Another reason Republicans hate Obamacare

[ProSense]

The new tax on the high-income earners and the wealthy.

Reported when the law passed in 2010:

A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.

http://www.nytimes.com/2010/03/24/business/24leonhardt.html

Krugman in 2011:

<...>

What would real action on health look like? Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure; limiting the tax deductibility of private insurance plans; and so on.

And what do these things have in common? They’re all in last year’s health reform bill.

That’s why I say that Mr. Obama gets too little credit. He has done more to rein in long-run deficits than any previous president. And if his opponents were serious about those deficits, they’d be backing his actions and calling for more; instead, they’ve been screaming about death panels.

Now, even if we manage to rein in health costs, we’ll still have a long-run deficit problem — a fundamental gap between the government’s spending and the amount it collects in taxes. So what should be done?

- more -

http://www.nytimes.com/2011/02/18/opinion/18krugman.html

It's the law, 2013:

Net Investment Income Tax

A new Net Investment Income Tax goes into effect starting in 2013. The 3.8 percent Net Investment Income Tax applies to individuals, estates and trusts that have certain investment income above certain threshold amounts. The IRS and the Treasury Department have issued proposed regulations on the Net Investment Income Tax. Comments may be submitted electronically, by mail or hand delivered to the IRS. For additional information on the Net Investment Income Tax, see our questions and answers.

Additional Medicare Tax

A new Additional Medicare Tax goes into effect starting in 2013. The 0.9 percent Additional Medicare Tax applies to an individual’s wages, Railroad Retirement Tax Act compensation, and self-employment income that exceeds a threshold amount based on the individual’s filing status. The threshold amounts are $250,000 for married taxpayers who file jointly, $125,000 for married taxpayers who file separately, and $200,000 for all other taxpayers. An employer is responsible for withholding the Additional Medicare Tax from wages or compensation it pays to an employee in excess of $200,000 in a calendar year. The IRS and the Department of the Treasury have issued proposed regulations on the Additional Medicare Tax. Comments may be submitted electronically, by mail or hand delivered to the IRS. For additional information on the Additional Medicare Tax, see our questions and answers.

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

It's Obamacare.
http://www.democraticunderground.com/10023715400

[liberal N proud]

1. They are subservient to Grover and his no tax pledge.

[ProSense]

3. Greed. n/t

[spanone]

2. republicans hate whatever their donors tell them to hate....

hence republicans hate the affordable care act

[ProSense]

4. And this is a small tax. n/t

[spanone]

5. it's totally irrational. as is the republican party.

[ProSense]

7. Some of them are lunatics. n/t

[gopiscrap]

6. Exactly

[ProSense]

8. The other reason is that

they hate the poor: http://www.democraticunderground.com/10023790604

[ProSense]

9. Kick! n/t

[ProSense]

10. Another!

Let it sink!

[Mojorabbit]

11. There will have a real fight on their hands depending on what

this includes, " Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure".

Every patient will not fit a standard algorithm. Doctors will hopefully rebel if they try too hard to act like insurance companies do and deny care that the doc on the ground deems necessary. Every family doc I know is waiting to see how this plays out.

[ProSense]

13. Of course

"There will have a real fight on their hands depending on what this includes, 'Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure.'

Every patient will not fit a standard algorithm. Doctors will hopefully rebel if they try too hard to act like insurance companies do and deny care that the doc on the ground deems necessary. Every family doc I know is waiting to see how this plays out."

...it'll meet resistance, especially from the insurance companies and those who put money ahead of quality care.

Will ACOs Pave the Path to Reform?

by David GornFriday, July 26, 2013

Accountable care organizations could be the linchpin of successful health care reform, according to experts at a forum last week in San Francisco.

"ACOs only take up seven pages in the uncountable number of pages in the Affordable Care Act but they are at the moment one of the fastest growing and most important elements of reform," said Wendy Everett, president of NEHI, previously known as the New England Health Institute, which sponsored the July 17 event in San Francisco.

"They're changing how health care is delivered and paid for in this country," Everett said, "and they're a vital and important part of what we're doing."

Everett said there are currently about 250 ACOs in the country, "with another 500 new groups that have submitted to be an ACO so far this year," she said.

- more -

http://www.californiahealthline.org/capitol-desk/2013/7/will-acos-pave-the-path-to-reform

More Doctors, Hospitals Partner to Coordinate Care for People with Medicare

Providers Form 106 New Accountable Care Organizations

Doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries now have access to high-quality, coordinated care across the United States, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.

Doctors and health care providers can establish Accountable Care Organizations in order to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. Accountable Care Organizations share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” said Secretary Sebelius. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative could be up to $940 million over four years.

The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.

The group announced today also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.

Also today HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.

For more information on the HHS issue brief, “Growth in Medicare Spending per Beneficiary Continues to Hit Historic Lows,” visit: http://aspe.hhs.gov/health/reports/2013/medicarespendinggrowth/ib.cfm

Additional information about the Advance Payment Model is available at http://www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.

The next application period for organizations that wish to participate in the Shared Savings Program beginning in January 2014 is summer 2013. More information about the Shared Savings Program is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/

For a list of the 106 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html

http://www.hhs.gov/news/press/2013pres/01/20130110a.html

[Mojorabbit]

14. No, it will meet resistance from good doctors

who want to treat their patients in the manner they deem necessary. Spare me your links. My husband is already in an ACO and has been for a good while and all the docs are caring for their patients as they think medically necessary. If enough treatments start being denied payment you will see rebellion. Once again, humans do not always fit an algorithm.

[ProSense]

15. Yeah,

"No, it will meet resistance from good doctors who want to treat their patients in the manner they deem necessary. Spare me your links. "

...I'm really relishing the fact that Obamacare is now enrolling people. After all the bullshit fear mongering and misinformation, the detractors got nothing.

^^^^no "links"^^^^

[Mojorabbit]

16. I am not sure what you are talking about

Every doc I know is thrilled that people will be able to get insurance including my husband who has had a pre existing condition for decades and has been unable to buy insurance till now.

That is not what we were discussing. We were discussing some administrative docs deciding how care should be given and deciding what care they will deny payment for, just as insurance companies do now. I was making a point that all patients will not fit in a pigeon hole and that may be an issue in the future. You then changed the subject.

[ProSense]

18. That sounds like

"I am not sure what you are talking about

Every doc I know is thrilled that people will be able to get insurance including my husband who has had a pre existing condition for decades and has been unable to buy insurance till now.

That is not what we were discussing. We were discussing some administrative docs deciding how care should be given and deciding what care they will deny payment for, just as insurance companies do now. I was making a point that all patients will not fit in a pigeon hole and that may be an issue in the future. You then changed the subject."

...a RW talking point, a misrepresentation of the board.

<...>

Medicare, on the other hand, is a big budget problem. But raising the eligibility age, which means forcing seniors to seek private insurance, is no way to deal with that problem....The answer is to do what every other advanced country does, and make a serious effort to rein in health care costs. Give Medicare the ability to bargain over drug prices. Let the Independent Payment Advisory Board, created as part of Obamacare to help Medicare control costs, do its job instead of crying “death panels.” (And isn’t it odd that the same people who demagogue attempts to help Medicare save money are eager to throw millions of people out of the program altogether?) We know that we have a health care system with skewed incentives and bloated costs, so why don’t we try to fix it?

http://www.nytimes.com/2012/11/16/opinion/life-death-and-deficits.html

The OP is primarily about the tax on high income earners.

[Mojorabbit]

19. You posted the link with the quote I was commenting on

'Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure."

I responded that that may be a problem with the medical community. I resent your insinuation that my response was akin to a right wing talking point. I am a retired nurse, my husband is a Democrat and a physician. It is not a right wing talking point. It is big discussion on the private doc boards. No one goes to school for that many years just to have some docs in admin somewhere decide how you should best treat your patients. No one likes it when the insurance companies try to do it and no one likes it when some other docs removed from the situation who have never seen your patient do it either. If you have something to say about my response to information YOU posted then please do. I would love to hear it.

[ProSense]

21. Not only

"I responded that that may be a problem with the medical community. I resent your insinuation that my response was akin to a right wing talking point. I am a retired nurse, my husband is a Democrat and a physician. It is not a right wing talking point. It is big discussion on the private doc boards. No one goes to school for that many years just to have some docs in admin somewhere decide how you should best treat your patients. No one likes it when the insurance companies try to do it and no one likes it when some other docs removed from the situation who have never seen your patient do it either. If you have something to say about my response to information YOU posted then please do. I would love to hear it."

...is this an already existing practice, but also the RW fear mongering around it creates the impression that it will ration care (death panels).

<...>

In 1991, as a commissioner on the Physician Payment Review Commission of Congress, I thought the RUC was a useful institution. I continue to believe so.

There is, in my view, great merit in government’s solicitation of the views of the profession whose economic affairs are being partially determined by the Medicare fee schedule. We should be thankful for the dedicated physicians who devote so much of their time to serving on the RUC Indeed, the C.M.S. recently wrote to the RUC, acknowledging its debt to these physicians.

As it happens, however, the C.M.S. tends to accept the RUC’s recommendations on RVU changes more than 90 percent of the time, which effectively makes the RUC the final arbiter in these matters. I do not believe that slavish acceptance of the RUC’s recommendations is a good thing, if only because the physicians on the RUC do labor under at least the appearance of a conflict of interest.

Medicare requires changes in the RVUs to be budget neutral overall, effectively forcing a zero-sum game on the RUC. This means that when the RUC recommends raising the RVU for some services, the RVUs of other services must be decreased. That adjustment has led to the “budget neutrality adjustment” in the American Academy of Family Physicians’ numerical example shown above.

http://economix.blogs.nytimes.com/2010/12/10/the-little-known-decision-makers-for-medicare-physicans-fees/

What is the RUC?

The AMA formed the RUC in 1991 to act as an expert panel in making recommendations to CMS on the relative values of Current Procedural Terminology (CPT) codes using the Resource-Based Relative Value Scale (RBRVS) that was mandated by Congress in 1989. For example, the RUC might propose that a 99214 is worth 2.53 relative value units (RVUs) while a left heart catheterization (code 93510) is worth 40.54 RVUs. RVUs are based on three components – physician work, practice expenses and professional liability; however, the RUC is primarily concerned with the first two (see “Anatomy of a Medicare payment,” and “It's all relative”). The RUC meets three times each year (February, April and September) for the purpose of developing its recommendations, which are then accepted, rejected or modified by CMS.

The RUC is composed of 29 members and 29 alternate members. Twenty-three of the members are appointed by major national medical specialty societies, including the AAFP, and each has one alternate member as well. Three of these seats rotate every two years; two are reserved for an internal medicine subspecialty, and the other is open to any other specialty. Representatives of the CPT Editorial Panel, the Health Care Professionals Advisory Committee and the Practice Expense Review Committee comprise three other seats. The remaining three seats are filled by representatives of the AMA, the American Osteopathic Association and the chair, who is appointed by the AMA. (See “Current RUC composition.”) The AAFP's RUC representative and alternate are appointed by the chair of the AAFP Board of Directors based on recommendations from the AAFP Commission on Practice Enhancement.

Of the 29 members of the RUC, only five currently represent primary care specialties as defined by the AAFP. The vast majority of the representatives to the RUC are appointed by other surgical, procedural or subspecialties. As a result, the work of representing primary care issues to the RUC has often been difficult.

The RUC also has an advisory committee. Each of the 109 specialty societies seated in the AMA House of Delegates, including the AAFP, may appoint one physician to serve on the RUC Advisory Committee. The advisers attend the RUC meetings and present their societies' recommendations, which the RUC evaluates. Specialties represented on both the RUC and the Advisory Committee must appoint different physicians to each committee to distinguish the role of advocate (i.e., the adviser) from that of evaluator (i.e., the RUC member). The AAFP's RUC adviser, like the RUC representative and alternate, is appointed by the chair of the AAFP Board of Directors.

http://www.aafp.org/fpm/2008/0200/p36.html

The IAPB brings this practice into the light. The members have to be confirmed by the Senate and the board's recommendations have to be approved by Congress.

<...>

Key to these savings is a proposal to strengthen the Independent Payment Advisory Board – IPAB, which was created by the Affordable Care Act. Here’s how IPAB works:

• 15 experts including doctors and patient advocates would be nominated by the President and confirmed by the Senate to serve on IPAB.
  
  
• IPAB would recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care.
  
  
• IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.
  
  
• Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB’s recommendations.

<....>

http://www.whitehouse.gov/blog/2011/04/20/facts-about-independent-payment-advisory-board

[Mojorabbit]

23. As I told you before

My husband is in the medical field. I am a retired nurse.We belong to multiple doctor discussion lists. It is a highly discussed topic. It is not a right wing meme. You can stop throwing out a lot of useless links. I am pretty well informed on the subject. There has been no interference as of yet. If there is there will be pushback. That is all. This has nothing whatsoever to do with rationing and I have no idea why you are inserting that into the discussion.

[ProSense]

24. Well,

"You can stop throwing out a lot of useless links. I am pretty well informed on the subject. There has been no interference as of yet. If there is there will be pushback. That is all. This has nothing whatsoever to do with rationing and I have no idea why you are inserting that into the discussion."

...you may not care about anyone else's opinion or the facts at those ("useless links&quot , what you said (http://www.democraticunderground.com/10023795712#post19) has everything to do with "rationing":

"That is not what we were discussing. We were discussing some administrative docs deciding how care should be given and deciding what care they will deny payment for, just as insurance companies do now. I was making a point that all patients will not fit in a pigeon hole and that may be an issue in the future. You then changed the subject."

It's also a mischaracterization of the board.

[Mojorabbit]

25. Pushing doctors into practicing within narrowly defined standards of care

and denying them payment if they do not practice within those parameters is not rationing care. I don't believe you have an inkling of what I am talking about and I am thinking this discussion is a waste of time. You have brought up three different issues instead of what we were discussing, accused me of using right wing memes, and do not seem to be able to grasp what I am trying to say. Perhaps it is me. I am overtired this evening. I think I will hit the sack. Have a lovely rest of the evening.

[ProSense]

27. Actually,

"Pushing doctors into practicing within narrowly defined standards of care and denying them payment if they do not practice within those parameters is not rationing care. I don't believe you have an inkling of what I am talking about and I am thinking this discussion is a waste of time."

...I know exactly what you're "talking about" and it's a misrepresentation of the board. I suspect you know that, which is why you aren't interested in the "useless links" that counter the point you're trying to make.

[Mojorabbit]

29. No you do not know what I am talking about. It is obvious from your links and your responses.

I was trying to be polite but you really don't. I am not misrepresenting anything. I am tired of your snark and really, you do have no idea. But of it makes you feel good to think you do and that I am just misrepresenting, have at it. Now I am really off to bed. This was a huge waste of my time.

[ProSense]

31. It's a misrepresentation

You want to be right, but your description of the program runs counter to the facts, and you fail to acknowledge that the practice is already in place.

[FarPoint]

12. It is good to keep all of these details in check.

This is why they,the GOP-Tea Party Terrorist want to end ObamaCare, ACA.....this is why they are holding America hostage!

Let us bookmark this....

[freshwest]

17. ProSense, this is the democraphic that will NOT be hurt by shutdown or default:

Tea Party radicalism is misunderstood: Meet the “Newest Right”

Our sense of the force currently paralyzing the government is full of misconceptions -- including what to call it

http://www.salon.com/2013/10/06/tea_party_radicalism_is_misunderstood_meet_the_newest_right/

This is what many don't want to believe, but it's the truth. And why the stakes are higher than anyone thought. It's not just some lunatic congressmen.

Obama's Social Security plans are shown in your article.

Obamacare is doing exactly what the progressives wanted, to lift the cap to ensure solvency of all these programs.

This is good news about Obama's plans, but very bad news about the GOP's plans. They will continue, they have the power to do so.

[ProSense]

20. These people are

"This is good news about Obama's plans, but very bad news about the GOP's plans. They will continue, they have the power to do so. "

...are delusional hypocrites. They're likely in the group of morons who don't realize that food stamps and Medicare are Government programs. Even if they do, they find some bullshit reason to justify their hypocrisy.

refuses to sign up for the ACA but has 10 kids on medicaid
http://www.democraticunderground.com/10023790066

It's like watching coverage of natural disasters in areas where people have sworn off government, and when the devastation is overwhelming they find a reason to seek government help.

Government is government, whether federal, state or local. These hateful assholes would eventually find a way to attack their fellow citizens (each other) if they didn't get their way. They're selfish idiots.

This means something: United we stand, divided we fall.

[ProSense]

22. Not to make light of this point

from the piece you linked to:

While each of the Newest Right’s proposals and policies might be defended by libertarians or conservatives on other grounds, the package as a whole—from privatizing Social Security and Medicare to disenfranchising likely Democratic voters to opposing voting rights and citizenship for illegal immigrants to chopping federal programs into 50 state programs that can be controlled by right-wing state legislatures—represents a coherent and rational strategy for maximizing the relative power of provincial white elites at a time when their numbers are in decline and history has turned against them. They are not ignoramuses, any more than Jacksonian, Confederate and Dixiecrat elites were idiots. They know what they want and they have a plan to get it—which may be more than can be said for their opponents.

True enough, though I still say they're selfish hypocrites who would eventually turn on each other.

In any case, that statement is true enough. They do know what they want, and the first part of their plan is to sabotage the federal government. Their actual power, as we saw in 2010, comes at the state and local level.

"The conservative plan is sabotage "

From the piece posted here: http://www.democraticunderground.com/10023788963

"In this sense, conservative Washington is a botch that will keep on working even after its formal demise. It defunded the constituencies of the liberal state while constructing a plutocracy that will stand regardless of who wins the next few elections and that will weight our politics rightward for years."

http://www.salon.com/2013/10/02/reaching_for_the_pillars_the_conservative_plan_is_sabotage/

Yet people pretend it's only happening in Washington. Across the country, Republicans are digging in to help their Washington counterparts sabotage the the federal government.

Look at Wisconsin. Texas would benefit greatly if Wendy Davis won.

The Cruelty of Republican States in One Chart
http://www.democraticunderground.com/10023790604

[Thinkingabout]

26. Texas needs help i getting state exchanges set up but I am hopeful Wendy Davis will bring great

Joy to Texas. It is going to be a battle I am willing to work. I have been fortunate in my life to always be insured but have hope for every citizen in the US. It might not be perfect but much better than none.

[Historic NY]

28. liars and losers...........

[Jamaal510]

30. K&R