Post SCOTUS ruling on the Affordable Care Act

A recent survey (admittedly uncontrolled, and unscientific) reveals several types of reactions to  the SCOTUS ruling on the Affordable Care Act.

1. Apathy
2. Continuing resistance
3. Liberals who equate Obamacare with socialized medicine.

Nothing could be further from the truth.  Apathy amongst providers is growing. Too much energy and time are involved fighting this battle for patients, which detracts time and energy from direct patient care.

Republicans                 Democrats                                

The Republican party has wasted much time and effort attempting to tear down the  Obamacare Wall by removing a tiny  cindereblock from the foundation.

The major problem with Obamacare is not the tax credit issue.

Blindly offering insurance coverage and access by politicians intent upon gaining political influence, and/or election is a great disservice to the American voter.  The internal workings of the American health system are overshadowed by HHS, Medicare, and Medicaid rulings which at times overrule the workings of the private sector.

As recently as 1965 governmental intrusion into health care was minimal.  Over the next 50 years involvement grew exponentially as Americans lined up for their 'entitlements'. As it grew, freedom of choicde gradually eroded.

President Obama now claims the Affordable Care Act is "the law of the land", much like he promised, "If you like your doctor, you can keep your doctor".  The truth is quite the opposite.  This one lie disenchanted any intelligent voter. He lied about that, and about the influence of Jonathan Gruber on the construction of the Affordable Care Act.  Obama lined up with Gruber and his statement about the American Voter being too stupid to  understand the law.

The lingering problem is that many Americans are ignorant how medical care is financed, and the insatiable appetite for  health  care...there is never enough.

In the long run SCOTUS' ruling will not mean much when the law is deconstructed and heavily amended.  It will require intellligent minds who are grounded in patient care and health administration, keeping it paitent and provider centered.

SCOTUS and the Affordable Care Act

As Yogi Berra said, "It ain't over until it's all over"

Any baseball fan can quote this fundamental Yogi Berra-ism. Berra was a famous catcher for the New York Yankees in the 1950s and 60s. I was a diehard Yankee fan during an era when they won  7 straight world  series, a feat yet to be duplicated in the 'modern era'.

it will be along time before ObamaCare and it's influence can be duplicated, nor produce a more disruptive, controversial law.

SCOTUS'  decision is far from ending the dispute about the Affordable Care Act.  Out of desperation the  GOP has focused it's effort to negate the entire law.  This is a fundamental flaw in the game to unravel the law.

Today there are many opinions from health reform pundits and politicians about what the SCOTUS ruling means.

No, Obamacare Isn't Any More 'Here To Stay' Than It Was Before The Supreme Court Decision 

Avik Roy
Forbes, 6/26/15

 “In a statement after the decision, President Obama declared that his signature health law is “here to stay.” But in his remarks, the President knowingly ignored the key concept in the case: that if the challengers had won, not one word of the law called the “Affordable Care Act” would have been changed. On the other hand, if voters elect a Republican President and a Republican Congress in 2016, quite a bit will change.”

Most Americans aren’t signing up for Obamacare

For the people that Obamacare claims to help—those who shop for coverage on their own—an analysis by the Manhattan Institute found that the law increased individual-market premiums by 49 percent in the average county, in its first year alone. Since, then many states are facing additional double-digit rate hikes.

The Case Against Obamacare: An eBook From Forbes 
Make no mistake. The new health law has disrupted coverage for millions, and driven up costs for millions more.

It shows that as a percentage of those eligible for Obamacare’s subsidies, only those near poverty—with incomes between 100 and 150 percent of the Federal Poverty Level—are signing up in large proportion. That’s because for them, taxpayers are subsidizing nearly all of the cost of their coverage. As you go up the income scale, Obamacare’s subsidies aren’t large enough to make up for the law’s steep premium hikes. This is exactly what I and my Manhattan Institute colleagues were concerned about when we first started writing about Obamacare’s “rate shock” problem.

Indeed, the vast bulk of Obamacare’s increase in health insurance “coverage” comes from its expansion of Medicaid. Medicaid is so dysfunctional that it has been shown to have “no significant effect” on health outcomes, relative to having no insurance at all.

Insurers will continue to announce premium hikes, and states will continue to struggle to fund roads and schools, as Medicaid eats up more and more of their budgets. Obamacare will remain unpopular.

And if voters elect a Republican President in 16 months, it will be elected officials—not the Supreme Court—who will be rewriting the law.

Bill Would Force Supreme Court to Enroll in Obamacare

A House Republican on Thursday proposed forcing the Supreme Court justices and their staff to enroll in ObamaCare. ....

King v Burwell Decision Teaches Sad Lesson in Law Making

(John Lynn) from EMR & HIPAA

In case you’re living under a hole (in the healthcare world we call that in the middle of an EHR implementation), the Supreme Court ruled on King v Burwell today. You can read the 47 page document here if you’re interested in the details of the decision. If you’ve ever read a Scalia decision or dissent, then you’ll know what to expect in his dissenting comments.

The Anti-Constitutional Consequences of King v. Burwell

Roberts gets it wrong -- Again from National Review Online

The Affordable Care Act was drafted with extraordinary carelessness given its importance, and conservatives who say that the Obama administration has implemented it contrary to its plain meaning have strong arguments. So opined six justices of the Supreme Court, including its most liberal members, in King v. Burwell. 

Read more at:

Supreme Court Upholds Obamacare Subsidies, President Says ACA 'Is Here to Stay' - ABC News

Supreme Court Upholds Obamacare Subsidies, President Says ACA 'Is Here to Stay' - 

The Supreme Court today voted 6-3 to uphold subsidies to states who do not operate their own health insurance exchange, thereby strengthening the market place across the United States.

Congress, overwhelmingly Democratic wrote a flawed law, the Affordable Care Act, poorly written and conceived will for the time being remain intact.

The vote is seen as a win for President Obama and the Affordable Care Act, and some say this will insure the survival of the law after 2016.  Republicans remain adamantly opposed to the law.  However Republican Governors can breathe a sigh of relief knowing that their  state constiuents will qualify for federal  subsidies.

The questionable wording is buried in the lengthy 1200 page law, most of which was not read by Congress.  As Nancy Pelosi  predicted, "We won't know what is in it until we pass it"

The wording, "established by the state"  appears ten (10) times in the law, found by this author in the certified text of the Affordable Care Act.

No one seems to have specified this wording in the law. The closest wording found:   (Section 1311)

(2) ELIGIBLE INDIVIDUALS MAY NOT USE EX-
12 CHANGE.—An eligible individual shall not be treated
13 as a qualified individual under section 1312 eligible
14 for enrollment in a qualified health plan offered
15 through an Exchange established under section 1311. 

Was it congress' intent to obfuscate it's plan to insure all Americans? The Supreme Court's Opinion is "YES"  firmly establishing the Affordable Care Act as the law of the land.

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Health Information Technology: Are we facing another bubble ?

U.S. Technology Funding -- What's Going On? from a16z

Some are comparing today's hot market in HIT to the Internet bubble of 1999.  However there are some significant differences.

The beauty here is its attempt to understand an organic phenomenon. IMO, it's also useful to look at the underlying drivers of (aka, incentives attributable to) that phenomenon. Today's large, "mature," post-IPO firms (Cisco, Apple, Microsoft, Ellie Mae, Intel, just to name a few) do less of their development in-house and rely more on the startup factories to generate new ideas; then the M&A engine kicks in to liquidate and (hopefully) integrate the new ideas. Sadly, most of these large(r) firms are saddled with un-innovative, un-inspired, un-inspiring, and sadly conventional senior managers, hence old thinking. It's too far a cry from the erstwhile "intra-preneuring" of the 70s and 80s to get to market relevancy, aka traction, while the market is still fertile and competitors sitting on laurels. Thanks for sharing this analysis.

Survey: Few Providers Discuss Wearables, Mobile Apps With Patients - iHealthBeat

Survey: Few Providers Discuss Wearables, Mobile Apps With Patients - iHealthBeat



Few health care providers are discussing wearable devices or mobile health applications with their patients, even though they believe the technology could be beneficial, according a MedPanel market survey of 415 providers, Health IT Analytics reports (Bresnick, Health IT Analytics, 6/22).

The researchers also found that providers are only somewhat satisfied with the products currently on the market. MedPanel suggested that the responsibility to boost mobile health use falls on vendors, who can improve their products to make them more appealing to providers (Health Data Management, 6/22).

For instance, a product that could integrate mobile health data directly with an electronic health record system in a way that supports productive workflow could boost mobile health recommendations among providers, according to the study.

• 38% of patients who are not using a wearable device could benefit from such technology; and
• 42% of patients who are not using a mobile health app could benefit from such technology (Health IT Analytics, 6/22).

A  key factor in adoption will be classification of the wearable as durable medical equipment and with FDA approval...........a difficult bridge to cross.

Big Gaps in How Medical Schools Are Preparing Students To Use EHRs - iHealthBeat

Big Gaps in How Medical Schools Are Preparing Students To Use EHRs - iHealthBeat

Electronic health records are a key part of practicing medicine today.

However, there's no national standard for how medical students should be trained on EHRs.

Practicing medicine today means interacting not just with patients, but also with
computers. As of 2013, nearly 80% of office-based physicians were using electronic
health records. But medical schools have been slow to keep up with the trend.
There's no national standard yet for how med students should be trained on EHRs.
Some are using computer systems from day one of their education. While others
may be forced to sink or swim once they start to practice.

Transcript of Audio Report 

Health insurer Cigna rejects Anthem takeover bid - Modern Healthcare

Health insurer Cigna rejects Anthem takeover bid - Modern Healthcare



(Modern Healthcare)



Health insurer Cigna Corp. has rejected a $47 billion offer to be acquired by Anthem, a larger rival, saying the terms of the bid are inadequate and "woefully skewed in favor of Anthem shareholders."



Cigna's sharply worded rejection came just one day after Anthem went public with its cash-and-stock offer, which amounts to about $184 for each Cigna share or about an 18% premium on Cigna's closing stock price on Friday.



The proposed deal would make Anthem an even bigger giant in an industry that many see as ripe for consolidation, as insurers struggle to cut costs in the face of new regulations and technological advances. Anthem has said the combined companies would have annual revenue of more than $115 billion and provide insurance for about 53 million people.



Insurers view the increased scale as a primary way to boost earnings and diversify their products. The Affordable Care Act caps health insurance profits as a percentage of premium revenue. The insurers, along with some independent observers, also argue that getting bigger will enable them to leverage lower prices from providers, drugmakers and other industry players, thus saving money for employers and consumers. 



"How big is big enough ? "



Any insurance mergers almost certainly would face rigorous antitrust scrutiny from the U.S. Justice Department because of the colossal sizes of companies involved and the multistate impact. The Obama administration in the past has been critical of insurers' premium increases, and rate increases by bigger new entities could jeopardize the administration's cost-control efforts under healthcare reform.