicine for what they are and applaud the conviction and bravery of Dr. Pigman!

 

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2014 Florida Nurses Association Campaign For Action

2014-02-14 23:04:50 edwardbriggs

DOWNLOAD FNA FOR ACTION PACKET


The 2014 Florida Legislative Session is poised to be a potentially significant year for the health of Florida and the profession of nursing.  Florida’s legislators will decide if 1.4 million uninsured Florida Families will gain access to healthcare, whether nurse practitioners will be allow to practice to the full scope of their education and training and several other key health related issues.

To help influence this discussion the Florida Nurses Association has initiated the 2014 Campaign For Action.  This grassroots campaign is designed to help assist nurses to education the public and encourage nurses and the public to influence legislators on key healthcare related issues.

 

Legislative Agenda Presentation: DOWNLOAD FNA FOR ACTION PACKET

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2014 Florida Nurses Association Pinellas County Legislative Forum

2014-01-01 11:43:48 edwardbriggs

REGISTRATION:

http://members.floridanurse.org/4DCGI/events/Register.html?Action=Register&ConfID_W=108&MenuKey=123

Each year the Pinellas County Florida Nurses Association Members holds its annual legislative event to meet with legislators and discuss key nursing issues.legislative forum poster

Please join us for our 31st  annual Legislative Forum.  The Pinellas County Chapter of the Florida Nurses Association will be meeting with Florida State Legislators to discuss issues and legislation that is being considered that will directly impact on nursing and patient care.

This is your opportunity to meet with your legislators and have your voice heard by them.  This event is open to all nurses, nursing students and individuals interested in healthcare delivery and nursing in Florida.

This  year important issues that we will discuss with the legislators include:

Allowing nurses to practice to the full scope of their education and training,

Expanding Medicaid in Florida,

Implementation of the Affordable Care Act in Florida,

Regulation and oversight of nursing education programs,

Nurses using the title “Doctor”, and

Other key issues.

Cost: FNA Member $25.00   Non-Member $30.00   Student $20.00

Online Registration closes on 1/20/14     Registration will be available at door for $30.00

This event includes a buffett dinner, cash bar and dessert.

Space is limited, so reserve your spot today!

DATE: Thursday January 23rd 2014

TIME: 6 PM

LOCATION: Banquet Masters 8100 Park Blvd Pinellas Park FL

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LEGISLATIVE PRIORITIES ARE VERY TELLING....

2013-12-15 19:30:57 edwardbriggs

In the years that I have been involved politically, and in health policy, I have discovered that legislative agendas tell you a great deal about the organization that published the agenda.

When an organization publishes it’s legislative agenda it is telling it’s members, it’s lobbyists and legislators what it’s priorities are for the coming year and what changes it believes are vital.  A legislative agenda acts an action plan, and as an identifier for the character of the organization.

When I first saw the 2014 Legislative agenda for the Florida Nurses Association I knew it wasn’t everything I had hoped for the organization, but it was a pretty big “wish list”.

Then I saw the legislative agenda for the Florida Medical Association for 2014.  A much larger “wish list” for sure, and for me some troubling wishes.

So I ask you to review these two agendas and see what you think.  And most of all remember this is Florida we are talking about, where 25% of the population doesn’t have health insurance, health care outcomes are less than stellar and access to health care is a major challenge.2014 FNA Legislative Platform FMA2014LegislativeAgenda-1

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Best graph ever

2013-11-23 15:08:09 edwardbriggs

This graph is from a great blog, “The Incidental Economist”.

The graphic demonstrates what are the average life expectancies in different countries (the up and down axis) and the amount spent on providing health care (the left to right axis).

Two striking things about this column is that the United States spends more on health care than other industrialized nations and we have some of the lowest life expectancies.  (US life expectancies are equivalent to those in Chile and Poland.  The majority of other industrialized countries have much better expectancies.)

The other thing that I find remarkable is the fact that we are so far out on our own.  NO other nation spends at much as we do and no other industrialized nation has such short life expectancies.

Says a lot about the United States having the “best healthcare in the world”.

For a detailed analysis check out the full post at http://theincidentaleconomist.com/wordpress/life-expectancy-and-health-care-spending/OECD-LE-Spending1

 

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THE CHALLENGE OF POLITICS VERSUS LOW INCOME WORKERS

2013-11-17 11:46:14 edwardbriggs

The recent bungled roll out of the healthcare.gov website has those in opposition to the Affordable Care Act  wagging their fingers in righteous indignation.  This will give further support to those in opposition to expanding Medicaid in Florida.  This coming year the Florida Legislature will again consider the possibility of expanding the Medicaid program to an estimated additional 1.4 million residents.  The overwhelming majority of the expansion would be paid for by the federal government and would extend health insurance to those making 138% of the federal poverty level.  By extending Medicaid in Florida many healthcare economists estimate it will drive healthcare costs down, create jobs and help to sustain our healthcare infrastructure. In human terms the expansion would provide 1.3 million Florida families with the security of healthcare access.

 

Unfortunately our leadership in Tallahassee continues to oppose the expansion.  Those in opposition use primarily two arguments against expanding Medicaid in Florida.  The first, and most divisive, is that it would extend Medicaid to “able bodied adults”.  The implication here is that the state would provide health insurance to underserving masses that chose not to work or accept responsibility for their own healthcare.  This argument misrepresents the truth and works to demonize those who would benefit from Medicaid expansion.  Those newly covered under the Medicaid expansion will predominantly be the working poor.  These are the individuals who bag our groceries, serve our food and bus our tables at restaurants and perform other jobs that pay close to the minimum wage.  These individuals, and their families, go largely without health care simply because they do not earn enough to pay for healthcare but make to much to presently qualify for Medicaid assistance.  These are hard working individuals who struggle to survive economically from day to day because we choose to not pay a truly livable wage.  These are the families that pay the price of our inexpensive foods and services.

 

The second argument made is that we cannot trust the federal government to produce the funds to pay for the expansion.  Those in opposition imply that the federal government will suddenly stop the funding and the state of Florida will be on the hook for tens of billions of dollars.  It strikes me strange that these same legislators have no reluctance to rely on the 500 billion dollars our state receives annually from the Federal government, but these funds tied directly to the Affordable Care Act cannot be trusted.  We continue to expand education, roads and security based on the promise of federal dollars, but providing healthcare to those most in need is somehow different and irresponsible?

 

The arguments and actions in opposition to the Medicaid expansion are neither economically prudent nor socially responsible.  These are political actions intended to obstruct the Affordable Care Act and gain favor from a political base.  These same actions do direct and irreparable harm to Florida’s families who struggle to survive.  As a Nurse Practitioner I have seen the faces of these individuals who work 2 or more jobs to survive and then are forced to come to the emergency room because they have no where else to turn for healthcare.   I have witnessed lives devastated, and lost, because of the lack of healthcare.  Our political leaders have the opportunity to provide our brothers and sisters the small security of healthcare.   As a fair and just society it is unethical to perpetuate a system that takes advantage of the working poor and denies them the security of healthcare access. It is my hope that our political leaders gain the wisdom to move beyond their parochial and partisan interests to take action in the best interest of our state and it’s citizens.

 

FOR MORE INFORMATION

 

Florida Center for Fiscal and Economic Policy

Analysis of impact on small employers

http://www.fcfep.org/attachments/20121113–The%20Other%20Beneficiaries.pdf

 

Florida CHAIN

Who benefits from Medicaid expansion

http://floridachain.org/wp-content/uploads/2013/03/expansion-population-charts-as-of-03.21.13.pdf

 

Florida CHAIN

Medicaid expansion fact sheet

http://floridachain.org/wp-content/uploads/2012/12/Medicaid-Expansion-Florida-Health-Alliance-12.11.12-.pdf

 

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Politics before people!

2013-09-19 22:02:06 edwardbriggs

Updated: Sep 19, 2013 @ 14:01:15

United States Speaker of the House has declared “victory” in passing bills that would defund ObamaCare and dramatically cuts funding to foodstamps.  The result of the Republican victory will be millions of american citizens who will go hungry and be denied access to healthcare.  The bill also continues the current sequestration cuts to federal spending.  The vote in the House was strictly along party lines.

The intention of the house may have been to fiscally responsible, however it appears that the majority of the pain will be born by low and middle income families.

It will be interesting to see how this action impacts the next election.

 

Posted: Sep 19, 2013 @22:02:13

Let us consider the fictional character of Jane Smith.

She is a single mother with two children.  To make ends meet she has two part time jobs that bring in an annual income of $30,000 per year.  Because she only works part time she is unable to get health insurance from her employers and she makes to much money to qualify for medicaid.  When she or her children are ill she depends on the health department, free care clinics or emergency departments.  She ignores her health needs because of it’s cost and has not had a PAP smear, breast exam or mammogram for many years.  Her children have not had a dental exam or vision exam in many years because she cannot afford it.  Jane knows her children need health care, and she wants to do it, but she simply cannot afford it.

Unfortunately Jane Smith isn’t fictional!  There are millions of Jane Smiths in our country who are struggling to survive without access to real, affordable primary care services.

The good news is that this January things will get dramatically better for Jane.  Under the Patient Protection and Affordable Care Act (ObamaCare) she will be able to shop for health insurance online at the health insurance exchanges.  She will be able to select the health insurance that meets her needs and her monthly cost will be approximately 4% of her annual income.   The federal government will be pay the remainder of the health insurance premiums.  The Insurance she gets will be health insurance that meets criteria that the law requires and covers certain minimum healthcare.   Under ObamaCare all preventative care (immunizations, PAP smear, Mammogram, etc) will be covered 100% by her insurance.  Her children will have full health insurance and have dental and vision care.  If she, or one of her children, has a chronic illness they cannot be denied health insurance or have to pay more. If you go to http://kff.org/interactive/subsidy-calculator/ you can calculate if you qualify for federal assistance and what level of assistance you would qualify for.

The bad news for Jane is that the United States House of Representatives has passed a bill that would defund ObamaCare.  The Republicans in the house have threatened a government shutdown as a means to pressure the president to stop his landmark legislation.  The Republican leaders claim that this is not political, but is conservative fiscal policy.  They declare they act because the american public demand it and out nation needs it!

Unfortunately the facts show that this is purely political gamesmanship without any consideration of how low and middle income families will suffer because of it.  The actions of the House leaders are neither nor or fiscally conservative.  This is politics, pure and simple!

Consider the follow claims by republican leaders…..

 

“The Majority of americans oppose the affordable care act!”

-According to polling conducted by The Kaiser Family Foundation 42 % of americans do oppose the Affordable Care Act, while 37% support the law.  A large proportion (20%) of americans have no opinion because they are unsure of what is in the law.  A key survey conducted by the Kaiser Family Foundation shows that 67% of americans oppose defunding the affordable care act, a clear majority. ( http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-august-2013/)

 

“By defunding ObamaCare we will decrease the defect.”

In a recent letter from the Congressional Budget Office Director to Congressman Paul Ryan he estimates that the federal defect will increase by approximately 109 billion dollars over 10 years if ObamaCare is defunded.  (http://www.cbo.gov/sites/default/files/cbofiles/attachments/hr45.pdf?elq=75fe64eb88e94f999417bb144c231e95&elqCampaignId=2031)  This may not to seem to make sense based on the amount of federal subsidies to help individuals buy insurance and enrolling low income families in Medicaid.  To understand this you must understand that the federal government pays billions of dollars to fund free care clinics, provides billions of dollars in grants to provide preventative care and pays hundreds of billions of dollars to compensate hospitals for uncompensated care.  Much of this funding is no longer necessary if more individuals have health insurance.  And as we improve the health of americans we also decrease the amount of money we spend to treat chronic illness.

Also consider that the major source of increases in healthcare spending for the federal government come from people who receive health care and cannot pay for it. (http://www.rwjf.org/en/research-publications/find-rwjf-research/2010/01/health-care-spending-under-reform.html)  By controlling these costs the rate of growth for health care spending should slow.

 

“There aren’t enough providers to care for all the new enrollees.”

ObamaCare includes billions of dollars for educating more physicians, nurses and other healthcare providers.  Defunding ObamaCare will result in decreasing the number of individuals to provide healthcare.

 

“The solution to the healthcare crisis should be market driven and not come from the government.”

Under the present health insurance system there is no competition.  Individuals cannot “shop” for health insurance, they can “apply” for health insurance and the insurance companies can cherry pick who they want to insure.  Most states have large insurance monopolies that control the market and control their rates.  Under ObamaCare the health insurance exchanges will provide a place where individuals can shop for the health insurance they want, see what they will be charged in advance and know in advance what services will be covered.  Under ObamaCare insurance companies cannot be denies coverage because of preexisting condition nor pay more for preexisting conditions.

 

I admit that there are problems within ObamaCare, but these problems can be fixed by simply amending the law.  Unfortunately the House of Representatives has voted 32 times to repeal the law, but have never attempted to “tweak” the law.  The objective has been, and continues to be, purely political.  I will not conjecture if this is racial, partisan or short sightedness.  I will state that the actions of the congress will do direct and serious harm to american families that are already struggling to survive.

It is time the grown ups within our political leadership step forward and take the reins.  There are real and effective solutions to the crisis facing out nation.  Immature, partisan and destructive actions such as those taken by out house of representative are not those solutions!

 

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Research shows 156 healthcare procedures that are not beneficial

2012-11-26 01:17:13 edwardbriggs

photoA recent study out of Australia demonstrates approximately 156 tests or procedures that are commonly performed and do not have any real benefit. The link below takes to the the appendix that lists the data.

http://www.australiandoctor.com.au/getmedia/e4905ed2-3382-4476-a18f-dfe5ac96b3e6/MBS_lowvaluetreatments_Nov12.aspx

This list is representative of the failure of the modern health care system to follow the basic “evidenced based practices” that we subscribe to. If the evidence does not support the procedure what is the motivation for doing it?

Stopping unnecessary tests and procedures are a simple partial solution to the burgeoning cost of health care in our country.

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Reduce surgical errors....or reduce nursing staff?

2012-10-18 15:39:09 edwardbriggs

A recent article that appears in the peer reviewed journal “Health Affairs” found that recent regulation changes that financially penalizes health care facilities for complications following surgeries will have a negative revenue consequence for the majority of hospitals.
The paper postulates that this negative income will likely result in decreased hospital days for patients and increased attention to reduce surgical complications. My concern is what I have seen over many years of being a front line health care provider and that is the reaction of Chief Financial Offers to look at the bottom line and reduce full time employees. These reductions will likely come from nursing staff in the operating theatre and replace them will less trained and skilled technicians.
I applaud the regulation and it’s intent, but am concerned about it’s implementation. The faster, and easier solution, for health care facilities is not to reduce reduction but to reduce cost to compensate for the revenue loss. The regulations should have included provisions to ensure the safety of the patients in the operating theatre

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Medicaid Expansion....pro and con

2012-10-18 15:16:28 edwardbriggs

Florida is at the center of the Medicaid Expansion debate. The Affordable Care Act greatly expanded the criteria that would allow individuals to qualify for Medicaid (a federal/state program of providing health insurance to poor and nursing home patients.)  Although the federal government picked up the lions share of the cost, states would have to assume some of the expense.  This led to debate and courts challenges.  The supreme court finally ruled that the federal government could not force the expansion on the states and the expansion was optional.

Florida has decided to opt out of the expansion. This decided is applauded and derided by various groups.  The challenge is deciding what are the facts free of the rhetoric.

Dr. Aaron Carol and Dr. Austin Frakt did a succinct analysis of the pros and cons.  Below is a small excerpt from their blog but I suggest you check out the complete post at:

http://theincidentaleconomist.com/wordpress/point-counter-point-mcaid-expand/

EXCERPTS

  • State elected officials are politically constrained in their choices. Antos is quite explicit on this (“If you choose the latter [Medicaid expansion in your state] you stand a good chance of being thrown out of office the next election.”) We discuss politics at the end of our paper, concluding that it is not our job to look after the political fortunes of state officials. That they will (or won’t) expand Medicaid and that they should (or should not) are separate matters.
  • Expanding Medicaid is not free for the states. Reading Antos’s paper you might think we dispute that, but we don’t.
  • Antos makes a direct appeal to the virtue of choice. We don’t take that up in our paper, but we do not dispute that there is value in choice.
  • The Medicaid expansion was a lower cost means of increasing coverage. Antos and we acknowledge that private coverage costs more, as would increasing Medicaid payment rates to providers.
  • States may be able to use the Medicaid expansion as a bargaining chip, to extract favorable waivers from the Center for Medicare and Medicaid Services (CMS). We wrote that, and Antos seems to agree. We also probably all agree that this is among the most important unsettled areas to watch in terms of health policy.
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What would Obama/Romney do to health care?

2012-10-14 02:26:12 edwardbriggs

We are in the final days of the 2012 election season, and a great deal of finger pointing is going around.  Both parties are claiming the other will destroy Medicare/Medicaid/Private Insurance.  If you listen to either Romney or Obama their opponent wants to do horrible things, take away your health care or destroy health care market!

The rhetoric unfortunately obscures the proposals the candidates have made, and finding an analysis of the impact of the proposals on television news media is nearly impossible.  (But they will give you an analysis of how they look, the cloths they wear and how many times they scratch their nose….all the important information!)

Thankfully the Journal of the American Medical Association (JAMA) has published a free, online analysis of the candidates proposals compiled by Aaron E. Carroll, MD, MS and Austin B. Frakt, PhD and how it will impact on the health insurance market in the United States.  You can view and download the analysis at: http://jama.jamanetwork.com/article.aspx?articleid=1379004.  (Please note that JAMA has a tradition of nonpartisan analysis.  Any doubts to the authenticity of the data are addressed at Dr. Carrol’s blog.)

You can also find a commentary by Dr. Carroll, one of the authors at his blog.

http://theincidentaleconomist.com/wordpress/jama-viewpoint-the-health-policy-election/

However, if you are one of those people who just want the facts in a simple to digest visual format, here it is courtesy of Drs. Carroll and Frakt:

Analysis of Romney and Obama health insurance proposals.

 

 

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The affordable care act explained!

2012-10-01 01:10:17 edwardbriggs

There has been a great deal of confusion and misinformation regarding the AFFORDABLE CARE ACT, what many have come to call “Obamacare”.

The Kaiser Family Foundation, a nonpartisan non-profit health advocacy agency have developed this explanatory video That I believe explains the law in a clear and concise fashion.

With the importance of the pending election and the expected complete roll out of the Affordable Care Act in 2014 educating ourselves and our neighbors is extremely important on this issue.

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Oct 18, 2o12 AANP AND ACNP MERGER ANNOUNCED

The American Academy of Nurse Practitioners and the American College of Nurse Practitioners have announced they will be merging to form a new combined entity to represent advanced practice nurses in the United States.  The new organization will be called THE AMERICAN ASSOCIATION OF NURSE PRACTITIONERS.

The two organizations will merge functions and the organizations ensure that the transition will be seamless.

For individuals who are accredited by the ACNP will not see any changes.  Accreditation by the ANCC is still under negotiation.

For more information visit: http://www.aanp.org/about-aanp/aanp-acnp-merger/85-about-aanp/1106-merger-faqs

Oct 17,2012 260 FLORIDA SITES RECEIVED CONTAMINATED STEROID INJECTIONS

The Florida Department of Health is reporting that a suspected 260 pain management sites may have received contaminated steroid injections from New England Compounding Company that is causing the epidemic of fungal meningitis across the state.
To get the latest news on the outbreak you can visit http://newsroom.doh.state.fl.us.

Who is at Risk?
Individuals who received epidural steroid injections from one of the affected pain management centers. Individuals with compromised immune symptoms (advanced age, diabetes, multiple co-morbidities, HIV) are at greater risk of developing the infection.

What are the symptoms?
Warning signs include headache, stiff neck, lower-than-normal temperature, nausea or vomiting, sensitivity to light, and hallucinations.

Unlike viral or bacterial meningitis, which tend to cause symptoms within hours of infection, the fungal form has an incubation period that can be as long as 43 days or more.

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