Health Care Reform Bill Pros and Cons, Winners and Losers

Big business sees little to cheer about

“The health-care legislation hits companies in myriad ways, from stricter coverage rules to new taxes, which could change how they offer health care to employees” From stricter coverage rules to new taxes, which could change how they offer health care to employees. Yet, many larger businesses worry the measure will do relatively little to hold down their overall health-care costs, once a primary goal of the legislation, and could even force them up.- more from the Wall Street Journal here

 

Health care industry winners and losers

Drug makers win, hospitals get more patients but fear loss of federal dollars, and doctors lose. See the section below for the impact on health care payers.

Impact on Health Care Payers

With the legislation and the expected package of changes, insurers stand to get more than 20 million new customers. New health-insurance “exchanges,” where consumers can shop for policies, will provide an easy way to reach these new customers. And the penalty for people who don’t buy in is somewhat tougher than laid out earlier. more from WSJ here

Health Care Provider Impacts

Health Care Provider organizations weighed in after the vote, praising the reform. Rich Umbdenstock, president and CEO of the American Hospital Association called the vote “a historic and long overdue step” that will make “a real difference in lives of millions of Americans.” “Healthcare is at a tipping point and the shortcomings within our health care system can no longer be ignored,” Umbdenstock said. Mandy Krauthamer Cohen, executive director of Doctors for America said the new law would expand the coordination of care and strengthen the physician workforce.

“While no bill is perfect, I am hopeful today for the future of medicine because of the many ways this bill will improve healthcare in America,” she said. Groups that joined with Doctors for America in supporting the bill included the American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, American Medical Student Association, American Medical Women’s Association, American Muslim Health Professionals, Association of Clinicians for the Underserved, Committee of Interns and Residents/SEIU Healthcare, Doctors Council SEIU, Association of Physicians of Pakistani Descent of North America, HIV Medicine Association, National Medical Association, National Physicians Alliance, National Physicians Alliance-New York, National Doctors Alliance/SEIU Healthcare, Nurse Alliance/SEIU Healthcare, Student National Medical Association, and United Nurses of America-AFSCME. Read more here

Health Care IT Vendors Will Benefit if They Have Experience In . . .

• Electronic Data Interchange, specifically EDI X12 HIPAA 5010 will gain ground as many health plans and providers do not fully grasp the impact of this change on their claims systems. HIPAA 5010 is required as a pe-curser to the ICD-10 (see below).

• ICD-10 – The new medical coding standard must be used by all U.S. providers and insurance companies by October 2013. Experienced vendors who can guide these companies through the complex transition from ICD-9 will see increased business.

• Health Care Information Exchanges   By 2014, exchanges that provide a more open market place for health care data as well as provider capabilities and pricing will become important. Experience in Enterprise Services Bus, Service Oriented Architecture (SOA) integration, electronic health records, as well as EDI and medical coding will be required.

Political Parties Pronounce Their Position

Reactions to the passage of the bill were predictable. 

Republican Reactions

Republican Congressman Kevin McCarthy blasted the House passage of the health care bill: “Today’s “historic” vote is a sad day. Washington failed America. The People’s House had a choice – vote to listen to the people and start over with a good bill, or dictate to the people that Washington knows best. 212 Democratic and Republican Members of Congress fought against the government takeover of health care, and voted to listen to America. However, 219 Democratic Members of Congress prevailed with passing an ideological agenda on a purely party line vote. Congress did not listen.” “This bill is a bad bill. It’s bad for our children who will inherit more debt, it’s bad for America’s job creators who will pay higher taxes, and it’s bad for Americans who are on a path to pay more taxes for Washington to control their healthcare. This bill contains $1.2 trillion in new spending at a time when America is borrowing 43 cents on every dollar it spends. Washington is once again stealing from our children’s generation.”

Democrat Discourse

Meanwhile Democratic Congresswoman Lois Capps praised the health care bill urging colleagues to vote for passage: “This moment has been a long time coming. I’ve worked on health care since coming to Congress and passing comprehensive reform has always been a major goal of mine. I’ve met with and listened to my constituents, along with countless doctors, nurses, hospital administrators, researchers, and other health care experts. They know that America’s health care system has many wonderful aspects: it can provide the most cutting edge care, cure diseases thought fatal only a few years ago, and devise new and exciting drugs, devices and treatments with mind numbing speed. But we also know our health care system’s problems are legion. Coverage is erratic, incomplete and can evaporate without notice; costs are out of control for consumers, businesses and taxpayers; and health outcomes are actually better in dozens of countries that spend far less per capita than we do. The legislation before us addresses these problems and will help ensure that affordable, quality health care is always available to all Americans. “…I will not argue this is a perfect bill because it is not. Most problematically, it lacks a public option, which would make the insurance market more competitive, ensure the greatest possible choice for consumers and bring down health care costs even more than the bill does already. More here from KVEC web site.

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.