HEALTH CARE COMPACT Blog

12-29-2011
Steve O'Keefe
Colonoscopy Law is a Pain in the Backside

Colonoscopy Law is a Pain in the Backside

The Patient Protection and Affordable Care Act (ACA) promised Americans free preventive care, including colon cancer screenings. However, a widely circulated Associated Press article by Carla K. Johnson shows consumers are routinely being charged for routine preventive care.

In the article, Johnson, a board member of the Association of Health Care Journalists, reveals how doctors, hospitals, and other medical care providers circumvent the letter of the law and charge consumers for preventive care. "[C]olonoscopies can go from free to pricey while the patient is under anesthesia," says Johnson.

[T]he greatest source of confusion is colonoscopies, a test for the nation's second leading cancer killer. Doctors use a thin, flexible tube to scan the colon and they can remove precancerous growths called polyps at the same time. The test gets credit for lowering colorectal cancer rates.

So if the doctor sees nothing, the colonoscopy is free. But if the doctor removes any polyps, the patient pays full price because the colonoscopy becomes a medical procedure rather than a preventive screening.

Johnson's article also talks about the confusion over mammograms. The service is free if it's a "screening mammogram" but is charged for it it's a "diagnostic mammogram." Confusion reigns over other preventive treatments, such as stop-smoking drugs. Should the drugs be free, or only the physician consult resulting in a prescription? And what does it take to change the law or the way it is interpreted? Here's Johnson on the subject of colonoscopies:

Doctors and prevention advocates are asking Congress to revise the law to waive patient costs — including Medicare copays, which can run up to $230 — for a screening colonoscopy where polyps are removed.

Will we need Congress to revise the health care law for every minor decision, such as whether aspirin taken for a heart condition is preventive and should be free? Given the speed with which Congress tackles such major issues as the debt ceiling, do we really want to be running to Congress every time we're charged for a test?

Under the federalization of health care, that's the kind of bureaucracy we can expect to deal with on a daily basis. Under the Health Care Compact, these decisions would be made at the state level. While not perfect, it's a lot faster tweaking state law than it is getting an act of Congress passed.

Source: "Preventive care: It's free, except when it's not," USA Today Dec. 28, 2011.
Image courtesy of Kitt Foo used under its Creative Commons license.

Steve O'Keefe is a freelance writer, author, and book editor whose writing has appeared in numerous libertarian publications.

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12-28-2011
Steve O'Keefe
Doctors Fear 27% Pay Cut from Congress

Doctors Fear 27% Pay Cut from Congress

A few months back, we ran a piece on the Health Care Compact Blog about how the Patient Protection and Affordable Care Act (ACA) is resulting in the loss of hundreds of thousands of jobs, during a time when reducing unemployment is supposedly "Job 1." In that piece, we introduced you to Michael F. Cannon, director of health policy studies for the CATO Institute, a free-market think tank in Washington, DC.

Cannon penned a scathing review of the ACA in the American Medical Association's journal of ethics. His piece begins with one of "Congress' accounting frauds" that enables legislators to continuously underestimate the costs of Medicare:

This 'sustaingable growth rate' (SGR) cuts Medicare payments to physicians every year on January 1. Or it would, except every year these cuts have come due, Congress has postponed them. But so long as hundreds of billions of dollars of future cuts remain on the books, future deficits and debt appear that much smaller.

Everyone knows Congress is going to postpone those cuts when docs and seniors start complaining. But by pretending that it won’t, Congress makes the federal government's finances look better.

It is almost January 1, and Congress has again come down to the wire on what has grown into a 27% cut in pay to medical professionals. David Glendinning of the American Medical News, picks up the story just before the holiday recess:

The House and Senate on Dec. 23 approved a two-month payroll tax cut extension package that included a two-month doctor pay freeze. That means physicians will continue to receive 2011 rates for Medicare services they provide through the end of February, and lawmakers will need to agree on a longer-term patch if they are to prevent the 27.4% cut from taking effect on March 1.

Physician groups, already furious that Congress came so close to forcing dramatic pay cuts, are facing the same harrowing situation in just two months. As Cannon pointed out, Congress is likely to continue postponing fixing the SGR because it allows them to disguise the true costs of Medicare.

How close did the federal government come to cutting off all payments for Medicare claims? Here's David Glendinning from the American Medical News:

The 27.4% cut looked likely enough in the final weeks of the year that the Centers for Medicare & Medicaid Services instructed the program's contractors to prepare to withhold physicians' 2012 claims for 10 business days.

The claims would be held, rather than paid or denied, to give Congress time to change its mind. If physicians don't welcome the idea of an immediate 27% pay cut, you can image how they feel about having their claims not paid at all. The holdup in payments could put a cold freeze on an economy that's just barely moving.

Twice in 2010, Congress failed to address the issue of physician pay and instituted pay cuts, then retroactively "patched" the legislation and recinded the cuts. Is this any way to run a national medical program? Medical professionals are outraged.

Can you imagine what kind of legislative hijinks await under the ACA? Having the federal government run health care means having our medical care subject to grandstanding and last-minute reprieves. As James May, MD, director of the California Medical Association said, "Congress isn't just playing with numbers -- they're risking the health of millions of seniors."

Source: "ObamaCare—The Way of the Dodo," Virtual Mentor, The Ethics Journal of the American Medical Association, Nov., 2011.
Source: "27% Medicare pay cut to return March 1 unless Congress makes new deal," American Medical News, Dec. 27, 2011.
Image courtesy of Images_of_Moneyused under its Creative Commons license.

Steve O'Keefe is a freelance writer, author, and book editor whose writing has appeared in numerous libertarian publications.

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12-27-2011
Steve O'Keefe
'Domestic Partner' Benefits and the ACA

Domestic Partner Benefits and the Affordable Care Act (ACA)

One benefit of the Health Care Compact is that states would have greater control over how their health care dollars are spent. On December 23, Michigan Gov. Rick Snyder signed legislation prohibiting extending health insurance benefits to domestic partners of public employees.

Exactly who is affected by the bill is uncertain. Dawson Bell of the Detroit Free Press reports "Snyder has said the prohibition will not apply to employees of the state public universities or state government employees." Well, if it doesn't apply to state government employees, who does it apply to? The Free Press has an answer:

The measure does apply to municipal and school employees, and to both same-sex and straight couples.

Michigan Republicans, who narrowly passed the bill through both houses of the state legislature, insist that the law does apply to university employees. The uncertainty has disrupted the state's universities, all but one of which provide benefits for domestic partners.

Kellie Woodhouse of AnnArbor.com, home to the University of Michigan, explains Snyder's interpretation of the law:

In a letter penned after signing House Bill 4770 this morning, Snyder said the ban 'does not extend to university employees' because of autonomy awarded to public universities in the Michigan Constitution. The University of Michigan reported that 570 adults and 48 children currently receive benefits through a domestic partner allowance.

The Patient Protection and Affordable Care Act (ACA) is silent on coverage for domestic partners, but instead requires all individuals to obtain health insurance. An earlier version of the health care law did contain a provision requiring benefits be extended to domestic partners. That version of law was scrapped in favor of the Senate version, which does not mandate domestic-partner benefits.

With the federalizing of health care comes federal decisions over who should be covered, and for how much. These decisions have dollar signs attached; we all pay the bill for them one way or another. We can expect many more dramatic decisions as a national standard for health care is imposed upon a diverse population—and the money to pay for it is extracted through taxes.

The Health Care Compact offers an alternative approach, where health care policy can be made at the state level, or through agreements between the states. Without it, we can expect many more divisive showdowns over who and what should be covered--and who's going to pay for it.

Source: "No health care for domestic partners under Michigan law signed today by Snyder," Detroit Free Press, Dec. 22, 2011.
Source: "Gov. Rick Snyder signs domestic partner benefits ban into law," AnnArbor.com, Dec. 22, 2011.
Source: "Domestic Partner Laws in Washington: How State Law and Health Care Reform Impact Section 125 Plans and Health Plans," Corporate Law Blog, Oct. 18, 2010.
Image courtesy of donjd2 used under its Creative Commons license.

Steve O'Keefe is a freelance writer, author, and book editor whose writing has appeared in numerous libertarian publications.

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