Update Hell

I look forward to the Congressional Budget Office’s updated and revised estimate of the cost and effectiveness of the Patient Protection and Affordable Care Act AKA “ObamaCare”, due next week but which I suspect will be somewhat delayed. Especially in light of the developing situation governors of states that opposed the PPACA in Court declining to expand their states’ Medicaid systems as the Supreme Court ruled was their right. If Florida and Texas opt out, I would be very much surprised if that doesn’t cut a big chunk out of the additional people that the plan was supposed to insure.

11 comments… add one
  • sam Link

    ” If Florida and Texas opt out, I would be very much surprised if that doesn’t cut a big chunk out of the additional people that the plan was supposed to insure.”

    Sure it would, but I heard Howard Dean say that under the ACA, Texas stands to pickup $52 billion (I’d imagine Florida gets a similar amount). He continued, saying that the hospitals systems in those states are being strained to their limits. I’m not sure how long Texas, Florida, et al. would really hold out, especially when the citizens look around at other states which are participating.

  • Icepick Link

    I don’t know, Sam. Opting out might look better and better. I just read an article that stated that 13,000 pages of new regs had already been written at the federal level, with much MUCH more to follow.

  • Icepick Link

    Also, look at it from Florida’s perspective: If Georgia, Alabama and other Southern states take the money, those poor folks desperate for insurance might all head north. If that were to happen it would lessen the strain on our system. SO here’s hoping our fine neighbors in Georgia buy into this mess and scoop up a lot of our poor folks with them.

  • Remember that in practical terms governors are responsible to the actual voters of their states. Not to the residents of the U. S. generally, residents of their states, or even registered voters.

    I also strongly suspect that there’s a substantial overlap between “actual voters” and “people who already have healthcare insurance”.

    The question whether the governor of Texas will be dinged by actual Texas voters for not raising their taxes to extend healthcare to people who don’t vote. To know that I’d need to take the temperature of actual Texas voters. I genuinely don’t know but I strongly suspect that actual Texas voters won’t penalize the governor if he doesn’t rise to the bait.

  • PD Shaw Link

    Illinois won’t opt out, but its not clear given budget problems that they will actually enact any laws. Supports of the program want the Governor to do it by executive order, something which as an uncany resemblance to one of the things Blagojevich got in trouble doing.

  • sam Link

    “The question [is] whether the governor of Texas will be dinged by actual Texas voters for not raising their taxes to extend healthcare to people who don’t vote. ”

    But that’s a tough sell (well, it is Texas, I grant), since the Feds pickup 100% of the cost for the first three years, and a state will never pay more than 10-15% of the cost thereafter. Moreover, wouldn’t it depend, in some measure, on how loud the yelps are from the hospitals?

  • jan Link

    Icepick

    I would hazard to say those 13,000 pages of regulations are but a prelude to what will be written too.

  • jan Link

    Welcome to Obamacare.

    A Wall Street Journal story the day after the Supreme Court ruling examined in detail its impact across the “health sector.” The words “doctor,” “physician” and “nurse” appeared nowhere in this report. The piece, however, did cite the view of one CEO who runs a chain of hospitals, explaining how they’d deal with the law’s expected $155 billion in compensation cuts. “We will make it up in volume,” he said.

    Would that be another word for human beings? It is now. At Obama Memorial, docs won’t be treating patients. They’ll be processing “volume.” And then, with what time and energy remains in the day, they’ll be inputting medical data to comply with the law’s new Physician Quality Reporting System (PQRS), lodged in the Centers for Medicare and Medicaid.

    Here’s the Centers’ own description of what PQRS does: “The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS).”

    We’re all pressed for thinking time these days, but the one group we should make sure has time to focus on what’s in front of them is doctors treating patients. Instead, they’ll also be doing mandated data dumps for far-off panels of experts.

    Costs and fiscal deficits will be important factors to think about in the implementation of Obamacare. However, what is even more of a probability (and downside) is what I’ve cited before — more impersonal medical care, mainly because of bureaucratic distraction doctors now have to face, along with greater patient loads and smaller times allotted for every patient. An Australian physician, visiting us years ago, claimed this was the biggest problem she encountered with their health care system — the small time she could afford to spend with her patients.

    The comment above, calling people volume, reminded me of one of my gripes when I was actively nursing — calling people by their room numbers rather than their names. Nursing aides would do this, and I would remind them that the patient had a name, and didn’t turn into an anonymous entity just because they were hospitalized. IMO, though, it will be next to impossible, to not have people become anything but numbers once Obamacare kicks in for real.

  • steve Link

    The piece you cite is just asinine Jan. I have a hard time believing anyone working in medicine would regard such BS with any regard.

    As to the gist of your post, I think this be a difficult decision for governors. You will have Romney campaigning on the idea that health reform should be managed by the states. Then, you will have the states refusing Medicaid money, but not having any alternate plan. Couple that with the states continuing to increase the number of their own mandates as health care costs increase, and I dont know how to predict the outcome.

    http://www.cahi.org/cahi_contents/resources/pdf/MandatesintheStates2011ExecSumm.pdf

    Steve

  • jan Link

    “The piece you cite is just asinine “

    What’s ‘asinine’ about it Steve? The article’s information or the opinion rendered? Aren’t you the least concerned about some of the bureaucracy encroaching on the time of physicians? This isn’t the only piece I’ve read, written by analysts, but also doctors themselves, who are far from being in awe of the ACA legislation. Maybe, this doesn’t bother you. But does that mean all medical personnel should be accepting of a system of care they think has more negative ramifications than positive ones?

  • Icepick Link

    What Schuler, no love for the first jobs report of Recovery Summer III?

    (Yeah, I know, the snark is recycled. But so is the job report. So is the economic recovery. So is the political rhetoric Obama will use today to say “It’s not my fault!” and the rhetoric Romney will use to say “It is Obama’s fault!”

    With all this recycling does my commenting count as a green job?)

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