Carter's Benefits

eNewsletter Volume 4, Issue 2 February 2011

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Healthcare Reform Unconstitutional ?

In the few months there has been a fury of activity in Healthcare Reform. Two separate courts have ruled on Healthcare Reform. December 14, 2010, in the closely watched suit brought by Virginia Attorney General Ken Cuccinelli, District Judge Henry Hudson found that the mandate “exceeds the constitutional boundaries of congressional power.” Hudson stopped short of blocking the law’s implementation until a higher court acts, but said he expects the administration to honor his ruling. Read more:

On January 13, 2011 federal judge Roger Vinson of Pensacola, Florida ruled that President Barack Obama's entire health care overhaul law is unconstitutional, placing even noncontroversial provisions under a cloud in a broad challenge that seems certain to be resolved only by the Supreme Court.

So where does this leave us? The same place as when the law passed on March 23, 2010. The courts have ruled the law unconstitutional, and everyone is in agreement this will be decided by the US Supreme Court. Till then, the law continues to move forward as written. I will continue to post updates on our news page and on our facebook page as they occur.

Recent News

  1. Judge Strikes down healthcare reform law.
  2. Healthcare Law Being Implemented Despite Repeal Attempts.
  3. Study Estimates 19 Percent Of Imaging Tests Conducted For "Defensive" Purposes.
  4. Sebelius: Obama "Very Serious" About Tort Reform.
  5. Legislation Introduced to Repeal Flexible Spending Account Limits
  6. Experts Suggest Supreme Court May Largely Preserve Healthcare Law.
  7. Aetna Pulls Out Of Colorado.
  8. Poll: Unpopularity of reform spikes.
  9. Senate Lawmakers Introduce Bills To Repeal 1099 Provision.
  10. HHS To Determine Benefits Covered Under Healthcare Law.
  11. More Patients Ordering Their Own Lab Tests Before Seeing Physicians.

Judge strikes down healthcare reform law.
(1/31, Brown) reports U.S. District Judge Roger Vinson struck down President Barack Obama's landmark healthcare overhaul as unconstitutional on Monday, in the biggest legal challenge yet to federal authority to enact the law.

Washington Post (01/31) reports In ruling against President Obama‘s health care law, federal Judge Roger Vinson used Mr. Obama‘s own position from the 2008 campaign against him, arguing that there are other ways to tackle health care short of requiring every American to purchase insurance.

“I note that in 2008, then-Senator Obama supported a health care reform proposal that did not include an individual mandate because he was at that time strongly opposed to the idea, stating that ‘if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house,’” Judge Vinson wrote in a footnote toward the end of the 78-page ruling Monday.

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Healthcare Law Being Implemented Despite Repeal Attempts.
American Medical News (2/14, Trapp) reports, "With an outright repeal of the national health system reform law blocked by the Senate, congressional Republicans aim to make 2011 a year of rolling back individual parts of the statute." Still, "key portions of the law are expected to take effect or move forward significantly this year despite any GOP efforts to cripple it," the article notes. "At this article's deadline, the Dept. of Health and Human Services was preparing to unveil rules governing accountable care organizations, one major aspect of the reform package for physicians," American Medical News adds.

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Study Estimates 19 Percent Of Imaging Tests Conducted For "Defensive" Purposes.

The Los Angeles Times (2/15, Roan) "Booster Shots" blog reported, "Imaging tests such as MRIs and X-rays frequently are performed so that doctors can protect themselves from lawsuits," according to research presented at the annual meeting of the American Academy of Orthopaedic Surgeons in San Diego. The review of "2,068 orthopedic patients" showed that "19% of the tests were ordered for 'defensive' purposes." Medical malpractice lawsuits "often hinge on charges that the doctor should have ordered more tests," said lead author Dr. John Flynn of Children's Hospital of Philadelphia. Such a claim "may be the driving force of so much of the defensive test ordering," he noted.

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Sebelius: Obama "Very Serious" About Tort Reform.
The AP (2/16) reports, "Putting his own stamp on a long-standing Republican priority, President Barack Obama is launching a drive to overhaul state medical malpractice laws and cut down on wasteful tests doctors perform because they fear lawsuits." In fact, "Obama's budget calls for $250 million in Justice Department grants to help states rewrite their malpractice laws in line with recommendations that his bipartisan debt reduction commission issued last year." Speaking before the Senate Finance Committee on Tuesday, HHS Secretary Kathleen Sebelius said, "I think the president is very serious about following up on this."

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Legislation Introduced to Repeal Flexible Spending Account Limits
This week, Senator Kay Bailey Hutchison (R-TX) and Congressman Erik Paulsen (R-MN) introduced, in the Senate and House, respectively, the Patients’ Freedom to Choose Act to remove future contribution limits on FSAs as well as include over-the-counter medicines as an allowable medical expense.  Read More

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Experts Suggest Supreme Court May Largely Preserve Healthcare Law.
CQ HealthBeat (2/11, Norman, subscription required) reports, "Two legal experts who have opposing views on the challenges to the health care overhaul law agreed on one thing Thursday -- that the US Supreme Court won't throw out the entire measure." CQ add that "instead, they raised the possibility that the high court will decide only on the constitutionality of the law's requirement that Americans have health insurance -- as well as provisions that seem clearly related, such as the ban on denial of insurance to people with pre-existing conditions." The court's decision "would leave the rest of the massive law intact, including its Medicaid expansion, many other consumer protections, and the creation of state-based exchanges to sell health insurance." Simon Lazarus, "public policy counsel for the National Senior Citizens Law Center," and "Ilya Shapiro, senior fellow in constitutional studies at the libertarian Cato Institute, spoke to the American Medical Association (AMA) advocacy conference."

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Aetna Pulls Out Of Colorado.
The Wall Street Journal (2/1, Johnson, subscription required) reported that as of February 1, health insurance giant Aetna Inc. will not sell new policies to residents of Colorado. The insurer will maintain services for current policy holders until they come up for renewal.
        CQ HealthBeat (2/1, Reichard, subscription required) questions whether Aetna withdrawal from Colorado is the "leading edge of a coming trend." CQ reports that while "Aetna's letter to Colorado regulators did not attribute the withdrawal to the health care law ... it didn't dispel the impression the market exit might have resulted from the overhaul law."
        According to the Denver Post (2/1, Jackson), Aetna currently covers "22,000 individuals in Colorado." Mary Anderson, a counsel to Aetna, wrote in a letter dated Dec. 21 to the Colorado Insurance Division that Aetna "determined it can no longer meet the needs of its consumers while remaining competitive in the Colorado individual health market."

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Poll: Unpopularity of reform spikes.
Politico (1/26, Haberkorn) reports, "Public opposition to the health care reform law spiked to a record high in a new poll out today -- but Americans don't necessarily want Republicans to spend time trying to dismantle it." Politico adds, "Fifty percent of Americans have unfavorable views of the law, according to a joint survey by the Kaiser Family Foundation and the Harvard School of Public Health. Opposition to the law jumped 9 percentage points from last month and is the highest since April, when Kaiser began asking the question every month."
CQ HealthBeat (1/26, Adams, subscription required) reports, "Republican attacks on the health care law may have had some effect in souring independents on the legislation, according to a new poll" conducted Jan. 4-14. Yet, "about 62 percent of respondents said that they don't think Republicans should cut off funding for the legislation," and "even among those who want the law to be repealed, about four in ten say they oppose defunding the law." Mollyann Brodie, "senior vice president and director of the Foundation's Public Opinion and Survey Research group," noted, "The public is frustrated with politics as usual, and may be saying that defunding a law is not how government should work."
NPR (1/25, Rovner) "Shots" blog reported that "the individual mandate that requires nearly all Americans to have health insurance starting in 2014 remains highly unpopular (opposed by 76 percent of respondents)." Nevertheless, "even opinion on the individual mandate itself does not seem all that stable," since it "falls to under 50 percent when told that the mandate is needed to require insurance companies to stop discriminating against people with pre-existing conditions. On the other hand, opposition grows even larger when people are told the requirement could mean people would have to buy insurance they find too expensive.
Kaiser Health News (1/26, Miles) reports, "Certain provisions of the health care law continue to carry public support -- 79 percent of Americans favor subsidies for low-income individuals to buy health insurance, and 85 percent support discounts on drugs in the Medicare doughnut hole, for example." Still, "in the months ahead, growing public aversion to 'politics as usual' may signal a change in the tone of the health care debate," and "how politicians frame key issues of public interest -- from reductions in federal spending to consumer protections in health insurance -- will be key," one health expert said.
The Hill (1/26, Millman), the Wall Street Journal (1/25, Hobson) Health Blog, Reuters (1/26, Heavey), and Modern Healthcare (1/26, Zigmond, subscription required) also cover the story.

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Senate Lawmakers Introduce Bills To Repeal 1099 Provision.
CQ HealthBeat (1/26, Ethridge, subscription required) reports, "Competing bills to repeal the unpopular tax-reporting requirement in the health care law were introduced in the Senate on Wednesday, giving hope to supporters who want to strike the provision early this year and pressuring the House to move on similar legislation." One bill, "introduced by Sen. Mike Johanns, R-Neb., has bipartisan support along with offsets; the second, introduced by Finance Committee Chairman Max Baucus, D-Mont., and Majority Leader Harry Reid, D-Nev., has no offsets, but does have the support of leaders who control what bills come to the floor."
The Hill (1/26, Needham) reports in its "On The Money" blog, "Congressional Republicans, Democrats and the White House have called the provision 'burdensome.' Although a repeal of the provision has bipartisan support, lawmakers couldn't reach an agreement last year." Notably, "both parties have seized on the 1099 requirement to score political points. Republicans are posing repeal of 1099 as part of their promise to chip away at the reform law, while Democrats are touting it as a sign of their willingness to improve the current law."

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HHS To Determine Benefits Covered Under Healthcare Law.
McClatchy /Kaiser Health News (1/11, Appleby) reports, "Even as House Republicans vow to repeal the health care law, government advisers are preparing this week to wade into one of the most contentious questions the legislation raises: What benefits must insurers cover?" Although the "law outlines 10 broad categories of coverage -- among them hospital and emergency services, prescription drugs, childbirth, and pediatric care -- it leaves specifics to the government," and whatever decisions HHS makes regarding specific coverage will impact millions of individual policy holders. That is why HHS "has asked the independent Institute of Medicine for advice." The group will meet starting "Wednesday behind closed doors, with public sessions scheduled for Thursday and Friday."
CQ HealthBeat (1/11, Adams, subscription required) says that this is "one of the biggest -- and until now, among the most overlooked -- fights over the implementation of the health care law," but it "starts in earnest this week as policy makers begin to determine which benefits insurers will have to cover beginning in 2014." As part of the implementation process, HHS must "decide which medical services and equipment are 'essential health benefits.'" Therefore, "drug and device manufacturers, physicians and other providers, patients, and others are watching closely to see how HHS officials settle" the matter. It is anticipated that "HHS officials will issue a proposed rule on essential health benefits by the end of the year so that insurance plans will have time to change benefits as needed before the provisions take effect in 2014."

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More Patients Ordering Their Own Lab Tests Before Seeing Physicians.
On the front of its Personal Journal Section, the Wall Street Journal (1/11, D1, Mathews, subscription required) reports in "Heart Beat" that the majority of people take a lab test only after a physician recommends it. Now, in light of high-deductible insurance plans, more patients are cutting out the so-called middle man by ordering their own tests, usually from an online service. Notably, heart-related assays are the most popular. Still, physicians say it would be best not to cut them out of the loop, considering their expertise in reading results. For example, ACC former president Alfred Bove points to the c-reactive protein tests, which can be unduly influenced by a bladder infection or bad cold.

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How does Carter's Benefits help ?
We continue to stay on top of changes in this industry. In a consultative role, Eddie Carter has begun hosting live seminars to update employers and Human Resource Managers on these changes. If you would like to host a meeting with your local community or civic organization, please contact me for details.

Eddie Carter, Consultant Eddie Carter,
Benefit Consultant
If you have questions or would like more information please give us a call or send us an email.  Our email address is Questions@CartersBenefits.Com

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