Lessons in Maryland for Costs at Hospitals
By EDUARDO PORTER
CUMBERLAND, Md. — This hardscrabble city at the base of the Appalachians makes for an unlikely hotbed of health care innovation.
Yet Western Maryland Health Systems, the major hospital serving this poor and isolated region, is carrying out an experiment that could leave a more profound imprint on the delivery of health care than President Obama’s reforms.
Over the last three years, the hospital has taken its services outside its walls. It has opened a diabetes clinic, a wound center and a behavioral health clinic. It has hired people to follow up with older, sicker patients once they are discharged. It has added primary care practices in some neighborhoods.
The goal, seemingly so simple, has so far proved elusive elsewhere: as much as possible, keep people out of hospitals, where the cost of health care is highest. Here, the experiment seems to be working.
Hospital admissions here are down 15 percent. Readmissions have fallen, too. In 2011, 16 percent of people who had been discharged went back into the hospital. Now, that figure is 9 percent. Many patients report that they are happier with the care.
And Western Maryland has reaped financial rewards. In the fiscal year ending in June, the system made an operating profit of $15 million on about $370 million in revenue, said Barry P. Ronan, the chief executive. That’s a spectacular return, given that the average margin at hospitals across the state is a meager 0.8 percent.
Western Maryland’s initiatives to take charge of people’s health, rather than simply provide services for a fee, fit a core objective of federal health care reform: changing hospitals and related facilities into something resembling an Accountable Care Organization.
Yet the innovations taking place in this corner of Appalachia rest on a policy that the architects of President Obama’s health care reforms never tried to emulate. Indeed, this innovation was only possible because in Maryland, hospital fees are subject to government price controls.
Western Maryland Healthcare System is one of 10 rural hospitals that agreed with the state’s Health Services Cost Review Commission to accept a guaranteed budget every year to take charge of the health care of the community they serve.
If revenue comes in under the budget one year, the hospitals are allowed to increase prices the next to make up for the deficit. If revenue exceeds the budget, however, they must reduce prices to give the surplus back.
Death Panels: This Time, Maybe Not So Scary
By PAULA SPAN
Give Representative Earl Blumenauer, an nine-term Democrat from Oregon, credit for two things. First, a sense of humor: He began an op-ed piece he wrote for The New York Times a few years back with, “I didn’t mean to kill Grandma.” He sometimes adopts the very phrase he got slurred with in 2010, referring to himself, ironically, as “the death-panel guy,” just as the president and his administration now embrace “Obamacare.”
Yes, it was Mr. Blumenauer who, as part of the effort to overhaul health care, introduced into the legislation an unremarkable provision requiring Medicare to cover voluntary discussion with a physician about advance directives and treatment preferences at the end of life. These consultations would take place every five years, more often if a patient’s health declined substantially.
Critics of our health care system frequently lament that providers are paid to do things — order tests, perform procedures — but not simply to talk with patients. Mr. Blumenauer, with co-sponsors and supporters in both parties, intended to change that. He’d been dismayed by the dreadful Terry Schiavo case in Florida. “One family’s tragedy turned into a political spectacle,” Mr. Bluemenauer told me. “This was something that was entirely preventable.”
Opponents of Obamacare seized on this modest idea — asking patients what they want really shouldn’t be so controversial — as the embodiment of evil. The falsehoods — that the provision was mandatory (no), that it advocated or enabled euthanasia (no) — spiraled, culminating in Sarah Palin’s denunciation of “death panels.”
So let’s give Mr. Blumenauer credit, secondarily, for nerve: He and several co-sponsors, again from both parties, have introduced the Personalize Your Care Act of 2013, which once more would provide for Medicare and Medicaid coverage of voluntary discussions of advance care planning. His initial effort “derailed in the heat of the debate about health care reform, the superheated rhetoric, the Tea Party frenzy,” he said. Now, “the hysteria has died down.”
This time, Mr. Blumenauer has vowed to meet with all 435 members of the House to explain his idea and seek their support, and has passed the 100-member mark. Even so, he doesn’t think the bill can pass this year. By 2014 or 2015, he thinks, “the time will be right.”
Wal-Mart to Offer Health Benefits to Domestic Partners
By THE ASSOCIATED PRESS
Wal-Mart Stores will extend its health care benefits to its American workers’ domestic partners, including those of the same sex, starting Jan. 1.
The company, the nation’s largest private employer, has been a target of attacks by labor groups for what they call substandard wages and benefits. It said Tuesday that the changes were made so it could have a uniform policy for all 50 states at a time when some states have their own definitions of what constitutes domestic partnerships and civil unions.
Employees can enroll their domestic partners from Oct. 12 through Nov. 1.
Wal-Mart defines domestic partners as spouses of the same-sex or opposite gender. They must be unmarried partners who are not legally separated, who have lived together for at least 12 months, are not married to anyone else, are in an exclusive relationship and plan to continue sharing a household indefinitely, said Randy Hargrove, a Wal-Mart spokesman.
“States have different definitions,” Mr. Hargrove said. “We are going to have our own definition that will apply to our associates.”
Americans oppose withholding funds for health law, poll shows
By Noam N. Levey3:00 AM PDT, August 28, 2013
| advertisement |
WASHINGTON -- While Americans remain deeply divided over President Obama’s healthcare law, a clear majority opposes withholding funding to implement the 2010 law, a new national survey indicates.
Fifty-seven percent of Americans say they disapprove of cutting off funding for the Affordable Care Act, while just 36% say they would approve such a move, according to the most recent poll from the nonprofit Kaiser Family Foundation.
Making suspension of the healthcare law a condition for future funding of the federal government has emerged this summer as a favored strategy by many Republicans looking for ways to derail final implementation of the law.
A large group of GOP lawmakers on Capitol Hill has urged Republican leaders to reject any government appropriations legislation this fall that continues to provide money for the law, even if the move would lead to the shutdown of the federal government.
But nearly 7 in 10 Americans who oppose this tactic said in the recent poll that “using the budget process to stop a law is not the way our government should work.”
‘Breaking Bad’ Is Fully Dependent on Our Broken Health-Care System
By Tricia Romano
The Daily Beast, August 27, 2013
When Breaking Bad first aired on AMC in January 2008, the country wasn’t yet in a recession and Obamacare wasn’t a word, but the health-care debate was front and center.
Though candidates Barack Obama and Hillary Clinton differed on the specifics, they agreed that the U.S. health-care system, which was bankrupting so many people, needed an overhaul. (John McCain, of course, didn’t support anything resembling single-payer or universal health care.)
By the time Breaking Bad’s second season premiered, everything had changed. The unemployment rate was skyrocketing, and people were losing their homes. Obama had just been sworn in and promised to reform the health-care system. Fixing health care wasn’t just a pie-in-the-sky dream; it now had a renewed urgency.
Walter White (Bryan Cranston)’s initial foray into making meth was about paying for his cancer treatment and keeping his family from going broke. And he was a manwith health insurance. Imagine his desperation had he been without it, as 55 million Americans are, according to the Commonwealth Fund.
In Breaking Bad’s first few seasons, Walt struggled to come up with the cash to pay for his treatment. The $5,000 deposit at the oncology center was a fraction of the overall expense, which would total $90,000, a number only the rich could afford. Forget about a high school chemistry teacher. Later his hospital stay runs up another $13,000 tab. And while Walt grumbles to Skyler (Anna Gunn) about stealing from his pension, he does the math—it’s going to take a lot of meth to make a dent in his financial hole.
On Sunday night, during White’s gross, false videotaped “confession,” he talked about how he was afraid the cancer diagnosis would “bankrupt his family.” He spoke of paying for his brother-in-law Hank (Dean Norris)’s health care—$177,000—which Hank called the “last nail in the coffin” preventing him from going to the DEA and spilling the beans.
In what other country would “I paid for your health care” be a menacing bribe?
If Breaking Bad had aired the ’80s, it would have read as a giant “Just Say No” campaign. But in 2013, with health-care costs rising and Obamacare on the brink of becoming a reality, the show’s main takeaway isn’t “meth is bad,” “money is evil,” or “people can’t change their nature.” Breaking Bad almost seems to be saying good health care is worth killing for.
Walter White finds other reasons to continue his downward spiral into madness—he’s a prideful, resentful, ego-driven sociopath, after all. Skyler was asking Walt how much money would be enough to feed his ego and desire for power when she took him to the storage unit and showed him a bed of cash. But though his cancer had receded at that point, Walt’s bed of money is a good reminder of how much money Americans really need to cover their health-care expenses, for cancer in particular. According to the National Cancer Institute, national cancer-care costs were $124 billionin 2010—$12.12 billion of that just for lung-cancer costs.
http://www.pnhp.org/print/news/2013/august/‘breaking-bad’-is-fully-dependent-on-our-broken-health-care-system
Several Republican-led states at the forefront of the campaign to undermine President Obama’s health-care law have come up with new ways to try to thwart it, refusing to enforce consumer protections, for example, and restricting federally funded workers hired to help people enroll in coverage.
And in at least one state, Missouri, local officials have been barred from doing anything to help put the law into place.
Updated: 9:19 AM
"We are a very rural state, we are the oldest state in the nation, and older people have higher per-capita health care costs. And we don't have a lot of competition in our health care markets," said Mitchell Stein, public policy director for Maine-based Consumers for Affordable Health Care.
Maine's health care costs averaged $8,521 per person in 2009, the most recent year for which statistics are available from the Centers for Medicare and Medicaid Services.
The Daily Beast, August 27, 2013
When Breaking Bad first aired on AMC in January 2008, the country wasn’t yet in a recession and Obamacare wasn’t a word, but the health-care debate was front and center.
Though candidates Barack Obama and Hillary Clinton differed on the specifics, they agreed that the U.S. health-care system, which was bankrupting so many people, needed an overhaul. (John McCain, of course, didn’t support anything resembling single-payer or universal health care.)
By the time Breaking Bad’s second season premiered, everything had changed. The unemployment rate was skyrocketing, and people were losing their homes. Obama had just been sworn in and promised to reform the health-care system. Fixing health care wasn’t just a pie-in-the-sky dream; it now had a renewed urgency.
Walter White (Bryan Cranston)’s initial foray into making meth was about paying for his cancer treatment and keeping his family from going broke. And he was a manwith health insurance. Imagine his desperation had he been without it, as 55 million Americans are, according to the Commonwealth Fund.
In Breaking Bad’s first few seasons, Walt struggled to come up with the cash to pay for his treatment. The $5,000 deposit at the oncology center was a fraction of the overall expense, which would total $90,000, a number only the rich could afford. Forget about a high school chemistry teacher. Later his hospital stay runs up another $13,000 tab. And while Walt grumbles to Skyler (Anna Gunn) about stealing from his pension, he does the math—it’s going to take a lot of meth to make a dent in his financial hole.
On Sunday night, during White’s gross, false videotaped “confession,” he talked about how he was afraid the cancer diagnosis would “bankrupt his family.” He spoke of paying for his brother-in-law Hank (Dean Norris)’s health care—$177,000—which Hank called the “last nail in the coffin” preventing him from going to the DEA and spilling the beans.
In what other country would “I paid for your health care” be a menacing bribe?
If Breaking Bad had aired the ’80s, it would have read as a giant “Just Say No” campaign. But in 2013, with health-care costs rising and Obamacare on the brink of becoming a reality, the show’s main takeaway isn’t “meth is bad,” “money is evil,” or “people can’t change their nature.” Breaking Bad almost seems to be saying good health care is worth killing for.
Walter White finds other reasons to continue his downward spiral into madness—he’s a prideful, resentful, ego-driven sociopath, after all. Skyler was asking Walt how much money would be enough to feed his ego and desire for power when she took him to the storage unit and showed him a bed of cash. But though his cancer had receded at that point, Walt’s bed of money is a good reminder of how much money Americans really need to cover their health-care expenses, for cancer in particular. According to the National Cancer Institute, national cancer-care costs were $124 billionin 2010—$12.12 billion of that just for lung-cancer costs.
http://www.pnhp.org/print/news/2013/august/‘breaking-bad’-is-fully-dependent-on-our-broken-health-care-system
The Register's Editorial: Why tie insurance to jobs?
In many households, one spouse buys health insurance through a job for the entire family. Now United Parcel Service Inc. has announced it intends to cut this coverage for working spouses of nonunion employees next year. About 15,000 spouses will need to obtain coverage through their own jobs.
The change will not affect those spouses who cannot get their own coverage because their employers do not offer it or the families of about 250,000 UPS workers who belong to unions.
A UPS spokesman said the change is necessary to keep costs down. Companies certainly can save money by no longer subsidizing health insurance for employees’ husbands and wives. That trend predates passage of the Affordable Care Act, and saving money is why such a policy is becoming more common.
In Congress, a Bid to Undo Dialysis Cuts
By ERIC LIPTON
WASHINGTON — Eight months ago, Congress ordered the Obama administration to eliminate a stark example of federal government waste: more than $500 million a year in excessive drug payments being sent to dialysis clinics nationwide.
But in a demonstration of just how hard it is to curb spending in Washington, more than 100 of the same members of Congress who voted in January to impose the cut are now trying to push the Obama administration to reverse it or water it down.
The conflicting message is due in part to the lobbying muscle of an industry dominated by two companies — DaVita Healthcare Partners of Denver and Fresenius, based in Germany — both of which have seen their bottom lines improve since 2011, when the federal government first started making the excessive payments.
While most of Washington has been on vacation, industry lobbyists aligned with nonprofit groups that in many cases they helped set up or finance have orchestrated a textbook campaign to protect the payments. They argue that the potential cut of $29.52 per patient visit from the previously planned $246 reimbursement for next year would force them to close or curtail services at some of the more than 5,000 dialysis centers nationwide.
At issue is how the government reimburses dialysis clinics. Until 2011, the government paid clinics for each dosage of an anti-anemia drug administered, a practice that led to concern that clinics were overusing the drug. But after adopting a flat fee for dialysis, the use of the drug plunged, while the dialysis companies’ earnings margins rose. That prompted Congress to order a cut in the drug fee.
Some outside experts say the industry is now effectively enlisting patients and members of Congress as a lobbying tool to protect their payments. The real problem, they say, is that the industry continues toopen or acquire new clinics even as growth in the number of patients on dialysis nationwide has slowed.
“Patients should not be used as pawns in a series of scare tactics to protest a change in a payment,” said Richard Berkowitz of Skokie, Ill., who said he was repeatedly pressured when he recently visited his dialysis clinic to sign a petition protesting the cuts, even though he routinely does dialysis on his own at home.
The industry — which lists dozens of lobbyists, including former Representative Earl Pomeroy, Democrat of North Dakota, and Thomas A. Scully, who ran the Medicare program from 2001 to 2004 — has proved its clout in Washington before. It persuaded Congress to pass legislation that as of 2011 allowed the industry to receive an annual adjustment in its reimbursement rate, which it will get in the coming year. That will slightly reduce the impact of the other proposed cut.
The federal government for decades has covered the cost of what is called end-stage kidney disease, the only chronic disease that has this automatic coverage. The benefit has cost the government more than $32.9 billion a year, the biggest part of it for dialysis. The result is that about 90 percent of the dialysis patients served by a company like DaVita rely at least in part on federal insurance.
Company officials say the drug payments should be maintained because they help the companies with other costs not sufficiently covered by the federal reimbursements.
States find new ways to resist health law
And in at least one state, Missouri, local officials have been barred from doing anything to help put the law into place.
The actions have drawn less attention than congressional efforts to cut off funding for the law, or earlier state decisions to refuse to set up online insurance marketplaces or reject an expansion of Medicaid, which sharply limited the law’s reach.
But the moves could impede Obama’s most significant domestic accomplishment, which, despite having withstood a Supreme Court challenge and a presidential election, still faces doubts about its viability. And they could affect implementation at a crucial time, just as some of the major provisions of the law, also known as Obamacare, are set to go into effect.
Maine tackles the rising cost of health care
Posted:TodayUpdated: 9:19 AM
The state, ranked fifth in per-capita health spending, is devising strategies for efficiencies when Obamacare arrives.
By Joe Lawlor jlawlor@pressherald.com
Staff Writer
States have begun tackling an issue that has vexed employers, individuals and governments at all levels for years: trying to control the rapidly rising cost of health care. Maine has an especially difficult task because it ranks fifth among the states for per-capita health care costs, according to 2009 federal statistics.Staff Writer
"We are a very rural state, we are the oldest state in the nation, and older people have higher per-capita health care costs. And we don't have a lot of competition in our health care markets," said Mitchell Stein, public policy director for Maine-based Consumers for Affordable Health Care.
Maine's health care costs averaged $8,521 per person in 2009, the most recent year for which statistics are available from the Centers for Medicare and Medicaid Services.
Choosing Wisely in Maine: Be Prepared with the Right Health Care Information
A guest post from Choosing Wisely in Maine
Life happens. As it does, it’s inevitable that you’ll see the inside of a doctor’s office. Although most of these visits will be routine scheduled checkups, some might be more serious.
Whatever the reason, it’s important to be prepared with the right information before you talk with your health care provider.
Choosing Wisely in Maine
Choosing Wisely®, a national initiative led by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports, is helping patients and health care providers have more informed conversations. Did you know you have access to dozens of fact sheets and tips available through the Choosing Wisely in Maine Campaign? All of these are made available from Consumer Reports, a trusted source of research and reporting since 1936. Together, the Choosing Wisely in Maine Campaign, the ABIM Foundation and Consumer Reports have one goal: to help you have more informed conversations with your doctor/health care provider.
What you should be asking your health care provider
Ask your doctor/health care provider these five questions before any medical test or procedure at your next appointment:
http://catchinghealth.bangordailynews.com/2013/08/28/im-not-your-mother-but/choosing-wisely-in-maine-be-prepared-with-the-right-health-care-information/
Life happens. As it does, it’s inevitable that you’ll see the inside of a doctor’s office. Although most of these visits will be routine scheduled checkups, some might be more serious.
Whatever the reason, it’s important to be prepared with the right information before you talk with your health care provider.
Choosing Wisely in Maine
Choosing Wisely®, a national initiative led by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports, is helping patients and health care providers have more informed conversations. Did you know you have access to dozens of fact sheets and tips available through the Choosing Wisely in Maine Campaign? All of these are made available from Consumer Reports, a trusted source of research and reporting since 1936. Together, the Choosing Wisely in Maine Campaign, the ABIM Foundation and Consumer Reports have one goal: to help you have more informed conversations with your doctor/health care provider.
What you should be asking your health care provider
Ask your doctor/health care provider these five questions before any medical test or procedure at your next appointment:
http://catchinghealth.bangordailynews.com/2013/08/28/im-not-your-mother-but/choosing-wisely-in-maine-be-prepared-with-the-right-health-care-information/
Portland working hard to combat homelessness, but changes to MaineCare could make problem worse anyway
PORTLAND, Maine — The city has been touting its recent efforts to combat homelessness, but some say the problem remains serious and is about to get worse.
In November, the City Council adopted the recommendations of a task force it appointed to come up with ideas for reducing and preventing homelessness. The recommendations included centralizing the intake process for emergency shelters, expanding case management services, and building new facilities to house homeless individuals.
The city is now using a seven-pronged strategy to implement the recommendations, and the results are starting to show.
For example, 300 adults who used city shelters have found stable housing this year, an increase of 30 percent over the same period in 2012, according to the city’s Department of Health and Human Services.
And after seeing steep increases year after year in the number of clients its shelters serve, the city saw a slight decrease last month: 439 people, down from a record-high 444 in July 2012.
“We’re still at an unprecedented level, but the trend is starting to reverse,” said Douglas Gardner, the department’s director.
At an Aug. 15 news conference, Mayor Michael Brennan hailed the work of the 18-member task force, social service organizations such as Preble Street and United Way, city staff and others for the progress that’s been made.
“We have pulled together a diverse group of partners who are working in tandem to seek solutions. This collaboration has become the catalyst to success best demonstrated by the hundreds of men, women and families who now have a home to call their own,” Brennan said.
Preble Street Executive Director Mark Swann agrees. “I think in all my years here, this has been the most focused, targeted and collaborative effort we’ve made to put a dent in the problem [of homelessness],” he said Monday.
There’s no single reason for the progress that’s been made, according to Gardner. Homelessness is a complex problem with many contributing causes, he said. But he cited a few of the seven prongs that are already helping.
The Portland Housing Authority is now providing rent vouchers so that homeless individuals can be rapidly rehoused. And case management has become a major focus. For example, clients coming into any city shelter now must meet with a case manager to develop an individualized plan to secure housing.
Services on the street have been expanded, too. Outreach workers now canvas city streets and campsites to help homeless individuals, 12 hours a day, six days a week.
“We’re really trying to meet folks where they are,” Gardner said.
Other prongs will not show results immediately. For example, the city has allocated $50,000 to fund siting and other pre-development work to build additional permanent housing for homeless individuals. And city planners are working to determine how zoning regulations may need to be adjusted in order to build a housing facility.
Meanwhile, a new challenge looms on the horizon: imminent changes in MaineCare, the state’s Medicaid program.
The unsteady rollout of Obamacare
By Caroline Poplin, M.D.
McClatchy-Tribune News Service, Aug. 26, 2013
Any program as large and complex as Obamacare (not to mention one facing such entrenched opposition) is going to encounter some turbulence on its shakedown cruise. But the recent glitches are as important for what they tell us about reform, as for what they do.
Obamacare (more formally, the Patient Protection and Affordable Care Act) will cover millions of currently uninsured Americans as advertised -- but with as little disruption to corporate profits as possible. Patients and taxpayers are to shoulder most of the additional cost.
The administration will delay for one year -- until 2015 -- the requirement that large employers offer their employees decent insurance, or pay a small penalty (the so-called "employer mandate"). There was no corresponding delay of the individual mandate, the requirement that all citizens sign up for insurance coverage starting in 2014, the most unpopular provision of ACA. This means that next year employees of the recalcitrant firms will have to buy health insurance without any contribution from their employers.
The Congressional Budget Office estimates this delay could affect up to a million people. If families cannot afford the insurance offered on the new exchanges, and fall below 400 percent of the poverty line, taxpayers will pick up part of the tab. The Kaiser Foundation calculates that about half the uninsured will qualify for Federal subsidies.
Congressional Republicans (and some Democrats) passed a bill to delay the individual mandate also. However, no one in Washington really wants that; it would hurt the insurance companies, who are adamant that young, healthy individuals be required to enroll so as to cover the costs of the sick, who will sign up right away.
The administration also quietly postponed for a year ACA annual and lifetime limits on out-of-pocket costs in some employer-sponsored plans. This delay will fall hardest on the sickest -- patients with diseases like cancer, multiple sclerosis, or HIV, where the costs of drugs alone can easily exceed $100,000 a year.
Democrats winced and largely remained silent. Republicans chortled, passed another symbolic bill, and continue to obstruct the ACA wherever they can.
Business contended -- and the administration apparently agreed -- that these two provisions were too complicated to implement on time. However, these are large corporations that deal with complex matters all the time -- and they had three years to plan. By contrast, figuring out the new exchanges, benefit packages and tax subsidies will be at least as difficult for individuals, who get just three months to plan; most exchanges will not be up until October, and people must enroll by January.
Is there something wrong with this picture?
http://www.pnhp.org/print/news/2013/august/the-unsteady-rollout-of-obamacare
McClatchy-Tribune News Service, Aug. 26, 2013
Any program as large and complex as Obamacare (not to mention one facing such entrenched opposition) is going to encounter some turbulence on its shakedown cruise. But the recent glitches are as important for what they tell us about reform, as for what they do.
Obamacare (more formally, the Patient Protection and Affordable Care Act) will cover millions of currently uninsured Americans as advertised -- but with as little disruption to corporate profits as possible. Patients and taxpayers are to shoulder most of the additional cost.
The administration will delay for one year -- until 2015 -- the requirement that large employers offer their employees decent insurance, or pay a small penalty (the so-called "employer mandate"). There was no corresponding delay of the individual mandate, the requirement that all citizens sign up for insurance coverage starting in 2014, the most unpopular provision of ACA. This means that next year employees of the recalcitrant firms will have to buy health insurance without any contribution from their employers.
The Congressional Budget Office estimates this delay could affect up to a million people. If families cannot afford the insurance offered on the new exchanges, and fall below 400 percent of the poverty line, taxpayers will pick up part of the tab. The Kaiser Foundation calculates that about half the uninsured will qualify for Federal subsidies.
Congressional Republicans (and some Democrats) passed a bill to delay the individual mandate also. However, no one in Washington really wants that; it would hurt the insurance companies, who are adamant that young, healthy individuals be required to enroll so as to cover the costs of the sick, who will sign up right away.
The administration also quietly postponed for a year ACA annual and lifetime limits on out-of-pocket costs in some employer-sponsored plans. This delay will fall hardest on the sickest -- patients with diseases like cancer, multiple sclerosis, or HIV, where the costs of drugs alone can easily exceed $100,000 a year.
Democrats winced and largely remained silent. Republicans chortled, passed another symbolic bill, and continue to obstruct the ACA wherever they can.
Business contended -- and the administration apparently agreed -- that these two provisions were too complicated to implement on time. However, these are large corporations that deal with complex matters all the time -- and they had three years to plan. By contrast, figuring out the new exchanges, benefit packages and tax subsidies will be at least as difficult for individuals, who get just three months to plan; most exchanges will not be up until October, and people must enroll by January.
Is there something wrong with this picture?
http://www.pnhp.org/print/news/2013/august/the-unsteady-rollout-of-obamacare
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