Can you tell us what this means - or do you need some lawyer to explain it to you. Thanks in advance!
MARCH 9, 2011 In Health Law, Rx for Trouble By JANET ADAMY Sandy Chung is grappling with a new kind of request at her pediatrics office in Fairfax, Va.: prescriptions for aspirin and diaper-rash cream. Dr. Sandy Chung, a Virginia pediatrician, says she is inundated with requests to prescribe nonprescription drugs because of the new health law. Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar. It says people who want a tax break to buy such items with what's known as flexible-spending accounts need to get a prescription first. The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies. "It drives up the cost of health care as opposed to reducing it," says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine. Though the new rules on over-the-counter drugs amount to a small part of the massive overhaul of the health-care system, the unintended side effects show how difficult it can be to predict how such game-changing legislation will play out in the real world. Some doctors, irked by the paperwork and worried about lawsuits, are balking at writing the new prescriptions. Pharmacists and retailers say the changes mean they have to apply a personalized label on some 15,000 different everyday products for customers paying with certain debit cards. fied expectations. The over-the-counter provision isn't the only part of the health-care law that has de experts predicted that new insurance pools for high-risk patients would attract so many expensive enrollees that funding would be quickly exhausted. In fact, enrollment is running at just 6% of expectations, partly because of high premiums. A provision preventing insurers from denying coverage to children with pre-existing health conditions prompted insurers in dozens of states to stop selling child-only policies altogether. And a piece of the law designed to centralize patient care by encouraging health-care providers to collaborate is running into antitrust concerns from regulators. To the handful of congressional aides who came up with the idea to limit tax breaks on over-the-counter drugs, it was supposed to be a minor tweak to raise revenue and to discourage wasteful spending on health products. Some 33 million Americans are in families that have flexible-spending accounts, which are funded through payroll deductions and allow consumers to pay for health expenses with tax-free dollars. The change also applies to health savings accounts designed for consumers in insurance plans with high deductibles. If fewer people use these accounts to buy drugs, the government gets more tax revenue. Retail sales of over-the-counter medicines amounted to about $17 billion in 2010, not counting sales at Wal-Mart Stores Inc., according to Nielsen Co. What the law's writers didn't anticipate was the determination of some people to squeeze every last drop of tax savings from their accounts. When Dianna Greer of San Diego and her son came down with a cold, she wanted a $13 bottle of NyQuil and daytime cold medicine—and she wanted to pay for it by tapping the $5,000 in her flexible-spending account. Ms. Greer says her doctor wouldn't write prescriptions without an office visit, so she went without the drugs. Later, she got the prescriptions from a doctor at the emergency room, where she was diagnosed with pneumonia. "It feels like you're begging for something when it's your money," she says. Much of the health law, which passed last year despite overwhelming opposition by Republicans, doesn't take effect until 2014. The nonpartisan Congressional Budget Office has projected that an additional 32 million Americans will get insurance, and the law has already extended tax credits to small businesses for buying insurance and allowed many parents to keep their children on their health plan until their 26th birthday. But opponents say it costs too much and gives the federal government too much control over health care. Republicans in the House voted this year to repeal the law, though the measure died in the Senate. Opponents are trying to get it struck down in the courts, a fight that is likely to last until at least next year. As that larger battle plays out, the over-the-counter provision is emerging as a top target for change. Republicans in both the House and Senate have introduced legislation to repeal it and return to the old system. The largest chain drugstore lobbying group is backing the effort, arguing that the new rules are inefficient and limit access to the medicines. Asked whether she would support such legislation, Kathleen Sebelius, secretary of Health and Human Services, said: "I'd take a look at it." A spokeswoman for the Treasury Department, which oversees tax policy, says the provision "enjoyed bipartisan support in Congress, but, as the president said, anything can be improved, and we are always willing to listen to ideas about how to make health care better and more affordable." Tax breaks for over-the-counter drugs date to 2003, as popular drugs like the allergy medicine Claritin began switching to over-the-counter status. The Internal Revenue Service loosened the rules on flexible-spending accounts so consumers could use them to buy thousands of nonprescription medications. The tax-free dollars can also go for insurance co-payments, eyeglasses and other out-of-pocket health costs. Critics say the accounts encourage overconsumption of medical services. Since consumers typically must forfeit unused funds by year's end, they often ended up scrambling in December to drain their funds by loading up on aspirin, antacid and the like. "The entire flexible-spending account thing is a waste of our taxpayer dollars," says Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology and a former paid consultant on the health law to the Department of Health and Human Services. "If you're going to scale it back, this is a natural place to start." (Another part of the law limits the amount consumers can save in flexible-spending accounts to $2,500 a year, starting in 2013.) Peeling back tax breaks for health plans was on the table in 2009 when lawmakers began drafting the health overhaul. Inside the Senate Finance Committee, aides to three Democratic and three Republican senators hashed out the blueprint for what ultimately became the final bill. Some big ideas—like limiting the tax break for employer-sponsored health insurance—lacked support, so committee aides lowered their sights. Making people pay the full price for over-the-counter medicines seemed like a way to reduce wasteful spending and generate money for the law's main goal: expanding health insurance to nearly every American. An objection came from William Pewen, senior health-policy adviser to Maine Republican Sen. Olympia Snowe. He believed the tax-free treatment could lower health costs and thought everyone should have access to a flexible-spending account. He told the group that he takes over-the-counter Prilosec, a heartburn medication, which meant he didn't need a more expensive prescription drug. "I didn't want to see us set up perverse incentives for people to use more costly drugs than they needed," Mr. Pewen says. He proposed a compromise that he concedes "was not the ideal solution." People could spend tax-free dollars on over-the-counter drugs, but only if they got a doctor's prescription. It wasn't exactly a new idea: Medicaid, the federal-state program for the poor, already covers some over-the-counter drugs if they are prescribed. Congress's number-crunchers estimated the change would generate $5 billion over a decade. Hardly anyone noticed it, even as it stayed in the bill through passage in March 2010. Only after the president's signature was dry did the American Medical Association realize what had happened and send a letter to the government warning of unintended consequences, including more office visits and extra paperwork. Sure enough, when the change took effect Jan. 1, patients began bringing lists of over-the-counter drugs to office visits and also requesting over-the-counter prescriptions by phone, doctors says. While it may not be worth the trouble for some patients, the savings can add up for those with chronic conditions, especially if the doctor writes multiple refills. A survey late last year by Nielsen found that nearly half of consumers with flexible-spending accounts would request the prescriptions as a result of the changes. Among those most upset by the changes are pediatricians, who say that small sizes of children's medicines and multiple children per family make the requests particularly burdensome. "It's an amazingly disruptive policy," says Jesse Hackell, a Pomona, N.Y., pediatrician who is charging $5 to fill such requests via phone. "I am now doing the IRS's work, and that's what I resent most." After writing two over-the-counter prescriptions free of charge in January, pediatrician Richard Schwartz of Vienna, Va., says he began imposing a $10 surcharge for each prescription, on top of the office co-payment. That is likely to discourage some patients from asking for a prescription, as the surcharge could outweigh the tax savings from using a flexible-spending account. Doctors are also concerned about malpractice lawsuits, since a prescription potentially puts them on the hook for any problems a patient suffers from over-the-counter drugs. Some malpractice insurers are urging doctors not to write any prescription without seeing the patient in person, says Lawrence Smarr, president of the Physician Insurers Association of America, which represents malpractice insurance providers. Retailers and pharmacies, meanwhile, say another aspect of the change caught them flat-footed. Many flexible-spending accounts come with a debit card, making it easy for consumers to draw down the money in the accounts when they shop at a pharmacy. But under the original IRS guidance, people couldn't use those cards for the prescribed over-the-counter medications. An industry group representing Wal-Mart, CVS Caremark Corp., Visa Inc. and other large corporations warned that could temporarily halt use of the debit cards for any pharmacy purchase. The IRS eventually decided the cards could be used—as long as the pharmacist labels and processes the over-the-counter item exactly like a prescription. That had another unintended effect. Thousands of over-the-counter products now must pass behind the pharmacist's counter when the customer pays with the special debit card. "At the moment it's considered a prescription, it's subject to all the regulatory requirements," says Mike DeAngelis, a spokesman for CVS. "It runs through our quality assurance process. We have to generate a label." The chain also puts each of the prescribed drugs in an individual paper bag. Despite the hopes of Mr. Pewen in the Senate, some consumers think they will be better off getting a prescription-only drug in place of an over-the-counter medication. In the Nielsen survey, 37% of flexible-spending account users said they would ask their doctor about prescription drugs that could replace their over-the-counter medicines. Dr. Chung, the pediatrician in Fairfax, Va., says she recently imposed a policy under which her office writes prescriptions only for chronic conditions, like allergies. That deflects pleas from parents wanting a quick Rx for their child's cold, but she's worried about pushback. "It makes us look like the bad guy," she says. http://online.wsj.com/article/SB10001424052748704692904576166554110739560.html
Now that's progressive government health care! Maricopa County Tests Workers' Saliva PHOENIX (CN) - Maricopa County is testing its employees' saliva to see if they use nicotine, calling it an incentive for workers to stop smoking, to save up to $480 per year on the county health plan. County officials said the number of employees who admit they use tobacco - about 10 percent - appears to be too low, the Arizona Republic reported. The saliva tests are meant to find out whether the alleged nonsmokers are telling the truth. The test is taken by swabbing the inside cheek. Maricopa County Manager David Smith sent employees an email on Feb. 11, describing the process. The mail states that county employees "must complete a saliva test that detects the use of nicotine" to be considered for the health insurance discount. "If you pass the test and if all your covered dependents have not used tobacco products for the past six months, you will qualify to save up to $480 annually ($20 savings per pay period) as an incentive for being tobacco free," the email states. The email describes tobacco use as "the occasional or regular use of a tobacco product including, but not limited to: cigarettes, cigars, pipes, snuff, chewing tobacco and any other product containing tobacco." Smith's email adds that if an employee gives the county "inaccurate information regarding covered dependent(s) in order to receive the incentive for which you are not eligible, you may be subject to disciplinary action up to and including termination." Some county employees feel the cheek swab is an invasion of their privacy and that the information taken from the swabs could be used to test for other medical conditions. But Smith's email claims that employees' test results "are confidential and will not be reported to Maricopa County." http://www.courthousenews.com/2011/03/17/34990.htm
some sanity from one state The Vermont House Passes Bill Calling For A Single Payer Health Care System In The State Last night, the Vermont House of Representatives debated and approved by a 92-49 a bill that would create a single payer system in the state. Shumlin praised the move as making Vermont the first state where “health care will be a right and not a privilege“: After hours of debate, the Vermont House of Representatives approved a bill that would create a single-payer health care system in Vermont. It passed 92-49. In a meeting right after the vote, the house speaker, the governor and others who worked on the bill called it a historic moment for Vermont. “Become the first state in the country to make the first substantive step to deliver a health care system where health care will be a right and not a privilege,” said Gov. Peter Shumlin. The “bill outlines a four-year timeline leading to establishment of the statewide, publicly funded system. It begins by setting up the Green Mountain Care Board on July 1 with a budget of $1.2 million to begin planning the new system. It then creates a health insurance marketplace — or ‘exchange,’ of the sort required by last year’s federal health care legislation. And it then calls for converting the exchange to the Green Mountain Care system.” Now that it has passed the House of Representatives, it will move on to the Senate, where it is expected to pass. A bigger hurdle Vermont faces is obtaining a waiver from the federal health care reform act and finding a way around federal ERISA laws — which “pre-empt states from enacting legislation if it is ‘related to’ employee benefit plans –that insurers could use to sue the state. The health reform law currently offers a waiver to states who meet certain standards by 2017; Rep. Peter Welch (D-VT) has introduced an amendment that would move the waiver date up to 2014 — an idea that President Obama has endorsed. This week, 200 doctors from 39 states including the District of Columbia signed an open letter saying they would seriously consider moving to the state to practice medicine if it enacted a single payer system. “The idea of having one set of rules, one form for billing, and knowing that all patients are covered – that would be wonderful,” said Scott Graham, a Kentucky family physician who signed the letter.
Could potentially help republican states argue that should be able to get out of the federal system, since states are able to enact HCR systems on their own. Also, I'd be a little worried for Vermont running a single payer system when neighboring states do not. Do you have to prove residency to get coverage or something?
I imagine they will have to put in some stiff residency requirements. Maybe it might be along the lines of getting in state tuition for the state university.
So she got pneumonia to save $1.08 out of principle? If so, she's a f-ing idiot. That's not the govt's fault.
No, it won't show how a US system would work because Vermont is one of the very few states suited for it. Vermont's median household income is well above average, it has one of the lowest unemployment rates in the nation, and it has one of the most homogeneous populations in the nation (98% white). Thus while the system may or may not work in Vermont, it definitely wouldn't work in more diverse areas where a limited number of rich and upper middle class are required to shoulder a huge financial burden to provide for throngs of poors, illegal aliens, and ne'er do wells.
None of that bolded part makes any sense. She didn't get NyQuil, so she got pneumonia? Because her doctor wouldn't write her a prescription for NyQuil?
Vermont is part of the US and while Vermont is unique in many respects it is also still has similarities with other states and this will be a US single payer system. I think one of the biggest questions it will answer is how does a single payer work with the private insurance industry in the US and also given the free movement of individuals across state lines how that will affect Vermont. Also what will this do to Vermont's budget and economy which is embedded in the larger US economy. This will be an interesting experiment and like other experiments it will have some limiting factors but that doesn't mean there isn't something that could be learned for the rest of the US.
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yeah, it's better to let them all die. or maybe they can all try to murder the rich people and get jail time and constitutionally mandated free health care too. seems like there's always so much money for killing innocent Afghans, and jailing drug users, but just never enough to feed and care for our own people. shame.
I was listening to the report about this on NPR yesterday and one of the biggest parts of this ruling is that one of the judges, Judge Sutton, is a very respected conservative jurist who has frequently argued cases before the USSC on behalf of states rights. That he ruled that the mandate is Constitutional is a pretty big move and one that shows that center right conservatives like Justice Kennedy might agree. From Judge Sutton's opinion. [rquoter]“Far from regulating inactivity,” Martin wrote, “the minimum coverage provision regulates individuals who are, in the aggregate, active in the health care market…because of two unique characteristics of this market: (1) virtually everyone requires health care services at some unpredictable point; and (2) individuals receive health care services regardless of ability to pay.”[/rquoter] http://ifawebnews.com/2011/06/30/federal-court-in-ohio-rules-health-reform-law-constitutional/
This is probably the only thing that makes this ruling useful. Up until now, it's basically been that liberal judges ruled in favor and conservatives ruled against. That's pretty useless as far as a legitimate long-term ruling goes. But if we finally have a judge flipping, then you have more of an indication of where this is headed. Still never know, but at least we have some guidance. Beyond that, all these individual rulings are sort of useless since we know this is headed to the USSC.
This probably won't sway Thomas, Scalia and Alito but Sutton's opinion might be persuasive for Roberts and Kennedy.
