WASHINGTON - Sen. Chuck Grassley of Iowa is seeking answers from the Obama administration on indications that Obamacare will bypass key anti-fraud protections.

"I am alarmed at indications that the Administration may try to exempt the Patient Protection and Affordable Care Act (PPACA) from certain federal anti-fraud provisions," Grassley wrote to top administration officials today.  "PPACA provides for billions of dollars in subsidies to be paid directly to insurance companies.  These taxpayer dollars should be subject to the full arsenal of civil and criminal anti-fraud protections provided by Congress."

Grassley's letter to Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder came amid statements that the administration does not consider qualified health plans and other programs related to the federally facilitated marketplace under the new health care law to be federal health care programs.  That appears to mean the Obamacare programs are not subject to federal anti-kickback statutes and the federal False Claims Act, one of the government's most effective tools against fraud, especially health care fraud in recent years.

Grassley raised these concerns at a Finance Committee hearing with Sebelius on Wednesday.  He asked her to explain her letter to a House member that the Obamacare health plans are not considered federal health care programs.  She suggested Medicare Advantage, for example, and Obamacare should be treated differently for federal anti-fraud protections.  Grassley believes both programs should be treated the same for anti-fraud purposes, since both involve direct payments from the government to private health care plans.

"Congress' intent to treat kickbacks under PPACA as False Claims Act violations is clear.  It cannot lawfully be nullified by the stroke of a pen through an administrative exemption," Grassley wrote today.  "If this nullification were allowed to stand, HHS would be removing a vital tool to investigate and prosecute fraud.  It undermines public confidence that the government is serious about protecting American taxpayer dollars from fraud, waste and abuse.   Intentionally attempting to strip away these vital protections by administrative fiat is extremely disturbing."

Grassley is the Senate author of the 1986 whistleblower amendments strengthening the federal False Claims Act, making it more effective than ever in exposing fraud against the government.

The text of Grassley's letter to Sebelius and Holder is available here.

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Experienced Caregiver Warns Those New to Insurance
Coverage: Speak Up

With 11,000 people becoming eligible for Medicare every day and an estimated 25 million Americans expected to gain health insurance through Obamacare on Jan. 1, access to doctors and hospitals will skyrocket.

And while that's a positive, patient advocate Ruth Fenner Barash warns that the U.S. health care system is not the benevolent safety net many people believe it to be. It can be abusive, incompetent, callous toward patients - and worse.

"Patients and their loved ones cannot blindly turn themselves over to this massive, technology-based system and trust that it will care - or take care of them," says Barash, who shares her health-care experiences in a new book, "For Better or Worse: Lurching from Crisis to Crisis in America's Medical Morass," (http://forbetterorworsebook.com/).  The cautionary tale traces the long death of her husband, Philip, through a medical journey fraught with mismanagement and excess, useless interventions and a sometimes complete disregard for pain - even when there was no hope of healing.

"We did experience some wonderful health-care professionals - brilliant, compassionate and helpful people - but they were not the rule," says Barash. "I learned a great deal from our experience, and with so many people now gaining access to health care, I want others to benefit from what I've learned. You can navigate the system; you just have to know how."

Barash offers these suggestions for patients and their loved ones, whether it's a trip to the doctor for a checkup or a diagnosis of a catastrophic illness.

• Avoid the emergency room. Emergency rooms were developed with the idea that few people would use them - most people would see their physician. But as health care costs rose, they became a primary care facility for those without insurance or the money to pay for services out of pocket. "Patients and their families were not expected to spend a long  time in the E.R. - presumably, they would be seen quickly and either admitted to the hospital or treated and released - so they're not designed for comfort," Barash says. "They've become very crowded, especially in cities, and patients might wait for hours sitting in hard plastic chairs in the waiting room. For someone who's sick or injured, this can be torture."

Sick people usually are not isolated, so waiting rooms also teem with germs, she notes.

• Be skeptical - question everything. Too often, we take the first thing we're told as gospel, Barash says. "If you have the luxury of time, take some of that time to think things through, to research and get second opinions," she says. Research your physician's connections. When you're referred to a specialist,  ask why that particular person. If you live in an area with a large academic community, ask around about the physicians and health-care providers with the best reputations. Who has the most experience in a particular niche? Who's doing the most promising research? How many times have you performed this procedure and what is your success rate?

• Ask what it costs - no matter who's paying. Our health-care system is absurd in the number of useless consultations, diagnostic procedures and interventions it foists on patients, Barash says. Whether our  hospital bills are fully covered by Medicare, Medicaid or private insurance, or we're paying a portion ourselves, we must all include cost in our discussions with health-care providers. "Part of the blame for having the most expensive health-care system in the world goes to us, the individuals, who don't question purchases or shop for prices as we would for groceries, clothing, or furniture," Barash says.  "If a test or consultation is ordered, understand why. Is it really necessary? You can say no!"

Finally, Barash says, we all must come to terms with the fact that death is a given. "My husband's problem, and the problem many of us may be doomed to face, is the seemingly endless getting there - a dying we don't want."

About Ruth Fenner Barash

Ruth Fenner Barash studied philosophy at City College of New York and did graduate work at the University of Chicago. In 1958, she met and married Philip Barash, a private practice attorney. She went on to work in public relations and real estate, served education and civic organizations at the executive level, and taught art in various media. Her long marriage was a "harmonious adventure" despite the couple's treacherous journey through the health-care system. Her husband died in 2012.

Woman Living with Incurable Cancer Offers 3 Ways to Get
the Most Out of Every Day

Jane Schwartzberg cringes when she hears someone say that a terrible accident or frightening medical diagnosis made them realize what's important in life.

"In some ways, I do wish everyone could experience a taste of terminal, if that's what it takes to make them appreciate the intangible gifts we receive not just during the holidays, but all year," says Schwartzberg, co-author with Marcy Tolkoff Levy of "Naked Jane Bares All," www.nakedjanebaresall.com, a new book that shares Jane's story with candor and humor.

"But I wish they'd known all along, and I hate the thought of goodness coming at the expense of so much suffering."

Schwartzberg says she was clear about what's most important before she was diagnosed with stage four incurable breast cancer. As a mother, wife, daughter, sister, aunt and friend, she knew that all that really matters is how much love we give and receive.  
The holidays are a wonderful opportunity for people to remember that and to focus on who they love. But, too often, they become a source of anxiety, stress, and tension. Financial concerns, having too much to do, and missing loved ones were among the top causes of holiday stress, according to a recent Mental Health America survey.

"Although I won't attribute any revelations about what's most important in life to my illness, I can say that there are a few things that I am trying to do better since getting sick," Schwartzberg says.

"The holidays are a great time to cultivate a spirit of gratitude and to re-focus on the things that are most meaningful."

For Schwartzberg, those include :

• Showing up. If you're worried about yesterday or always planning for tomorrow, you're missing the present moment and any wonderful experiences it may hold.

"Although my clock ticks louder than others, I know we are all here for a short time," Schwartzberg says. "I am determined to find joy in every single day. It may come from the simplest of things: a view from my window, a great conversation or a hot cup of coffee. But I know I need to be always present and available, with an open mind and open heart, to experience any of it."

• Riding her love train. We all have people in our lives who care about us, and it's important to let them know how much we appreciate them. Schwartzberg's "love train" is a metaphor for all of the people she chooses to share her life with.  "They are rooting me on and giving my family and me love and support," she says. "I try to be as meticulous and thoughtful as I possibly can be with those on board, and that means making sure they know how much I love and value them."

• Knowing my place in the world. There is a Jewish teaching that says everyone should carry with them two pieces of paper, each in a separate pocket. One paper should say, "I am but dust and ashes."  The other, "The world was created for me."

"I constantly remind myself that both statements are true," Schwartzberg says. "I am capable of incredible things to improve the world, and I am just a tiny speck in the universe. Powerfulness and humility can, and do, exist for me side by side."

As the holidays approach, keep in mind that the best gift you can give - or receive - is love.

"It's not a table full of food or gadgets you can't afford," she says. "Approach this holiday season as if it could be your last, and you'll probably find much more to revel in than to stress about."

About Jane Schwartzberg

Jane Schwartzberg, 45, is the co-author of the newly released book, "Naked Jane Bares All," the many-layered story - told with humor and candor -- of how she learned to embrace life when she was down for the count. Jane is a financial services executive and founder and former CEO of a start-up technology company.

"Naked Jane Bares All" was co-written by veteran writer Marcy Tolkoff Levy. Following a year of interviews and many late nights with Jane, her family and friends, Marcy formed the foundation of a colorful, poignant and even humorous collection of vignettes about how Jane continues to get back up when life throws her down.

Today, Health and Human Services Secretary Kathleen Sebelius testifies in from of the United States House of Representative's Energy and Commerce Committee regarding the botched rollout of Obamacare. Below is a recent blog piece by Chris Jacobs on the Obama Administration's knowledge that millions who would lose insurance under Obamacare; despite promises to the contrary.

Several experts are available to comment on this topic:

Nina Owcharenko
Bob Moffit
Ed Haislmaier
Chris Jacobs
Alyene Senger

 

How the Administration Knew Americans Would Lose Their Current Health Plans

Chris Jacobs

 

October 29, 2013

There has been much chatter about an NBC News report last night highlighting one clear fact: The Obama Administration knew millions of Americans would lose their current health plans due to Obamacare. That the Administration knew about the impact of Obamacare on Americans' health plans is clear, not least because internal Administration documents suggest an effort to downplay the law's impact to the public.

At issue are regulations issued in June 2010 implementing the "grandfathering" provisions of Obamacare. In theory, this section of the law was intended to allow individuals to keep their existing health plans if they liked them. However, as a leaked draft of the "grandfathering" regulations reveals, the Administration knew that would not be the case. This paragraph, on page 56 of the leaked draft, admits that "most plans will relinquish their grandfathered status" over time?in other words, many Americans will lose their existing health coverage (emphasis added):

After careful consideration, the Departments opted against rules that would require a plan or sponsor to relinquish its grandfathered status if only relatively small changes are made to the plan. The importance of gradual change outweighs the risk of market segmentation. Similarly, the Departments concluded that sponsors and issuers of grandfathered plans should be permitted to take steps within the boundaries of the grandfather definition to control costs, including limited increases in cost-sharing and other plan changes not prohibited by these interim final regulations. As noted earlier, deciding to relinquish grandfather status is a one-way sorting process: after some period of time, most plans will relinquish their grandfathered status since plans rarely stay exactly the same. These interim final regulation will likely influence the time frame over which plan sponsors decide to relinquish grandfathered status.

Compare that paragraph to a very similar paragraph on page 11 of the official, publicly released regulation. The final version struck a sentence emphasizing "the importance of gradual change" in transitioning health coverage to the new, post-Obamacare regime?and said that "more plans," not "most plans," will relinquish their grandfathered status over time. In other words, the Obama Administration tried to massage and downplay the regulation's impact on Americans' ability to keep their health coverage, even though the substantive contents of the rule changed very little from the leaked draft to the official document.

For millions of Americans?as many as 16 million who buy their own health insurance, according to one estimate?Obamacare will prove anything but a "gradual change." They are losing their existing health plans and have no good options. Some will migrate to Obamacare's new (non-functioning) exchanges, where the law's new requirements mean their premiums could increase substantially. This is change?a change that Heritage predicted?but it's not the change President Obama sold to the American people.