Fact Checking Sen. Menendez ACA Diatribe

Dear Senator Menendez,

As a N.J. citizen, taxpayer, physician, husband and father, I must offer factual correction on your healthcare policy ACA diatribes.

You tweeted:

Nothing could be further from the truth in your partisan message:

1. Insurance coverage is not healthcare.
2. Forcing citizens into ACA Medicaid at taxpayer expense is foolhardy.
3. ACA through “guaranteed issue(preexisting conditions)” destroyed the risk pools that kept prices stable. Now ALL commercial plans premiums have doubled and tripled.
4. The individual insurance market was decimated by ACA, destroying any semblance of insurance competition.
5. ACA put most private practice independent physicians, that are more efficient and cheaper, out of business and working for hospitals. As you know, hospitals inflated pricing schemes also extorts taxpayer dollars
6. ACA also pushed insurers toward “narrow networks.” eliminated patients long-term relationships with physicians and further limited their choice of physician and facility.
7. ACA and forced government dependence will bankrupt the country and its citizens, as a whole and individually.
8. Remember the three big lies of Obamacare? Keep your doctor. Keep your insurance. Each family will save $2500. All proven false partisan narrative.
9. Attacking the president of the United States is a waste of time, money and energy when he would gladly work with you on these issues.

I would be glad to work with you and other legislators on competitive free-market plans and assure quality and give patients best choice and restore personal responsibility and freedom.

Sincerely
Craig M. Wax DO
Independent family physician, media host and healthcare policy expert

What is Healthcare? And How to Fund It.

Dear Chairman Alexander,

Thank you very much for asking America’s MD and DO Physicians to weigh in on solutions to improve Americans’ health and launch an efficient and sustainable path for the healthcare ecosystem.

The first critical step is educating your colleagues that there is a difference between medical care and health insurance. My recent article published in Medical Economics may help policymakers understand that the difference matters: https://www.medicaleconomics.com/med-ec-blog/what-healthcare

Solving the current healthcare policy disaster ultimately means less federal intervention and regulation, combined with more freedom and liberty.

Please consider:

1. Expanded universal HSA heath savings accounts for all, independent of insurance, and usable for every healthcare service, medication and device.

2. Remove ACA restrictions on insurance policies and stop multi-billion dollar bailouts of the insurance industry. Insurers have driven up costs. Instead allow a diversity of insurance plans to compete side by side: from catastrophic with high deductible to first dollar HMO-coverage. Unique individuals should be shopping for unique plans to suit their own needs.

3. Repeal the Group Purchasing Organization safe harbor to the Anti Kickback Statute that is also being abused by Pharmacy Benefits Managers. The federal government has permitted kickbacks disguised as “rebates“ for decades and it must stop. Make kickbacks illegal again. GPO and PBM middleman must compete legally and not extort manufacturers.

4. Innovative solutions like Direct Primary Care (DPC), and similar direct payment arrangements between specialists and their patients are must not be subject to over-regulation under insurance rules . These arrangements are not insurance but cut out the third party bureaucracy driving up the cost of care. DPC serves to strengthen patient-physician relationships not interfere in them. This healing relationship is critical for regaining health and health maintenance. It makes both patients and physicians responsible to each other directly, as it should be.

5. Allow physicians and patients to opt out of Medicare, MACRA, and other top-down government programs. They should be voluntary, not compulsory. Direct contracting between patient and physicians will save lives and tax dollars.

6. Consider legislation to protect patient access to physicians of their choice, even if they are not in their plan’s network. Narrow networks serve to trap patients into obtaining care in the most expensive settings instead of from higher quality and less expensive options like independent physicians.

Please feel free to contact me via letter, email, social media, phone, or any other mechanism for short and long-term planning. Together we can harness free market and personal individual responsibility to organically solve America’s healthcare crisis.

My article catalog: https://www.medicaleconomics.com/authors/craig-m-wax-do

Best wishes for good health,

Craig M. Wax, DO
Family Physician
VP Healthcare Policy, Practicing Physicians of America
National Physicians Council on Healthcare Policy member
Independent Physicians for Patient Independence
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax
HealthIsNumberOne.com

10 Reasons to ‘Refuse to Enroll’ in Obamacare

From our friends at Citizen’s Council for Health Freedom:

OPEN ENROLLMENT 2018: 10 Reasons to ‘Refuse to Enroll’ in Obamacare

‘Command and Control,’ ‘Claw Backs,’ ‘Narrow Networks’ and More Are Reasons to Stay Out of an Expensive, Privacy-Compromising Gov’t Plan.

Just a few days remain in the open enrollment period for the Affordable Care Act (ACA), and for those still on the fence, Citizens’ Council for Health Freedom (CCHF) is sharing the top 10 reasons to “Refuse to Enroll.”

“For more than eight years, the Affordable Care Act has been changing America’s health care landscape—and not for the better,” said CCHF president and co-founder Twila Brase. “Costs have skyrocketed because younger, healthier Americans wisely chose not to enroll, unlike the Obamacare architects thought they would. Health plans that were already making money hand over fist received bailouts for insuring older, sicker individuals, some with uninsurable conditions. With a new administration that’s making bold steps against the ACA way of doing health care, there are many reasons not to enroll in a flawed government system that compromises care, ties doctors’ hands and shares our private medical information.”

CCHF’s “10 Reasons Not to Enroll in Obamacare” include the following:

  1. Obamacarecoverage is a government program; not private insurance.
  2. It’s “a second Medicaid-style program,” said former CBO director Douglas Holtz-Eakin.
  3. The Affordable Care Act (ACA) exchanges facilitate redistribution of American’s wages, reported Fox News in 2010, just days after the law was signed.
  4. User fees added to premiums fund operations of these ‘command and control’ exchanges, according to an “Overview of Health Insurance Exchanges” from the Congressional Research Service.
  5. ACA exchanges may automatically enroll you in Medicaid, such as this story in Minnesota.
  6. If you underestimate your income, the IRS can ‘claw back’ premium subsidies you received.
  7. Your choices are limited, as a result of “narrow networks” of doctors and hospitals.
  8. Federal law and most states no longer penalize you for refusing to buy insurance.
  9. Health care sharing is a more affordable, cash-based option for coverage.
  10. The federal exchange database (“Health Insurance Exchange Program” System of Records) collects, stores and shares private information from all enrollees.

For many years, CCHF has also shared a list of wise—and legal—alternatives to signing up for costly government coverage:

  1. Buy private insurance outside the government exchanges, such as a private policy, employer-sponsored coverage or a private insurance exchange.
  2. Claim one of several general exemptions to the mandate or one of its many hardship exemptions. The Trump administration added several hardship exemptions in April, including one related to abortion, and also announced earlier this month that documentation is not required for those who take these exemptions.
  3. Become a member of a health care sharing ministry, a viable, affordable option for some families that is skyrocketing in enrollment—and the second of the nine general exemptions.

“Americans also need to understand that although the mandate and penalty are gone in a practical sense, they are technically still in place,” said Brase. “While Congress zeroed out the penalty tax starting in 2019, Congress did not repeal the ACA mandate to be insured or the penalty itself. It only zeroed out the penalty for going uninsured. The language for the mandate and the penalty are still in law, but the cost of the penalty is now zero dollars. While this provides welcome relief to many, a future Congress could turn around and easily reinstate the penalty for being uninsured because the penalty language is still in law. They could simply go from zero to whatever penalty they wish to impose for going uninsured.”

Americans should also know that the individual penalty was zeroed out beginning in 2019, so those who went without coverage in 2018 may be still on the hook for penalties—and may still be able to claim exemptions to avoid those penalties.

For more information about CCHF, visit www.cchfreedom.org, its Facebook page or its Twitter feed @CCHFreedom. Also view the media page for CCHF here. For more about CCHF’s initiative The Wedge of Health Freedom, visitwww.JointheWedge.comThe Wedge Facebook page or follow The Wedge on Twitter @wedgeoffreedom.

Can Organized Medicine Say Goodbye to Bias?

As physicians are saying goodbye to organized medicine maybe organized medicine should realize it is time to say goodbye to bias.

In a recent email “Update” the NJ Association of Osteopathic Physicians and Surgeons trumpeted a headline copied directly from the Governor’s press release:

Governor Murphy Announces Impact of New Jersey’s Actions to Stabilize Health Insurance Market

Can’t we at least report the news without bias and have the debate and discussion in our newsletter rather than a rosy review a Partisan headline?

The recitation of the Governor’s talking points continued:

The reduction in health insurance rates is the direct result of New Jersey’s first-in-the-nation action to continue an individual mandate, after the elimination of the mandate by the Trump Administration at the federal level, and to implement a reinsurance program beginning in 2019. The two laws, signed by Governor Murphy in May, were cited by the Center for American Progress in its listing of New Jersey as the national leader among states for having taken action to protect consumers from federal sabotage of the Affordable Care Act.

Why isn’t the headline, “Governor Murphy forces mandatory tax payer bailout of insurance companies per ACA.” ACA 2010 forces taxpayers to bailout insurance companies and their cronies under penalty of law and IRS.
We can objectively and comparatively report on what health insurance cost in 2009 when basic and essential (B&E) coverage by Horizon was inexpensive before it was canceled due to ACA. For many New Jerseyans, their premiums, deductibles and out-of-pocket costs doubled due to ACA since 2010.

Can’t we at least Report the news without bias and have the debate and discussion in our NJAOPS newsletter rather than a rosy review a partisan headline directly from Trenton?

We do credit NJAOPS for excising this sentence from its version of the Governor’s missive:

“Our work is based on the core belief that health care is a right – not a privilege,” said Governor Phil Murphy. “

 

We also credit NJAOPS with responding positively to this inquiry that they will try to improve their reporting in the future

However, IP4PI will take this opportunity to educate NJ Governor Murphy:

Insurance denials must stop!

To: Lily Tyson, Chief Health Insurance Bureau
NJ Department of Banking and Insurance

Re: Horizon BCBS discrimination

Dear Chief Tyson,

This letter is to make you aware that Horizon BCBS and its affiliates are harming a patient with their precertification, prior authorization, appeal and denial of services processes. The patient indicated below has diabetes and multiple medical conditions, which he diligently and routinely follows up at our office. For the past three months, the patient and I have aggressively pursued a continuous glucose monitoring device to assist both of us in getting his blood glucose under best control.

Despite the fact that the patient and I agree on this, Horizon BCBS and its affiliates have denied the patient this medically necessary item. Further, while the Endocrinology Society, The American Association of Clinical Endocrinologists and the American diabetes association clinical societies all recommend continuous glucose monitoring for best management of diabetes Horizon BCBS and its affiliates insist on harming the patient by denying him this medically necessary tool.

Furthermore, Horizon BCBS medical directors have denied this patient the necessary medical monitoring device, thereby potentially causing their insured harm, and may be liable as they are making care decisions and denial of care decisions for the patient.

I ask:

  1. Do they have the patient’s informed consent to make care decisions?
  2. Are they licensed physicians in NJ?
  3. What is their malpractice coverage for this activity?
  4. Are they specialty trained in endocrinology?
  5. As employees of Horizon BCBS, do they have a conflict of interest?

Horizon BCBS precertification, prior authorization, appeal and denial of service processses are harmful to both patients and physician providers of medical services.  Please put Horizon BCBS on notice to case and desist making clinical care decisions for patients through their onerous and harmful money making processes. This is especially critical in light of the pending NJ law that would mandate the purchase of insurance products like those offered by Horizon BCBS.

Sincerely,

Craig M. Wax, DO, Family Physician

CEO Pay Watch: United Health CEO $27 Million in 2017

$27 Million earned in one year for UnitedHealth’s outgoing CEO, reports the Star Tribune. That’s a lot of moohlah, right?

In the big picture it’s chump change. Get your barf bag ready:

The CEOs of 70 of the largest U.S. health care companies cumulatively have earned $9.8 billion in the seven years since the Affordable Care Act was passed, and their earnings have grown faster than most Americans’ during that time, according to an Axios analysis of federal financial documents.

https://www.axios.com/the-sky-high-pay-of-health-care-ceos-1513303956-d5b874a8-b4a0-4e74-9087-353a2ef1ba83.html

And the above numbers don’t even include 2017.

$10 Billion would pay for a year of Direct Primary Care memberships for over 11 million Americans; that’s almost everyone enrolled in an ACA plan on the individual market.

Anyone wonder where your healthcare dollar and Obamacare ACA tax money is going?

Call your congressman and demand the repeal of ACA Obamacare and let’s let the free market bring up quality and prices down! Capitol Hill Switchboard: (202) 224-3121.

 

Promoting Choice and Competition to Empower Patients and their Physicians

A friend of IP4PI writes in:
I just read President Trump’s executive order on choice and competition across state lines. It has these amazing provisions which have not been discussed in the media at all!! These provisions go to the heart of a competitive market-based healthcare system.
“(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.”
The whole order can be read here: https://www.whitehouse.gov/the-press-office/2017/10/12/presidential-executive-order-promoting-healthcare-choice-and-competition . I love the title to promote choice and competition.  I don’t think the order was overreach, because the language is to ” PRIORITIZE three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).” and “FOCUS on promoting competition in healthcare markets and limiting excessive consolidation “.  I did note this part:” Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.”
Stay tuned for opportunities to comment!