And In the “More ‘Affordable’ Care Act ‘Good News’ ” Department . . .
Anyone with three or more working brain cells can see that there are serious problems with the Pathetically Puerile Patient Protection and Asinine “Affordable” Care Abomination Act (PPACA), often referred to as “Obamacare”. Yet it seems that each day reveals yet another little hidden “gem” – now that the law’s been passed and we’ve actually been allowed to read it.
The latest little “gem” coming to light is a real pearl. In effect, on 1 January 2014 the law changes who can determine whether an individual qualifies for Medicaid.
No, I’m not talking about the new income limits for Medicaid imposed by the PPACA Medicaid Expansion. I’m literally talking about the law changing who can determine if an individual qualifies for treatment under a state’s Medicaid program at state expense.
Medicaid is a state program – or, more precisely, a collection of individual state programs – to which the Federal government kicks in a large part of the funding. The fraction of the funding provided by Uncle Sam depends primarily on a state’s per capita income. Wealthier states get less; poorer states get more. (Hmm, that sounds familiar – something about “. . . to each according to his need” keeps coming to mind.)
Previously, Medicaid eligibility and rules were determined by state legislatures when they passed enabling state legislation and established regulations for the operation of Medicaid within that state. That’s by design; these are state, not Federal, programs.
The PPACA changes who can make Medicate eligibility decisions.
How? As of 1 January 2014, under Section 2202 of the Pathetically Puerile Patient Protection and Asinine “Affordable” Care Abomination Act hospitals will be allowed to make something called “presumptive eligibility determinations“.
Sound like a good idea? Really? Does letting a fox guard the hen-house sound like a good idea?
What this means is that the hospitals themselves – not State Medicaid officials – will now be allowed to decide whether someone who comes to them for care qualifies under State Medicaid rules for treatment under Medicaid. They’ll do that based on information provided by the patient at the time of treatment. If the hospital decides correctly, the state pays under Medicaid.
But if the hospital blows it, or the information provided by the patient is a lie – the hospital eats the cost of the mistake, right? So there’s no problem, right? Just like they do for emergency care for the indigent?
Wrong. If the hospital is wrong or gets hoodwinked – the hospital still gets paid by Medicaid. For the hospitals, it’s a no-lose proposition. The state pays either way.
Yeah, you’re hearing that correctly. On 1 January 2014, this abomination of a law hands the authority to write checks against Medicaid programs to every hospital in the country that’s qualified as a Medicaid provider, with effectively no penalty if they abuse the privilege. Only blatant criminal fraud will likely be a “showstopper” – and even blatant fraud will likely be damned difficult to prove.
Think that new authority will get abused bigtime? Is the Pope Catholic?
Look, I love hospitals. They’ve almost certainly saved my life at least once, and possibly a second time as well.
But most hospitals are for-profit enterprises. Let me translate that term for our “progressive” brethren, who often struggle with basic economic concepts: that means they exist to make money. So if they have an opportunity to make an extra buck legally – and even sometimes not-so-legally – they will, ethics be damned.
Further: even the non-profit hospitals out there – really aren’t. They just plow their excess earnings into nicer facilities, newer equipment, better bennies, and other such things rather than call them “profits”. They won’t turn down any extra cash, either. Ditto public hospitals; they have operating budgets too, and extra income lets those operating budgets stretch farther.
Insurance, Medicare, and Medicaid fraud perpetrated by healthcare providers and hospitals are today already widespread, huge problems. Hell, IMO healthcare billing practices today already are outrageous and come damn close to criminal fraud as it is. (Don’t believe me? Get a copy of any detailed hospital bill some time and take a hard look at what hospitals charge patients for routine things like aspirin, generic ibuprofen or acetaminophen, bandages, and other minor medical items – on top of their room and nursing charges. Then come back and tell me you don’t believe me.)
If you don’t think this is gonna be abused, I have a bridge to sell you. Great location, high traffic – and I’ll make you a “really good deal”.
It’s looking more and more like any state who opts out of this nonsense absolutely has the right idea.
Category: Health Care debate
What seems to be overlooked by most folks is the difference between healthcare and medical insurance. The Emperor and his minions have succeeded in requiring that all Americans obtain the latter, but they can’t do a whole helluva lot about the former. Thus, many good and large hospitals are accepting only certain insurance and if yours is not among them, congratulations, you have insurance without the healthcare you expected. Ain’t that a kick in the ass? Hospitals get to choose what insurance they will accept but the pickings are slim under obamacare. The cheapest—the affordable—plans pay the least to hospitals and physicians and, so, they are not welcome at an increasing number of hospitals.[Insert laughter here.]
Did you hear about the fellow who signed on through the website and received private info about another fellow? And the government just learned that those “navigators” who are available to help guide a caller through enrollment are not screened for criminal priors. Thus, a con man can easily obtain most every sensitive piece of info about you. And even if that were not true, who is in your home, whether the adults work, and the ages of dependents present can easily be learned during the ‘interview,’ leaving you an easy target for burglary, at least (“Is there a gun in the home?”) All in all, it’s not only a mess, it’s a dangerous mess and one would have to be a bloomin’ moron to sign on to obamacare. Congratulations Congress, especially Reid and Pelosi. Helluva job there!
Wait a second, Hondo. Are telling me that insurance is no guarantee of care? (Giggle.)
But have you heard about what Cameron’s government in the UK has been doing with hospitals? Continuing the closure programme that started back in 1992, to ‘consolidate hospitals for better care’.
In 1992: http://www.independent.co.uk/news/uk/hospital-closures-1533627.html
In 2012: http://www.telegraph.co.uk/health/healthnews/9365881/Hospital-closures-inevitable-and-NHS-operation-rationing-will-continue-warns-think-tank.html
In 2013: http://www.theguardian.com/society/2013/jan/24/nhs-politics-closures
Cash crunches create closures. Hey, that’s cool – a lot of alliteration for a little information.
Oh, yeah, the VA is tearing down its historic older buildings to ‘consolidate its structure for better care’. I sent that off to Jonn this morning.
Yeah – national (lack of) health care is a good thing, isn’t it?
I almost forgot: Carrie Underwood and Brad Paisely were dissing (dissecting) obamacare on the CMA awards last night. I didn’t watch it, but there was a blurb about it on the net this AM.
I can only say this about the mess: 😛 PPPPPPPPPPPPPPPPP
To the morons who voted for obamao in 2008 and 2012 and who are now whining because their insurance plans got cancelled: Schadenfreude’s a sick bitch, and she’s laughing at you right now; and oh, from me to your whiny little liberal asses: GO FUCK OFF…
@ EX-PH2. I just saw it on TV. Very funny you can certainly YouTube it later for a coffee laugh.
Yes, it is, Master Chief.
Did you see the clip about Mr. Thune asking Ms. Sebelius a direct question about whether or not the statement on ‘keep their current insurance’ was true or false? And he got ‘no answer’ (waffling), which is now on record.
Laughed so hard, I almost woke Mikey out of a nap.
EX-PH2 … On a prouder note a fallen Soldier’s truck was center stage last night during CMA’s … I think song of the year!
Good. At least we do know that we are not alone in this mess.
I have here a video of Ms. Sebelius being questioned by Sen. Cornyn (TX) about whether or not the statements by bodaprez and the WH website are true or false.
http://www.cbsnews.com/video/watch/?id=50158615n
Note the waffling and NOT answering a direct question (true or false) with a direct answer.
Sen. Thune’s bit was similar.
I guess it’s more important to Sebelius to kiss the asses is WDC than it is to realize that the videos of her ‘performance’ are on the net (which is Foreverland) and everyone can see them, even those of us who don’t have TVs no mo’.
There isn’t a single official in this administration that can or will give a straight answer short of a gun being put to their heads (figuratively–easy, NSA and Secret Service people) and maybe not even then.
All they have to do is weather this shitstorm, blame the GOP (which seems all too willing to take the blame) and ride it out a midterm election until everyone is in the same shitty system, and then we’ll just blithely accept whatever they give us.
It’s the Alinsky way.
Yeah, but, Sparky, we’re not slurping the warm koolaid out of a plastic tumbler. And some of those who WERE doing that are beginning to come out of their comas. I wouldn’t lump them all together any more.
I saw one of the local news anchors last night asking about the difficulties with the website and ID theft and the manchild (who, btw, was quite adorable; I thought she’d cream her jeans over him) who was discussing it was quite sure that everything will be ‘fixed up’ before too long.
We’re approaching mid-November and I have more done on my stories than the gubbmint has done on its own ‘storytelling’.
Nice to see your tax money at work, isn’t it?
PH2–according to Gallup’s latest poll, Bodaprez is in the high-30’s. Others have him in the low-40’s, at best.
This is WITH a die-hard following, an administration that wouldn’t know the truth if it sat on their faces and wiggled, and an all-too-compliant MSM willing to push any bullshit to keep the real incompetence/malfaesance out of the news cycle.
If people KNEW what they were getting into, if the MSM even gave one microscopic shit about the truth, putting it out there in a timely fashion rather than sitting on it until after the election, he would have been defeated last year in a landslide that would have made Reagan in 1984 or LBJ in 1964 look like a squeaker.
Personally, if the media was even remotely balanced, he’d be in the mid- to low-20’s right now. Yeah, that bad.
NH … all goverment agencies have been instructed by the WH through political appointees to keep everything in the box.
The dedicated career government work force is coming out of their skin … but is not allowed to scream. Now whistle blowing, that is a different story and it takes time to obtain lawyer, present case, obtain status and finally talk. I say, just around run up for 2014 elections there will be a line of government employees rerady to discuss a variety of bed time stories: IRS, Libya, OhBama Care, to name only a few.
@12
One can only hope, Master Chief …
Those Blue states that couldn’t wait to grab all of that new federal medicaid money are now reading The fine print and the shock is setting in. It is unfortunate that they are intoxicated by all the cool-aid that many of them still think the money is free. In Oregon some eighty percent of all Obamacare sign ups are for Medicaid, not Insurance. I’m sure that the same is true in my home state of WA. The fact that the program is only funded thru 2015 at the 90 per cent rate. At that time the funding for Expanded Medicare must be met by the states. Without massive new taxes the Blue states will be spiraling towards bankruptcy. Itoldyaso!
Now I have a fuggin’ headache.
Well, Master Chief, Sparky, now bodaprez is trying to soothe those who have wounded feelings by saying he’s ‘sorry they lost their coverage’, etc. (link here) http://news.msn.com/us/obama-says-hes-sorry-americans-losing-insurance
without actually saying he was sorry for making those promises in the first place.
D’you know what it’s like when something tastes like feet? Yeah.
Well, I do hope bodaprez knows what a crapweasel is, because he’s a crapweasel double bigtime.
I’m sitting here laughing about this mess after spending two hours backing up my stuff on my computer to a standalone backup, partly because I’m tired and partly because there is a new theft virus going around called a ‘codelocker’, something even the NSA can’t crack if they can’t get to it in time.
I would love to wish that sheissich virus on the maroons who cook up these asinine ideas in Washington. Especially the NSA, CIA, and whoever the shmuchs are that are behind it all.
Sie sind Arschlochen.
@17. Yes, its’s a nasty little bugger but it infects only dimwits who open files attached to emails from obviously suspicious and unknown senders, as I understand it.
What I don’t understand is how these ransom virus guys get away with it. I mean, a ransom has to be paid. That money goes to an account, doesn’t it. I really do wish I knew more about how these guys get away with this stuff, even if they are operating out of mud hut in Nigeria.
They’re hiding behind walls that even the Matrix would envy, as I understand it. Apparently, the code encryption has a countdown clock and if the code isn’t cracked before it hits ‘0’, your files are gone for good. Which is why I hope someone at NSA is dumb enough to open something by mistake.
All I know is that it comes from somewhere in Russia, and if these are part of the population that grew up living on blackmarket barter and criminal activity that the KGB couldn’t stop, they a) don’t give a damn who gets hurt; and b) will probably never get caught.
It’s just too bad they don’t use their powers for good. 😉
Get a copy of any detailed hospital bill some time and take a hard look at what hospitals charge patients for routine things like aspirin, generic ibuprofen or acetaminophen, bandages, and other minor medical items – on top of their room and nursing charges.
True, but also note that if you have insurance, what the hospital bills is often 3x to 5x more than what insurance actually pays. It’s all a numbers game, but those without insurance get stuck with (and pursued for) the whole amount, even though the hospital knows that on average they will only get about 25% of what they ask for. This sort of crap hurts the working poor most of all (because those on Medicaid don’t have to worry in the same way as those just not-poor enough to qualify have to worry*). Also, because different plans may pay differentially, an armada of clerks are needed to keep things even close to straight, thus adding phenomenonally to costs, even though they clearly provide no actual medical value. The US health care system is screwed up and needs to be fixed, that is indisputable. However, Obamacare is not the way to do it.
*In my starting-out naive days I tried to waive the out-of-pocket co-payment fee for poor patients but was soon set straight by the money people. Waiving the co-pay while submitting the rest for reimbursement from Medicare or Medicaid is considered insurance fraud. This occasionally leads to the insane situation of slipping the patient a nice portrait of Andrew Jackson for him to give my clerk on his way out, because I am seriously worried about his condition and want him to come back for a follow-up without forcing him to make the choice between the co-pay and feeding his kids. What a f*’d up system.
Mike_C: true. And irrelevant.
The insurance companies and the Federal/state governmental bodies that pay out know that the hospitals’ charges are inflated as hell. That’s why they refuse to pay more. And they have the size to demand a fairer payment in exchange for their business (the volume of business gives them leverage).
The individual consumer has no such leverage, and gets screwed by hospitals and (often) other medical providers regarding charges. The price gouging in many cases is so extreme it could be considered criminal fraud.
It’s not only private medical care that inflates its bills, either. I’ve seen the VA charge a co-payment for an over-the-counter item obtained through a VA pharmacy that was literally 4 times the commercial cost of an equivalent item purchased at Wal-Mart (a 1 oz tube of antibiotic ointment). The co-payment was $8.00. A 2-pack of 1-oz tubes of an equivalent antibiotic ointment purchased OTC at Wal-Mart was $3.97 plus tax.
Hondo, you ought to know by now that the standard co-pay for prescription anything from the VA is $8.00.
And you also should know, if you don’t already, that Walgreen’s, Walmart, CVS, Osco, and even Family Dollar stores all take coupons, and Walmart and CVS both have rewards points that you can use to help pay for something.