Thursday, April 2, 2009

Health Care and the Stimulus

The US Federal Government has just recently passed the largest economic stimulus package in history. The bill was a gargantuan hodgepodge of our tax dollars thrown into various markets to try and stimulate spending, credit, and other economic channels. However, with all the hoopla, conversation by endless talking heads, and media attention over all the hundreds of billions of promised government bailout money, little has been said as to who will get what. What we do know is that our children and grandchildren will be choking under the burden of paying for it for decades to come.
Part of the stimulus bill was devoted to health care. According to MastersInHealthCare.com, a list of the Top 10 aspects of the bill concerning health care can be found on their site--(http://www.mastersinhealthcare.com/blog/2009/10-things-you-need-to-know-about-the-healthcare-stimulus/). One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Here is the overview:

1.) Health care industry set to go tech: One of Obama’s umbrella strategies for reforming health care and stimulating the economy involves pumping money into health care technology systems. He hopes to create a health information network for hospitals, rural and urban clinics, and other health care centers by making all medical records electronic; making existing medical technologies more accurate and effective; and reducing errors in medical care. This technology boost to the health care system will, Obama hopes, save money, create jobs, and improve the standards and delivery of health care and medical information. The Dallas Business Journal reports that the stimulus package will invest $19 billion for health information technology.

2.) The unemployed will still receive health care benefits, at least temporarily: Obama plans to ease the burden of health care costs for the unemployed and reduce the number of uninsured Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals who get unemployment checks would also be able to receive Medicaid, as would their spouses and children who are under the age of 19, reported the New York Times in January. States will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com reported that Obama "released $15 billion in economic stimulus Medicaid funds for states" to disperse.

3.) Children’s Health Insurance Program Reauthorization Act of 2009: The Senate and House reformed the Children’s Health Insurance Program under this legislation, which extends insurance to nearly 4 million more children by reworking the Social Security Act. The program will help families of low-income children who do not qualify for Medicaid pay for their health insurance, and states will still be able to set their own income eligibility requirements. The program is funded by a tax increase on cigarettes.

4.) Governors hold power over releasing funds: While the federal government has designed and approved the health care stimulus package, governors are in charge of actually releasing funds, creating eligibility requirements when appropriate, and overseeing the implementation of the stimulus plan in their states. In late February, governors like Louisiana’s Bobby Jindal (R), opposed many parts of the economic plan and may reject at least some of the money that is coming to their state from the federal government. The New Orleans Times-Picayune reports on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to Medical News Today, other governors are begrudging about accepting funds that are meant to be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are arguing for more flexibility in how they disperse the federal funds.

5.) Federal government helps states fund COBRA for unemployed: The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired, switching between jobs, or have dependents at the time they stop working the option to continue their group health benefits for a limited time. Some beneficiaries may have to pay for the group rate insurance, however, but the U.S. Department of Labor holds that "COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage." Under Obama’s stimulus plan, the federal government will provide states with subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA premiums "for eligible workers who are involuntarily terminated," according to the accounting firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily terminated on and after September 1, 2008, and qualifying employers include those who are subject to COBRA legislation, as well as small employers who are subject to State Continuation legislation.

6.) Job training funding for those entering health care industry: In another measure to stimulate the economy while improving health care standards, Obama plans to increase job training opportunities for those entering the health care industry. The stimulus budget has allotted $750,000,000 "for a program of competitive grants for worker training and placement in high growth and emerging industry sectors," $500,000,000 of which will go to renewable energy programs. The rest will be distributed by the Secretary of Labor "giv[ing] priority to projects that prepare workers for careers in the health care sector."

7.) Preventive care takes precedent: In his address to Congress in February, Barack Obama outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the health care reform boasts "the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control." According to a report by NPR, this move would also create jobs, at least in the short term, even if it did not result in sustainable medical research projects, as hoped.

8.) A contract for accountability: In order to promote accountability in health care reform and to make sure that all of this funding is actually helping the economy and the health care industry, Obama’s plan includes a contract between the federal government and the Institute of Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute to "produce and submit a report to the Congress and the Secretary [of Health and Human Services] by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research" that will eventually be subjected to public commentary and review.

9.) Health IT dominates in all areas of medical industry: The stimulus package lists several ways in which new health care information systems and technologies will help the facilitation of medical care and the industry as a whole. These include the exchange of patient medical records and a subsequent reduction in wait times at hospitals and health care facilities; the increase of telemedicine technologies for those living in rural areas and who do not have access to cutting edge medical resources; "technologies that help reduce medical errors;" and "technologies that meet the needs of diverse populations."

10.) Total health care stimulus cost: $150 billion: The total cost of all these (and more) health care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion, according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid incentive programs, $2 billion for technology grants, and $19 billion for a health information technology movement.
According to an article on Bloomberg.com by Betsy McCaughey, former lieutenant governor of New York and an adjunct senior fellow at the Hudson Institute, there are hidden issues that need more exploration and evalution in the health care stimulus package. The bill’s health rules will affect “every individual in the United States”. Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors. But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions. These provisions in the stimulus bill are virtually identical to what Tom Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.” Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.
Also, the report goes on to talk about penalties. Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time”. What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make. The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research. The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs.
Additionally, according to Bloomberg.com, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later. The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. Hiding health legislation in a stimulus bill is intentional. The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.
According to Medscape Medical News, the aim is not simply to provide relief but stimulus, with the hope of making the road to recovery less long and winding for some things that will move reform ahead. Those things include significant new appropriations for comparative effectiveness research, health information technology, and prevention and wellness.
According to National Review Online, this stimulus bill is the biggest land grab in the health sector ever attempted by the federal government, and it would be a major step toward thrusting full responsibility for health-care financing onto the American taxpayer—today and for decades to come. Also, there will be a substantial burden on employers: The bill would impose a back-door mandate for them to continue providing health insurance to workers long after those workers have left. PricewaterhouseCoopers says the ten-year cost of this provision would be up to $65 billion just for those workers currently eligible for COBRA (the current program through which people can participate in ex-employers’ health plans). The estimated costs would be even higher if many more workers retire early, as they likely will if they know they can continue their employment-based coverage indefinitely. The U.S. already spends $2.2 trillion a year on health care.
Americans must be vigilant where our tax money is spent, especially for health care. Bigger is not always better.
Until next time. Let me know what you think.

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