I will be sending this to Members of Congress tomorrow. Please call or write members of Congress ASAP.
March 21, 2017
You were elected on a promise to repeal and replace Obamacare. If you vote “yes” on the GOP healthcare bill Thursday, you will fail to uphold your promise. I have read the bill word for word. Have you read it? I have also read the ACA, MACRA, the MACRA rules, and much more healthcare law ad nauseum word for word. Have you? The AHCA makes horrible things worse. I pray you will stand up for what is right and for what you promised, instead of acquiescing to pressure from those who represent selfish interests against the will of the American people. The bill is clearly written to appease, if not reward, big healthcare insurance executives, big hospital interests, and the Left. Why?
The healthcare debacle is extraordinarily complex; I doubt most politicians even understand a fraction of it. I implore you to pause and seek counsel from physicians and patients like me who live and work in the trenches under the shackles of bad healthcare law. I am sick and tired of hearing about sausage making and half a loaf. I long for strong leaders, statesmen who will do what it takes to achieve the exceptional, the ultimate goal, and honor their word- not settle for 2 steps back, enabling the perpetual tantrum of adolescents who throw stones from safe spaces seeking to destroy what our Founders created, as they wallow in relative truth, suckling on the government teat of dependency.
In addition to all the talking points fed to you, here are 3 things I gleaned from reading this bill and prior law for myself that make terrible law worse, that no one is discussing- that you will be responsible for if you vote “yes” instead of innovating, thinking outside the box, and crafting transformative, healing legislation that achieves repeal, as you promised.
- SEC. 113 Eliminates DSH cuts: The hospital and insurance interests must love this. It will bankrupt us and make healthcare costs explode, as history proved when unlimited DSH payments and financing flexibility increased DSH spending from $1.3 Billion in 1990 to $17.7 Billion in 1992. Thus, DSH cuts were implemented. Eliminating DSH cuts now will accordingly result in a 10-fold increase in government spending if we look at recent history. DSH stands for Disproportionate Share Hospital. Hospitals receive money from the federal government for providing “uncompensated care“ to Medicaid and other underprivileged patients. Such allocation of federal money applies to the cost of inpatient and outpatient care. It financially behooves hospitals and healthcare entities to artificially inflate their bills and then accept a lesser sum of money from an insurance issuer or patient to make the claim that they are providing uncompensated care and justify receiving ever-increasing sums of federal (taxpayer money). This results in the institutionalization of such bogus practices as the Chargemaster bill and lack of transparency. What we need is transparent pricing across the board and a law that fosters price transparency not massive price inflation.
- SEC. 2203 and 2204 will similarly result in artificially manufactured overbilling, lack of transparency, and increased transfer of taxpayer money to hospitals and insurance companies. Between 2018 and 2026 the federal government will appropriate $100 Billion dollars to the States and require them to pay issuers all claims that exceed $50,000 but do not exceed $350,000. It doesn’t take a genius to foresee the explosion of “bills” that will be miraculously amount to $50,000.01 and require payment from the State using federal (taxpayer) money under the pretense of “market stabilization.” In reality, no one ever pays the “bill.” “Allowables” are negotiated by insurance companies and accepted. This elimination of DSH cuts mentioned above will result in massive skyrocketing of bills, which is incentivized by the repeal of DSH cuts and forced payment of high claims to issuers by States using federal money. The hospitals and insurance companies will gluttonously consume increasing federal funds until they are all gone- and then what. Patients will be left high and dry- broke without care. Again, we need policy that fosters cost transparency and lowest cost to patient, not what this law does. This law rewards what could be construed as collusion and money laundering.
- Subtitle ___ Remuneration From Certain Insurers- This seems to me to be a bone thrown to insurance executives. (AKA a massive, flagrant personal multimillion-dollar payoff). It terminates the limitation on deduction of remuneration for taxable year exceeding $1 Million for the top 5 earners of publicly held health care insurance corporations, like the CEO, etc. Translation, under this bill, they CAN deduct huge remuneration packages. What do you think? Read it-it takes awhile pulling all the references –section 162(m) of the Internal revenue Code of 1986.
There is so much more that is bad, but while I have devoted the time to read this, most will not take the time to even read what I’ve written here. This is your job. You ran for it and were elected to do it faithfully. I just want to take care of my patients and have my doctors take care of me without such sinister, wasteful government and special interest intrusion.
Please, stop the insanity. Take a deep breath. Do the right thing, and do what you promised. Save the American patient and the United States of America. We can and must do better.
Kristin S. Held, M.D.
San Antonio, Texas