Alexander-Murray Exacerbates Flaw in ACA’s “Catastrophic Plans”

DPC physicians and patients take note!

An aspect of Alexander-Murray will exacerbate an under-appreciated flaw in ACA requirements for plans considered “catastrophic plans.”

Alexander-Murray will allow anyone to have a “catastrophic plan” as such plan is defined by ACA. ACA limits enrollment in these plans to enrollees under 30 years of age or enrollees who have a waiver. Alexander-Murray would do away with these limitations. So far so good.

Another ACA limitation on these plans — found in  ACA section 1302(e) — is that the plans will provide no benefits until the enrollee’s annual out of pocket limit has been reached, except that the plan must cover “at least 3 primary care visits.”

This will harmful to patients of DPC practices and is bad policy. It essentially forces primary care to be handled in-network — great for the insurance companies but not for the patients orthe doctors.

Ideally the requirement should be struck from ACA.  Alternately, a small change along the lines of this or something similar [in brackets] might help fix this problem:

(B)the plan provides—
(ii)coverage for at least three primary care visits, [unless the enrollee is separately contracted with a direct primary care physician, in which case the plan will refund to the enrollee an amount equal to the value of such coverage.]

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IP4PI to CMS: Exempt Independent physicians from ACA MACRA MIPS and APMs

CMS ACA MACRA MIPS and APMs discriminate against independent solo and small primary care practices, while unfairly advantaging hospital health systems who employ doctors. Please exempt solo and small physician practices of 9 or fewer doctors or less than 999 Medicare patients. CMS ACA MACRA MIPS and APMs will put small independent practices out of business and will deprive patients of their physician, jeopardizing their health.

Submit your comments at:

https://www.regulations.gov/comment?D=CMS-2016-0060-3944

The Real Reasons for the Trump Train

I challenge all to examine the real reasons that Donald J. Trump won the Presidency of the United States: 

1. Eight years of failed President Obama administration policies both domestic (Obamacare) and foreign (Iran, Middle East and Benghazi)

2. Democratic party embracing violent racist groups like Black Lives Matter while bashing Trump supporters and Republicans with false accusations of racism. 

3. Mainstream media liberal slant

4. Both Republican and Democrat parties leadership ignoring the will of the people for decades

5. The character, record and selfish profiteering of Hillary Clinton.

Now we must begin the task of the old and new leadership listening to the citizenry, unifying our people behind our founding principles of freedom and liberty, and getting our country back on task to champion individual rights and minimize government intrusion in our daily affairs. 

Craig M. Wax DO

Family physician

Media host

Member of congressional subcommittee National Physicians Committee on Healthcare Policy NPCHCP.org

My Story: Changing to the Direct Primary Care Model at age 50. ~M. AVILES, M.D.

By MARIBEL AVILES, M.D.  President and Physician at Innova Medical Care, P.A. The First Direct Primary Care in Orlando JANUARY 24, 2016 –  I am a  51 years old family doc. After 20 plus years of practice  and having worked in my traditional solo practice, several health care companies-  big and small, hospital based and […]

http://directprimarycarejournal.com/2016/02/14/my-story-changing-to-the-direct-primary-care-model-at-age-50-m-aviles-m-d/

Be there! Exclusive interview with Dr. Ben Carson on Healthcare – January 14

Tune in to Your Health Matters, 89.7 WGLS FM – Rowan Radio – on January 14 at 5:30pm ET US for a one-on-one discussion with the one and only Dr. Ben Carson!

Dr. Carson talks with YHM host and IP4PI founder, Dr. Craig M. Wax about how we CAN maximize high-quality, low cost medical care for all Americans. “We can afford good healthcare,” says Dr. Ben Carson. 

Not in the Rowan Radio listening area? No problem. Join the conversation streaming online at http://wgls.rowan.edu/.

BE THERE!

Obamacare, MACRA, Medicacre and Opting-Out: form Orwellian Chill to Shakespearean Chuckle

In this cowardly new world of government mandated “Meaningful Use” electronic medical records and mandated adoption and application of World Health Organization derived ICD-10 codes to billing, it’s nice to trade the Orwellian chill for a Shakespearean chuckle every once in a while. Today is one of those days. I am a physician and surgeon […]

https://krisheldmd.wordpress.com/2015/11/19/obamacare-macra-medicacre-and-opting-out-form-orwellian-chill-to-shakespearean-chuckle/

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

imageFirst question out of the barrel might be “how can that be”.  It’s really not too difficult to figure out.  A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them.  This has been in the news for a while actually, so how did you end up with United Healthcare.  It’s easy, Catamaran is the Pharmacy Benefit Manager for Cigna, so when United bought the company, it became a subsidiary of United Healthcare, so there you go.  The company is now a subsidiary of the huge too big to fail health insurer, who actually gets 2/3rds of their revenue from insurance policies and the rest from selling software and algorithms for a big chunk of the other third. Continue reading