Obamacare Delay Similar To Previous Medicare Delay Under George Bush

Republicans are obsessed with Obamacare delays. Some of the delays have been helpful to allow for orderly transition to the new rules. The latest, allowing people to complete the process if they started an application for insurance before the deadline, seems like common sense and basic fairness (which might be why Republicans have such a problem with it). NBC News pointed out that George  W. Bush also had a similar delay with the Medicare D program:

As Republicans complain about the Obama administration’s latest deadline extension for Americans to purchase health insurance, Democrats are countering with this reminder: The Bush administration did something similar in 2006.

Back then, as it was implementing the Medicare prescription-drug benefit Bush had signed into law, the GOP presidential administration announced it was waiving penalties for low-income seniors and those with disabilities who signed up late.

As one Knight Ridder report put it at the time:

The move follows a recent administration decision to allow the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.

“In other words, you can apply after May 15th without penalty. And that’s important for low-income seniors to understand,” President Bush told a group of older Americans in Sun City Center, Fla., on Tuesday.

There’s one key difference between Bush’s Medicare prescription-drug benefit and Obama’s health-care law: Democrats didn’t try to scuttle the Medicare law’s implementation (especially since some of them had voted for it), while the same isn’t exactly true of GOP actions regarding the health-care law.

But the 2006 story is a reminder that when it comes to the implementation of complex new laws, both Democratic and Republican administration have changed the rules to encourage enrollment.

Republicans who complain about delays in the Affordable Care Act under Obama had no problem with a comparable delay under George Bush, showing once again that their positions are motivated by opposition to Obama and not any higher principles.

Bill Calls For Adding ICD-10 Delay To Latest “Doc Fix”

I recently pointed out that the Republicans killed a recent attempt to repeal the Sustainable Growth Rate formula by attaching a measure to end the individual mandate in the Affordable Care Act. With failing to repeal the Sustainable Growth Rate it becomes necessary for Congress to pass yet another temporary “doc fix” to prevent Medicare reimbursement from automatically falling so low that doctors will not be able to afford to see Medicare patients.

Medical Economics reports that a proposal to delay the transition from ICD-9 to ICD-10 diagnoses codes from October 2013 to October 2014. The transition was originally passed under the Bush administration, so ignore the Republican claims which are out there which blame Obamacare for the change. While there are benefits to the newer system which is used by the rest of the world, the change would be very expensive for medical practices. Changes such as this also take up a lot of physician time, reducing the number of patients which can be seen each day.

Such decreases in productivity would come at a poor time in 2013 when millions of new people will receive health insurance due to the Affordable Care Act and will need to find physicians who are accepting new patients. In addition, the second phase of requirements for electronic medical records (EMR’s) also kicks in for many physicians this October and having two sets of major changes will further reduce physician productivity, making it more difficult to accept new patients. Personally I had to greatly restrict accepting new patients for several months after the first phase of requirements went into effect, and anticipate again having to limit accepting new patients this fall if both the new EMR requirements and change to ICD-10 take effect simultaneously.

The AMA and many other physician groups have been lobbying for a further delay in ICD-10 implementation, which has already been delayed in the past. Medical Economics reports:

The ICD-10 transition has been a major point of concern for physicians due to its scope and cost to implement. In recent months the American Medical Association (AMA) ramped up opposition to the ICD-10 transition, and petitioned CMS for a delay to the implementation of ICD-10.

According to the AMA, small practices can expect staggering costs ranging from $56,639 to $226,105 to implement the new code set. According to a February survey by the Medical Management Group Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were only “somewhat ready.”

Molly Cooke, MD, FACP, president of the American College of Physicians, said the college favors the delay. “The college has expressed concern at every opportunity about the implementation of ICD-10. I’m not sure the healthcare system loses a lot if we delay implementation for another year, and it certainly would give our members a bit of a breather.”Earlier this month, the Republican-led House passed a bill to repeal SGR and replace it with a formula that would calculate payments based on quality metrics. But the bill received widespread opposition from Democrats because it was paid for by a five-year delay in the individual mandate in the Affordable Care Act (ACA).

Cross posted at The Moderate Voice

Lack Of Information And Misinformation Suppressing Enrollment In Insurance Plans

Recent polls are showing some of the obstacles to extending coverage among the uninsured. A study published Monday by the National Academy of Sciences showed that a substantial number of consumers lack basic knowledge of how insurance works which would be necessary to intelligently purchase coverage. A new Kaiser Health Tracking Poll shows lack of knowledge of the deadline for obtaining coverage and widespread belief in many of the false claims being spread by opponents of the Affordable Care Act.

Many are unaware of next week’s deadline to obtain coverage and avoid potential tax penalties:

A third of those who lack coverage as of mid-March are unaware that the law requires nearly all Americans to have health insurance or pay a fine. When it comes to the specifics, four in ten of the uninsured (39 percent) are aware that the deadline to sign up for coverage is at the end of March, leaving about six in ten unaware of the March deadline.

When reminded of the mandate and the deadline, half of those without coverage as of mid-March say they think they will remain uninsured, while four in ten expect to obtain coverage and one in ten are unsure.

Many plan to not obtain coverage due to cost concerns, unaware of financial assistance available:

While some report trying to get coverage from new options available under the ACA, large shares of the uninsured remain unaware of two of the law’s key provisions that could help them get coverage. About half the uninsured are unaware that the ACA gives states the option of expanding their Medicaid programs, and more than four in ten don’t know that it provides financial help to low- and moderate-income individuals to help them purchase coverage.

The Kaiser poll showed a reduction in the gap between those who see the law unfavorably as opposed to favorably. While more now have a favorable opinion than previously, the majority continue to have an unfavorable opinion. Much of the opposition is based upon misinformation spread by opponents:

“It’s too expensive for regular people.”
“it’s costing too much money. It’s supposed to help people with low incomes and it’s not.”
“Because it’s a financial hardship on the U.S.”

The first two are based upon lack of knowledge of the assistance available which does make coverage more affordable. The third has been shown by the recent non-partisan report from the Congressional Budget Office to be false. Among its other benefits, the Affordable Care Act will reduce the deficit, reduce unemployment, and help stimulate the economy by freeing people from the insurance trap, enabling more people to work for and start small businesses

Opposition also includes a belief that the individual mandate is unconstitutional despite a Supreme Court ruling upholding the law. Some expressed the false belief that the ACA gives government more control over personal health care choices, echoing further scare stories from the right wing as to what the law does.

Despite unfavorable views about the law, a majority still would prefer to see improvement to the law as opposed to repeal or a Republican alternative:

Perhaps reflecting this sense that the debate has gone on long enough, more of the public would like to see Congress keep the law in place and work to improve it (49 percent) or keep it as is (10 percent) rather than repeal it and replace it with a Republican-sponsored alternative (11 percent) or repeal it outright (18 percent).

The poll found that many aspects of the law are popular, even if many people are unaware of these and other benefits:

As previous Kaiser tracking polls have found, many of the ACA’s major provisions continue to be quite popular, including across party lines. For example, large shares of Americans – including at least seven in ten overall and at least six in ten Democrats, Republicans, and independents – have a favorable view of the fact that the law allows young adults to stay on their parents’ insurance plans up to age 26, closes the Medicare “doughnut hole” for prescription drug coverage, provides subsidies to low- and moderate-income Americans to help them purchase coverage, eliminates cost-sharing for preventive services, gives states the option of expanding Medicaid, and prohibits insurance companies from denying coverage based on pre-existing conditions. Nearly as many (including a majority across parties) have a favorable view of the “medical loss ratio” provision that requires insurance companies to give their customers a rebate if they spend too little money on services and too much on administration and profits. Somewhat more divisive is the law’s Medicare payroll tax on earnings for upper-income Americans, which is viewed favorably by about three-quarters of Democrats and just over half of independents, but just a third of Republicans.

The individual mandate remains highly unpopular. Anticipation of this is one of the reasons I opposed the individual mandate prior to passage of the Affordable Care Act, preferring an alternate system to provide incentives to purchase coverage and penalize those who try to game the system by waiting until sick to purchase insurance.

Much of the opposition to the ACA is based upon beliefs about the law which are untrue:

Misperceptions also persist about things the ACA does not actually do. For example, nearly half the public (46 percent) think the law allows undocumented immigrants to receive financial help from the government to buy health insurance, and another two in ten (22 percent) are unsure whether it does. A third of the public (34 percent, including 32 percent of seniors) believe the law establishes a government panel to make decisions about end-of-life care for people on Medicare, with another quarter saying they are unsure (23 percent of the public, 25 percent of seniors).

Unfortunately both lack of information and intentional misinformation being spread by opponents of the Affordable Care Act is likely to cause a substantial number of people to go without coverage this year. The deadline is fast approaching for purchasing coverage on the exchanges. There is no deadline for those who qualify for coverage due to Medicaid expansion, but Republicans in many states are also denying this benefit to residents of their states even though the federal government picks up almost all of the cost.

Cross posted at The Moderate Voice