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

Is the hysteria about health insurance covering #pre-existing medical conditions #FakeNews?

Yes. The media hysteria that Republicans want to deny healthcare to Americans with pre-existing health conditions is #FakeNews. And here’s why:

ACA changed the health insurance industry from individual rating to community rating. This is a chief reason premiums have doubled since 2010. With individual rating, a healthy non-smoker pays less than someone that is an unhealthy smoker with cancer; rightfully so. With community rating under ACA, everyone’s insurance costs go up because the unhealthy smokers are often not paying a rate proportionate to the costs they are likely to impose on the system; unfair from a self maintenance perspective. Although ACA purportedly allows the imposition of a “smoker’s penalty” it is not required and a number of states (including California and New York) prohibit higher rates for smokers.

Then came the liberal social justice argument of what shall we do with those that are unhealthy smokers with cancer? The answer that had worked previously to Obamacare were risk pools. People with risk, just like bad drivers with extensive crashes, were assigned to companies to except the risk. ACA Obamacare did away with the risk pools and now everyone is considered a high risk and expensive. From the quality and price perspective, it seems fair to charge everybody the same. From the perspective of self-respect and taking care of oneself, it is completely unfair to rate people in this way.

The latest hysteria on pre-existing insurance coverage is indeed a political strawman argument, not a real issue..

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

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.]

The AMA is utter garbage. But, you knew that.

Here they go again. Once again the AMA is promoting what’s best for the big government / big insurance / big hospital cartel instead of advocating solutions that will truly empower patients, physicians, and increase access to high-quality, low-cost care.

How can we motivate Congress to act on ACA? End their illegal exemption!

From our friends at Independent Women’s Voice:

For the Senate to pass ObamaCare repeal and replace with only 51 votes, they’ll need to take action by September 30th.

How can we motivate Congress to act? By President Donald J. Trump ending Congress’ illegal exemption from ObamaCare.

Here’s what you need to do STAT:

  1. Sign the petition at www.NoWashingtonExemption.com
  2. Write President Trump and tell him to end the illegal exemption: https://www.whitehouse.gov/contact
  3. Read this explainer from Michael Cannon of CATO to become an expert on this crucial issue: http://www.washingtonexaminer.com/congress-illegal-and-egregious-obamacare-exemption-explained/article/2633383