Category Archives: ACA

Foreign Patients Get Liver Transplants in US Hospitals First

ProPublica, those lovely folks who published several articles some time back on workers’ comp, are at it again.

This time, they are focusing their ire on how foreign patients are getting liver transplants at some US hospitals ahead of Americans waiting for such transplants.

The story, published yesterday, was co-published with a local Fox station in New Orleans.

From 2013 to 2016, New York-Presbyterian Hospital gave 20 livers to foreign nationals who came to the US solely for a transplant, essentially exporting the organs and removing them from the pool of available livers to New Yorkers.

Dr. Herbert Pardes (I was familiar with his name from living in NY), wrote that, “Patients in equal need of a liver transplant should not have to wait and suffer differently because of the U.S. state where they reside.”

Dr, Pardes was the former chief executive, and is now the executive vice president of the board at New York-Presbyterian.

Yet, according to the story, Dr. Pardes left out NY-P’s contribution to the shortage, as stated above from 2013 to 2016.

These 20 livers represent 5.2 percent of the hospital’s liver transplants during that time, which was one of the highest ratios in the country.

ProPublica reported that unknown to the public, or to sick patients and their families, organs donated domestically are sometimes given to patients flying in from other countries, who often pay a premium. Some hospitals even seek them out.

A company from Saudi Arabia said it signed an agreement with Ochsner Medical Center in New Orleans in 2015.

The practice is legal, according to the story, and foreign nationals must wait their turn in the same way as domestic patients. The transplant centers justify this on medical and humanitarian grounds, but at a time when we have an Administration touting “America First”, this may run counter to the national mood.

The  director of the transplant institute at the Mount Sinai Hospital in New York, Dr. Sander Florman, said he struggles with “in essence, selling the organs we do have to foreign nationals with bushels of money.”

Between 2013 and 2016, 252 foreigners came to the US purely to receive livers at American hospitals. In 2016, the most recent year for which there is data, the majority of foreign recipients were from countries in the Middle East, including Saudi Arabia, Kuwait, Israel and the UAE. Another 100 foreigners staying in the US as non-residents also received livers.

At the same time, more than 14,000 people, nearly all Americans, are waiting for livers, a figure that has remained very high for decades, they report. By comparison, fewer than 8,000 liver transplants were performed last year in the US, an all-time high. National median wait time is more than 14 months, and in NY, the time is longer.

In 2016. more than 2.600 patients were removed from waiting lists nationally, either because they died or were too sick to receive a liver transplant.

All this is happening at a time when the party in power is seeking to take health care away from those who recently received care for the first time in a long time from the ACA, and at a time when the medical travel industry is focused not on transplant surgeries, but on boutique treatments and surgeries for wealthy or upper middle class Americans to go abroad for bariatric, plastic or reconstructive surgery, knee surgery, dental care, etc.

And yet, when the very idea of medical travel is broached in the medical community, it is disparaged and discouraged by physicians and others as unsafe, impractical, and not worth the effort, Obviously, it is well worth the effort on the part of foreign patients to come here and take organs meant for Americans, so why not allow Americans to take their organs?

Is it because the hospitals that supply these organs to foreign patients are making huge sums of money, and the poor schnook American with liver disease (or kidney disease, as in the case of yours truly) must die so that an American hospital can improve its bottom line?

It is high time to cut the crap and promote medical travel the right way and for the right reasons, not only for those who can afford it, but those who need transplants and can’t get them here.

That is the true nature of the globalization of healthcare…a two-way street.

 

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CMS Proposes to Allow States to Define Health Benefits

A connection of mine today posted a link to a CMS Fact Sheet in which they propose to allow states to define essential health benefits beginning January 1, 2019.

According to the fact sheet, this rule is intended to increase flexibility in the individual market, improve program integrity, and reduce regulatory burdens associated with the PPACA in the individual and small group markets. (See my post, “Regulation Strangulation“)

The rule also includes proposals that would provide states with more options in how the essential health benefits (EHBs) are defined for their state, it would also enhance the role of states related to qualified health plan (QHP) certification, and to provide states with additional flexibility in the operation and establishment of Exchanges, particularly the Small Business Health Options Program (SHOP) Exchanges.

Finally, they propose to permit states to reduce the magnitude of risk adjustment transfers in the small group market to minimize unnecessary burden, and proposes other changes that would streamline the Exchange consumer experience and the individual and small group markets.

What does this really mean?

Anytime the federal government attempts to allow the individual states to determine or define certain social benefits, we end up with a hodgepodge of rules, regulations, costs of impairment, etc.

We know that in certain states, the loss of a body part in one state has an impairment value different from the same body part in another state, according to the ProPublica report .

So when I see that CMS wants to allow states to define what essential health benefits are,  we have to ask ourselves, what do they mean by essential, and is one state’s essential health benefits, another state’s burden?

I understand that certain states, particularly so-called “Red” states with conservative governors and legislatures, will be free to decide that certain treatments and procedures are just too expensive for them to cover, or that they violate the ethical or moral sentiments of the community in the state, i.e., abortion, birth control, sexual reassignment surgery, etc.

Allowing states to define and decide what is essential and what is not, may be harmful to the health of many of their citizens, even if it saves the state money.

And I am rather leery of CMS’s desire to “strengthen” the individual or small group markets, because who decides what constitutes strengthening, and who makes those decisions and under what circumstances.

Rather than allowing legislators and governors to decide what medical care their citizens can receive in their state, rather than trying to shore up a market, whether it is the individual market or the group market, we should move to provide all Americans with the same health care and the same medical benefits, coast to coast, under a Medicare for All plan.

Anything less would be worse than what we have now, and would be more costly and more complex and confusing. This rule should be scraped.

Copper, or Cop Out?

The recent bipartisan health care bill, posted here, is an attempt to save the cost-sharing reimbursements that the Orangutan ended last week, and that the White House (the adult day care center) has not endorsed.

This is what Health Care.gov says about these copper plans, with commentary from Don McCanne of Physicians for a National Health Plan.

HealthCare.gov
ACA Catastrophic Plans
Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.
Deductibles — the amount you have to pay yourself for most services before the plan starts to pay anything — are very high. For 2017, the deductible for all Catastrophic plans is $7,150.
According to Dr. McCanne, the bill will extend CSR’s for two years in exchange for concessions from Sen. Patty Murray.
One of those concessions, Dr. McCanne says is  to allow anyone to purchase on the exchange the catastrophic plans that are currently available only to individuals under 30 or those who qualify for certain hardship exemptions. These plans are sometimes referred to as copper plans, indicating that they have an actuarial value below the other metal tier plans (bronze, silver, gold, and platinum).
The appeal of these plans, he adds, is that their premiums are very low, but that is because their actuarial value is only 50 percent – they cover an average of about half of health care costs.
For 2017, the deductible for these plans is $7,150.
He believes that the concept that we can take beneficial policies and detrimental policies and combine them to come up with a reasonable compromise is a fallacy. Bad policies are bad policies, and they cannot be neutralized by political accommodations.
His solution is a national health plan.
Otherwise, it is either copper or a cop-out.

Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.

 

ACA Subsidies to End

Here is the New York Times article tonight which will appear in tomorrow’s paper.

The Orangutan is blowing up the health care law, and with it, the health care system.

Cutting off subsidies to cover low-income individuals and signing an Executive Order that will create chaos and uncertainty is dangerous, reckless, and despicable.

Not even Gru is that mean-spirited and inhumane.

The Roman Senator Cato the Elder ended his speeches by declaring that “Carthago delenda est”. which means Carthage must be destroyed.

We need a modern Senator to declare that “Trump sit remotus”, means Trump must be removed.

Executive (Dis)order

The signing this morning of an executive order by the Orangutan will have, in the opinion of some of the bloggers and politicians, spell disaster for the nation’s health care system.

It will, if carried into action, likely siphon healthy people from the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.

The rationale for such a move that has been given is that since Congress has not been able to repeal and replace the ACA, an executive order will, piece by piece.

Coupled with the recent budget move to eliminate the CHIP program for children’s health (New York State faces dire consequences if Congress does not act on CHIP), and cut backs to Medicare and Medicaid, the intent here is to privatize health care for some, and eliminate it for others, and to get government out of health care providing altogether.

There are provisions in this order for greater competition, short-term coverage, and lower premiums with less coverage. Why this is better is beyond me, unless the Orangutan is seeking to destroy health care so that single-payer will be the only option.

Cutting healthy people out of the ACA means leaving sick people to struggle with a health care law that many say needs to be fixed, not repealed and replaced. But because the Tea Party ranted and raved before it was enacted, and the Orangutan and the GOP campaigned on getting rid of it, they had no choice but to sabotage it if they could not do so through legislation.

I predict that we will soon see the total collapse of our health care system thanks to this stupid, overreaching, and ill-advised Executive Order. I even read today that the Vice President had to remind the Orangutan to sign the darn thing, something that almost slipped what is left of his so-called mind.

Welcome to Crackerbox Palace.

The Wisdom of Solomon?

You all know the story of King Solomon in the Bible where he was called upon to settle a dispute between two women, each claiming to be the mother of a baby. Solomon’s “solution” was to order the baby be cut in half, so that each mother would have half a baby. But when she realized what this would mean, the real mother spoke up and spared the child from being split in two.

Well, something posted today on LinkedIn, sort of reminded me of that story. Rather than paraphrasing it, I am posting the item here for you.

Trump plans to split Obamacare in two

President Trump plans to sign an executive order this week that takes aim at the Obama-era Affordable Care Act, according to sources. Among the changes, the order would give individuals and small businesses in association health plans more options to opt in for lower-cost — albeit less comprehensive — plans not allowed under the ACA, leaving older and sicker individuals with fewer options and pricier premiums. It would also provide short-term insurance for up to a year, reversing the three-month deadline put forth by the previous administration. If the order is signed, the market could divide in two, adding more difficulties to traditional markets under the ACA while opening the door to new types of insurance.

It seems the Orangutan now fancies himself with the wisdom of Solomon in regard to dealing with the “problem” of getting rid of the ACA. Like the two women in the story, the two parties in Congress each claim their own view of health reform, and since neither side is getting their way, the Orange King is doing it for them by signing an Executive Order.

And like the proverbial baby, splitting health care in two solves nothing. But don’t let that stop the Orangutan. He’s the wisest person there ever was, or didn’t you know that?