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A Plan to Repeal and Replace Obamacare

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Obamacare is a proven policy failure. Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process. Congress must focus on the fundamentals: equalizing the tax treatment of health insurance; restoring commonsense regulation of health insurance; and addressing the serious need for reform in Medicare and Medicaid by adopting policies that give individuals control over their health care. High quality health care means all Americans should be free to choose a health care plan that meets their needs and reflects their values. Congress must act now to repeal Obamacare and replace it with a new set of options that empower Americans, not government.

Read the full report at Heritage.org.

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Alabama Should Open Up Doors to Direct Primary Care

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Alabama should consider making sure direct primary agreements do not constitute insurance under state law, one of the greatest hurdles facing DPC models today. This would free doctors and patients from many expensive regulations imposed under the state’s insurance code. It would also help open up the state’s health care market to more DPC programs and improve health care freedom across Alabama. According to the Docs4PatientCare Foundation, “14 states [have] thus far [chosen] to clarify that DPC is not a ‘risk-bearing entity’ for the purposes of regulation by state insurance commissioners.” Similar proposals have been introduced over the past year in Georgia and Tennessee, and another will soon be introduced in Maine.

Under a direct primary care program, patients pay a monthly membership fee, typically ranging from around $50 to $80. As part of the membership, patients receive a more generous allocation of appointments than they would under most traditional plans, even when taking into account some same-day appointments and house calls. The guarantee of a set monthly fee removes the layers of regulation and bureaucracy created by the traditional insurance system and allows physicians to see fewer patients and focus more on each patient.

Routine tests and procedures are also included in most DPC plans, and lower membership fees are often charged for programs that do not provide these additional services. According to the Docs4Patient Care Foundation, under a DPC model, medical practice overhead can be reduced by as much as 40 percent. Proponents of DPC programs agree these services are best used in conjunction with a high-deductible health care insurance plan or another form of catastrophic coverage to handle in-patient health care services. The American Academy of Family Physicians has endorsed the DPC model.Direct primary care empowers patients and doctors, giving them more freedom to establish and participate in health care provider models that work best for all patients. Alabama should remove unnecessary regulatory barriers to direct primary care to help revitalize the state’s primary health care system.

Direct primary care empowers patients and doctors, giving them more freedom to establish and participate in health care provider models that work best for all patients. Alabama should remove unnecessary regulatory barriers to direct primary care to help revitalize the state’s primary health care system.

Read the full research and commentary at The Heartland Institute.org

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“What Happens When Doctors Only Take Cash”? Everybody, Especially Patients, Wins

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Time has a great story about bringing basic market forces to medicine. Titled “What Happens When Doctors Only Take Cash,” the article uses the Oklahoma City Surgery Center as a model for a different way of doing business. Co-founded by the outspoken libertarian Keith Smith and Steven Lantier, two anesthesiologists, the center takes no insurance whatsoever. Instead, they take cash only and advertise and guarantee their prices and services. The result is pretty goddamned amazing…

The all-inclusive price for every operation is listed on the website. A rotator-cuff repair for the shoulder costs $8,260. A surgical procedure for carpal tunnel syndrome is $2,750. Setting and casting a basic broken leg: $1,925….

The Surgery Center would charge $19,000 for [patient Art Villa’s] whole-knee replacement, a discount of nearly 50% on what Villa expected to be charged at his local hospital. And that price would include everything from airfare to the organization’s only facility, in Oklahoma City, to medications and physical therapy. If unforeseen complications arose during or after the procedure, the Surgery Center would cover those costs. Villa wouldn’t see another bill.

Read the full article at Reason.com.

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Americans Experience Personally ObamaCare’s Broken Promises

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While millions of people have received health coverage through the Affordable Care Act, many millions more have felt personal harm.  Republican leaders have provided assurances that repeal and replace measures will protect the people who are receiving coverage now under the health law.  And considerable effort also is being devoted to building a bridge to new coverage that will protect others from the damage that it has done and is doing to their pocketbooks and their access to medical coverage and care.

The costs of health insurance are crippling many families’ finances, including forcing them to work extra jobs.  An Uber driver who lives in Maryland told me last week that he is working this second job so he can pay for health insurance. The premium for the policy for himself, his wife, and one child is $1,200 a month.  He must spend hours away from them every week to meet his obligation to provide coverage. While many millions are covered, millions more are pleading for relief.

The impact on young people. One of the ways that the Affordable Care Act tried to help young people was by allowing them to stay on their parents’ policies until age 26.  But this provision is not free.  “We find evidence that employees who were most affected by the mandate, namely employees at large firms, saw wage reductions of approximately $1,200 per year,” according to Gopi Shah Goda and Jay Bhattacharya of Stanford and Monica Farid of Harvard.

As this new wave of young adults was added to their parent’s existing job-based policies, the cost of coverage inevitably climbed.  Companies responded by scaling back cash wages as a share of overall compensation. The study found that the costs of the 26-year-old mandate weren’t “only borne by parents of eligible children or parents more generally.” The costs were spread to each worker—not just the dependents’ parents.

Read the full article at Forbes.com.

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A doctor’s perspective: Who stands for patients in the health-care debate?

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The AMA owns the coding system that every doctor in America is required to use in order to be reimbursed by insurance; it makes a stunning $72 million off the program every year. It is in patient’s best interests to reverse the trend of ever-increasing health insurance costs, but the AMA depends on the health-insurance industry for money.

The American people are the victims of a system so complex that even many practicing physicians have a hard time unraveling it. But they are certain that their patients’ needs are suffering. Your physician, the one delivering or caring for your children, the one who guides you through your twilight years, has little voice and less confidence in this establishment, mirroring the feelings of frustrated Americans

There is hope.

Dozens of grassroots physician groups are working for real reform. We are aligned together and actively collaborating, to find real solutions to heal our sick system.  United, we have a stronger voice to advocate for our patients. We see your suffering. It’s personal for us, because medicine is personal. You learn that the first time you interview a patient and lay your hands on them for examination.

We believe reducing administrative glut and creating more choices of coverage are the two main components to increase quality access to care and reduce cost for all. The Health Rosetta Principles, formulated as a collaborative effort among entrepreneurs and visionaries in the health-care space, covers the basic tenants of our proposed changes. A  specific, patient-centric representative plan has been developed by the Docs4Patient Care Foundation.

It’s time for Congress and President Trump to let our nation’s doctors help shape the future of healthcare.  It’s time for our government to listen to America’s doctors, who have their patients’ best interests at heart.

Read the full article at Philly.com.

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Virginia Lawmakers Discuss Direct Primary Care Bill

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An alternative to the usual medical billing set-up is the hot topic tonight at the state capitol. A bill that could get traction again this year would support the growing movement of direct primary care.

The health insurance reform commission heard Thursday from doctors and other supporters of this care model. Last year, the governor vetoed legislation that would have clarified state law on direct primary care.

Some are hoping to see this legislation make it through for 2017.

“It finally came to me at one point that the problem was that we were working for the wrong employer. That is we had forgotten that we worked for patients,” said Dr. Garrison Bliss, chair of the Direct Primary Care Coalition.

Doctor Garrison Bliss was a pioneer of direct primary care in Seattle. He’s pleased to see that practice expanded to hundreds like his across the country. The concept is patients pay a flat monthly fee to a doctor and have unlimited access to office visits.

“And primary care is actually the center-post upon which healthcare rides. And when it is not there, health care gets more expensive and more dangerous,” said Bliss.

 

Read the full article at NBC 29.

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Democrats Defect from Obamacare

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For practically all of the Obama administration, the partisan battle lines over the Affordable Care Act were clear. Democrats love it. Republicans want to kill it. End of story, right?

But at the end of 2016, as President Barack Obama prepared to leave office and the health care law entered another open enrollment period, something unexpected happened: Democrats stopped defending Obamacare. It wasn’t despair over the law’s fate in the hands of President Trump. The trend began when Hillary Clinton was still the presumptive winner.

In October, Minnesota’s Democratic governor, Mark Dayton, complained publicly that although the health law had “many good features,” it was “no longer affordable to increasing numbers of people.” Around the same time, Democratic House Minority Leader Nancy Pelosi, whose determination to pass health care legislation helped push the bill over the congressional finish line in 2010, was asked on Meet the Press about the high price of health insurance premiums under the law. “Let’s see how it works, and let’s improve it,” was her response. She also noted, as she has before, that what she would really “love” is a single-payer system. Just three years before, as the law’s coverage expansion kicked in, she had touted it as a path to “more affordability, more accessibility, better-quality care, prevention, wellness, a healthier nation honoring the vows of our founders of life, a healthier life.”

Also in October came complaints from former President Bill Clinton about a provision of the law that provides financial assistance to individuals at between 100 and 400 percent of the poverty line. “The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies,” he said at a rally in Michigan. He called the subsidy scheme “crazy” and declared that “it doesn’t make sense. The insurance model doesn’t work here.”

Read the full article at Reason.

 

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Price Transparency Is Nice. Just Don’t Expect It to Cut Health Costs.

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You probably know where to pump the cheapest gas and how to get price comparisons online in seconds for headphones and cars. But how would you find the best deal on an M.R.I. or a knee replacement? No idea, right?

This lack of price transparency in health care has been cited as one of the reasons we spend too much on it. It’s easy to overpay. Health care prices vary tremendously. And there is no established relationship with quality.

In Los Angeles and San Francisco, one analysis found, mammography prices vary by over a factor of five — from a low of $128 to almost $700. Prices for IUDs and lower-back M.R.I.s vary by a factor of three. An examination of Massachusetts health care prices found nearly a fourfold variation in M.R.I. prices. Despite these differences, even patients motivated to find the lowest price often can’t.

Read the full article at the NYT website.

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Direct Primary Care for Local Governments

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Local governments across North Carolina, like other employers, are wrestling with the question of how to provide quality health care to their employees in a cost-effective manner. This is particularly important for local governments because those plans are paid for by taxpayers.

One county, Union County, has piloted an innovative program in an attempt to both lower the cost of providing health care to its employees and improve the quality of, and access to, that care. In 2015, Union County expanded its health benefits to include a Direct Primary Care (DPC) option for employees.1It is the first county in the state to offer such a plan, and its experience offers valuable lessons to other counties.

What is DPC?

Direct primary care (DPC) is a simplified health care business model that removes insurance companies from basic primary care. In exchange for a monthly, out-of-pocket fee, patients have unrestricted access to their physician and unlimited access to a defined package of services. In most cases, primary care physicians are available around the clock, in person, by phone, through text, and even via Skype. There is no limit to how often patients can access their doctors or how many services (from within the defined package) can be used. Much like a gym membership, which allows a person unrestricted access to whatever equipment and classes they wish as often as they wish, DPC grants access to whatever primary care the patient needs. And all of this is done for an average monthly fee of around $75.2,3

DPC has been around for 20 years but has only recently started to grow significantly in popularity. As of 2014, over 4,400 doctors in the U.S. had transitioned to direct primary care delivery. While this represents less than 2 percent of family doctors in the U.S., it is a significant increase from just 146 in 2005.4

Read the full article.

 

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Here’s an alternative to your despised high-deductible health care plan

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No matter what President-elect Trump and the Republicans do to Obamacare, health care costs are going to continue to rise.

The reason is straightforward: Both before and after Obamacare, health care costs rose predominantly because of unnecessary utilization of health care resources. Decades of unnecessary blood tests, X-rays, specialty visits, ER visits, surgeries and inpatient hospitalization represent an epidemic that’s been every bit as financially devastating as an infectious disease. Insurance premiums reflect the trend: In 2015, the average annual cost of employer-sponsored family health plans was $17,545, with employees contributing on average $4,955.

As a result, employers have had to make a difficult choice. Given that high-deductible health plans (HDHPs) are about 10 percent cheaper than PPOs, more and more employers have been turning to HDHPs to save money. But this decision is tough on employees. Switching to an HDHP doesn’t prevent their premiums from rising; it just prevents them from rising as much as they would have. And in some cases, their deductibles rise so much that they end up paying for most of their health care completely out of pocket.

One way employers can reduce employee outrage is to sign them up with a primary care physician who practices direct primary care, a relatively new model.

In January, after having spent 20 years as a faculty member at the University of Chicago, I left academia to start my own direct primary care practice, ImagineMD, in downtown Chicago. Currently there are approximately 4,000 to 8,000 such practices in the U.S. Just as you don’t use your car insurance to pay for oil changes and tire rotations, in direct primary care, you don’t use your health insurance to pay for primary care visits. Employers are charged a modest retainer fee per employee per month to provide their employees 24/7 access to their primary care physicians via phone and same-day or next-day appointments.

In addition, the direct care model can actually save money for self-insured employers and their employees despite the upfront fee, making it a potential antidote to general dissatisfaction with HDHPs. This is because the improved access to a direct care provider actually reduces the rate of unnecessary health care utilization. In one study, researchers evaluated the cost-benefit of the largest direct primary care practices in the U.S. In 2010 (the most recent year of the study), these patients experienced 83 percent fewer elective admissions, 56 percent fewer non-elective admissions, 49 percent fewer avoidable admissions, and 63 percent fewer non-avoidable admissions when compared to patients in traditional fee-for-service practices.

Read the entire article at Crain’s Chicago.

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