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BACKLASH: This Is How to Kill RyanCare, Says One Conservative Group

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Conservative groups are now campaigning for the defeat of the American Health Care Act, the bill introduced by House Republican leadership to allegedly repeal and replace Obamacare.

Heritage Action labeled the bill “bad policy.” FreedomWorks called it “Obamacare-lite.” And the Club for Growth said it is a “warmed over substitute for government-run healthcare.”

Senate Conservatives Action, the political arm of the Senate Conservatives Fund, is urging voters to contact their representatives to oppose “RyanCare” (or, “Obamacare 2.0”) and demand full repeal of Obamacare.

“The truth is that RyanCare keeps Obamacare’s most expensive coverage mandates,” SCF President Ken Cuccinelli writes. “[I]t keeps much of Obamacare’s costly Medicaid expansion, it continues to impose penalties on people who don’t keep their coverage, and it continues to provide government subsidies using a new entitlement program.”

After campaigning on full ACA overhaul for years, and noting that Congress managed to place a full repeal bill on President Obama’s desk in 2015, SCA notes GOP leadership could only come up with “minor changes” to the ACA.

Conservatives such as Sen. Rand Paul, R-Ky. (A, 92%) and certain members of the House Freedom Caucus are urging Congress to, first, pass the 2015 repeal bill, and then move forward with a replacement bill from there.

“The sad, but unavoidable, fact is that RyanCare will not lower costs and improve access to health coverage, but it will cause Republicans to own the disaster that follows,” Cuccinelli writes, calling voters to action:

According to Senate Conservatives Action, only 20 to 25 Republicans in the House of Representatives and three to five Republicans in the Senate are needed to scrap RINOcare and send GOP leadership back to the drawing board on a true Obamacare repeal conservatives can get behind.

SCA provided the contact information for the following 20 members of Congress and urged voters to call and “insist on full repeal of Obamacare.”

GOP REPRESENTATIVES

Jim Banks (R-Ind.)

Ted Budd (R-N.C.)

Bill Flores (R-Texas)

Jeb Hensarling (R-Texas)

Barry Loudermilk (R-Ga.)

Tom McClintock (R-Calif.)

Alex Mooney (R-W.Va.)

John Ratcliffe (R-Texas)

Mark Walker (R-N.C.)

Roger Williams (R-Texas)

GOP SENATORS

Tom Cotton (R-Ark.)

Ted Cruz (R-Texas)

Joni Ernst (R-Iowa)

Deb Fischer (R-Neb.)

Ron Johnson (R-Wis.)

Mike Lee (R-Utah)

Rand Paul (R-Ky.)

Marco Rubio (R-Fla.)

Ben Sasse (R-Neb.)

Pat Toomey (R-Pa.)

(For more from the author of “BACKLASH: This Is How to Kill RyanCare, Says One Conservative Group” please click HERE)

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Trump’s 5 Health Care Principles, Explained

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President Donald Trump didn’t shy away from asking Congress to unwind Obamacare during Tuesday night’s joint address, and he presented lawmakers with a list of five policies to consider as Republicans craft their replacement for the health care law.

During his speech, Trump called on lawmakers to repeal and replace Obamacare, and reform the health care system to “expand choice, increase access, lower costs, and at the same time, provide better health care.”

“Mandating every American to buy government-approved health insurance was never the right solution for our country,” Trump said. “The way to make health insurance available to everyone is to lower the cost of health insurance, and that’s what we are going to do.”

The president offered few specifics on what reforms he would like to see Congress pursue as they work toward a replacement for Obamacare.

But Trump did outline five policies he supports in a proposal that will dismantle the health care law.

Many of the policies are in line with those backed by House Speaker Paul Ryan and Health and Human Services Secretary Tom Price. But some have been met with resistance from the House and Senate’s most conservative members.

The GOP conference hasn’t yet united around a plan to repeal and replace the law, and Trump’s comments seemed to tip the scales in favor of leadership’s suggested reforms.

But, conservatives have said they’ll oppose any legislation that doesn’t fully repeal Obamacare, and their hard line sent Republican leaders back to the drawing board.

Here are the policies Trump said he would like to see in an Obamacare replacement plan, and where they stand in the context of the current debate.

1. “We should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges.”

Obamacare’s pre-existing conditions provision has become one of the health care law’s more popular measures. Under the Affordable Care Act, insurance companies were prohibited from discriminating against consumers with pre-existing conditions.

Trump, Price, and congressional Republicans have repeatedly said they want to make sure Americans with pre-existing conditions have access to health insurance.

Most replacement plans include a provision barring insurers from discriminating against customers with pre-existing conditions if the person maintained coverage continuously, and a draft proposal—viewed as the leading plan—leaked to the press last week penalized individuals who let their coverage lapse by raising their premiums 30 percent for a year.

2. “We should help Americans purchase their own coverage through the use of tax credits and expanded health savings accounts—but it must be the plan they want, not the plan forced on them by our government.”

Republicans across the board agree on expanding health savings accounts, or medical savings accounts.

In fact, GOP leaders want to see the expansion of health savings accounts included in the bill that will repeal Obamacare.

But where Republican leadership and conservative lawmakers are at odds is in the financial assistance available to customers buying individual market coverage.

Tax credits were a staple of Obamacare replacement plans rolled out by Price and Ryan, and the leaked repeal document created refundable tax credits based on age—ranging from $2,000 for consumers under 30 to $4,000 for consumers over 60.

But conservatives object to the idea of refundable tax credits and say they’re a form of “Obamacare lite.”

They’re not ruling out all forms of financial assistance for consumers, though. Last month, the House Freedom Caucus, a group of approximately 40 conservatives, backed an Obamacare replacement plan from Sen. Rand Paul, R-Ky., and Rep. Mark Sanford, R-S.C., that created a $5,000 tax credit for those who contribute to their HSAs.

By referencing tax credits explicitly, Trump seemed to side with Ryan and Republican leadership.

However, conservatives after the speech suggested that Trump didn’t explicitly endorse “refundable tax credits,” which leadership’s plan calls for, and which they object to.

3. “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”

Trump hasn’t offered specifics on which changes to Medicaid he would prefer. However, he seemed swayed by Ohio Gov. John Kasich, a Republican, after a meeting at the White House on Friday—Trump suggested Kasich meet further with Price and chief of staff Reince Priebus to discuss Obamacare’s future more.

Kasich is opposed to repealing the Medicaid expansion, but favors making changes to the Affordable Care Act.

Governors who decided to expand the program, as well as Republican senators representing those states, have opposed a rollback of the Medicaid expansion, which expanded eligibility.

Still, Republican governors are working with congressional leaders to discuss potential changes and come up with a plan for the future of the Medicaid program.

Trump’s call for giving governors “resources and flexibility” with Medicaid seems to go along with Republican plans to block grant the program.

Some Obamacare replacement plans call for Medicaid to be turned into a block grant, or a lump sum of money allocated to the states. Others, though, favor a per-capita allotment.

Like the tax credits, the future of the Medicaid expansion is a point of contention for conservative lawmakers.

House and Senate conservatives are urging Republican leaders to bring a bill from 2015 rolling back key provisions of Obamacare, including Medicaid expansion, before members vote again.

Any proposal that falls short of that legislation won’t earn their support, and Medicaid expansion, specifically, is a sticking point for the conservatives.

4. “We should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance, and work to bring down the artificially high price of drugs, and bring them down immediately.”

Trump’s fourth policy calls for medical malpractice reform.

The issue hasn’t been prominent in debates over Obamacare’s future, though, Price and Ryan did say in the past they wanted to make tort reform part of their replacement plan.

On drug pricing, though, Trump has criticized the “artificially high price of drugs” before. During the campaign, the president said he was in favor of letting Medicare negotiate prescription drug prices.

Last month, White House press secretary Sean Spicer confirmed Trump hadn’t changed his stance. But the high cost of prescription drugs has largely been left out of discussions surrounding Obamacare’s replacement.

5. “The time has come to give Americans the freedom to purchase health insurance across state lines—which will create a truly competitive national marketplace that will bring costs way down and provide far better care.”

The ability to purchase health insurance across state lines has been the one health care reform Trump has consistently advocated.

And on this policy, in particular, Republicans are in agreement.

Some Obamacare replacement plans floated by GOP lawmakers over the years would allow consumers to buy coverage across state lines, including Ryan’s “Better Way” plan, Price’s proposal, and the Paul-Sanford replacement bill.

Trump and his fellow Republicans believe allowing insurers to sell across state lines will increase consumers’ access to coverage.

This proposal is beneficial for insurers based in states with strict regulations that can drive up the cost of plans, since they would be able to sell coverage in others with less stringent mandates.

However, it’s not the only thing that needs to be done to lower costs and boost competition, according to Sabrina Corlette, a research professor at Georgetown University. (For more from the author of “Trump’s 5 Health Care Principles, Explained” please click HERE)

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Why Job-Based Health Insurance Is Terrible for Americans’ Health and Wallets

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One of the problems with working in the realm of health care policy is that there are a lot of landmines on the path to reform, both political and technical in nature. So many of these obstacles are government created — from the big entitlements to state and local regulations — but one hurdle many people don’t think about is employer-provided health care.

Over half of all Americans get their health care coverage through their employer. Since it’s been that way for decades, folks tend to assume it’s a natural creation of the free market. What’s more, a great many of the people who get their health insurance as a perk of the job are pretty okay with that and certainly don’t see employer-provided insurance as a problem.

So here’s the short story of why employer-provided insurance isn’t natural, and in many respects is holding back patient-centered health care reform.

A brief history of the employer health care tax credit

The reason that employer-provided insurance looms so large in the private insurance market is because of a tax incentive that dates all the way back to World War II. In the midst of the war, the government imposed strict wage controls on many industries in an attempt to tamp down on the costs of war goods. But wages are one of the prime ways for companies to compete for higher quality workers.

As a result of these wage controls, companies turned to alternative ways to attract the best workers. And it turns out, the health insurance and other “benefits” didn’t count as “wages” for the government’s purposes. In fact, businesses figured out that they could deduct money used towards providing these benefits as a business expense in their taxes. For its part, Congress not only turned a blind eye to this practice, it formally encoded the deductibility of employee health benefits into the tax code in 1954.

From that point on, a company would have been foolish not to include health benefits as a part of its offers to prospective long-term employees. Not only were health benefits an attractive selling point on their own, paying the equivalent amount in wages would have subjected both workers and employers to the exorbitant income and payroll taxes that the uber-progressive Roosevelt administration left behind.

Why employer health insurance is not the awesome thing you might think it is

So the dominance of employer-provided care in the American market is largely an accident of tax policy. Yet, to be fair, if have a long-term, stable job with full health benefits provided by your company, this model is pretty cool. So why is it a problem?

What if the company goes under? What if you really would rather change jobs, but your child has an expensive condition that might not be covered under another company’s plan? Or your company’s version of a health “benefit” is to provide you an HMO plan where the insurer gets to dictate every bit of what doctors you can see and what treatments you can get?

What if, instead of your employer benefit, you’d rather have that same amount of money to invest in a private insurance plan of your choosing, and maybe (if your chosen plan is less expensive) something else? What if you don’t believe in some of the medical practices your premiums help cover, like abortions, and you’d rather opt for a different model of care entirely?

Well, if you opt out of your employer’s benefits, good luck. Your insurance costs and most of your health care costs on the private market aren’t tax-deductible. It’s like taking an enormous pay cut.

In addition, the modern economy increasingly doesn’t accommodate the kind of close company ties that made employer-provided insurance so popular. Younger workers are switching jobs more often, and innovations in technology have led to the creation of a broad “gig economy” where more people are self-employed or work contracts and odd jobs for multiple employers.

Incentivizing overuse

Worse, because employers would rather not suffer any more payroll taxes than necessary, they’re inclined to offer the best, most comprehensive “Cadillac” insurance plans possible rather than simply paying employees more. These super-expensive, low-deductible, nearly zero-copay plans create an incentive for people to be totally unrestricted with their consumption of health care services. After all, their insurance company pays all the bills, so if out-of-pocket cost for a given procedure is only $20, who cares how much it actually costs?

Overconsumption of health care is only the beginning of the problem created by an abundance of insurance plans that make health care seem “free” to consumers. Without the market forces created by customers comparing prices and trying to find the best value for good quality service, the price of health care is left mostly to negotiations between third-party payers and hospitals and doctors. Add in the costs imposed to health care providers by stingy government services like Medicaid, and private insurers become locked into a constant dance with hospitals to offer lower compensation for higher charged costs.

Individuals who don’t like their employers’ choices of care, who don’t have the employer option at all, or who don’t want to go through insurance for whatever reason, are left to deal with prices of care that are geared towards getting the most out of insurance corporations and the government. For many services, those are prices which many individuals cannot possibly afford.

This is not a functioning free market and hasn’t been for at least a couple generations.

Towards a free market in health care

These gold-plated insurance plans wouldn’t cease to exist in a fully free market, but given the option between an excessively generous insurance plan and keeping some of that money for other purposes, many people would certainly choose the latter. Rather than $10,000 worth of “free” insurance, some employees might prefer to have that cash to shop for the amount of covers that best suits them, in a competitive market.

One crucial step towards this is to allow a competitive individual market to exist in the first place. That means repealing all of Obama care’s regulations on what services every insurance plan must cover and what insurance companies are allowed to charge to which customers, and all the rest. In the digital age, it is hard to imagine that private websites would not step in to ease the process of choosing a plan in place of the existing healthcare.gov interface.

And then you allow individuals to keep more of their own income to purchase the health coverage they want tax-free, just like companies do. The large majority of political support in Republican circles appears to lean towards providing this relief through insurance premium tax credits (Speaker Paul Ryan, R-Wisc. (F, 51%) and HHS Secretary nominee Dr. Tom Price, R-Ga. (D, 62%) both back this approach, among others).

There are a multitude of problems with this approach in my view, which I’ll get into in its own article about why tax-deductible contributions to large HSAs are a superior approach. Regardless, the aim is to allow consumers the maximum amount of choice and flexibility in acquiring coverage. What consumers demand will go a long way towards determining whether employer-sponsored insurance remains the avenue for health care access for a majority of Americans.

Free markets aren’t predictable, and politicians hate risk

The fact is, no one knows exactly what the market response would be to leveling the playing ground between individuals and employers in buying health services. Will it lead to employers just dumping their workforces into the markets? Probably not, but it’s not impossible. The thing about individuals and service providers acting within a free market is that their behavior is never fully predictable. But the beauty of it is that demand also sparks innovation, and individuals who are able to keep more of their own money to buy the care they need are likely to encourage all manner of avenues for providing access to health care that aren’t common or even extant right now.

But politicians naturally hate uncertainty. Uncertain outcomes that don’t go as well as they hope can lead to bad elections for them, so their incentives are always to create more rigid guidelines, less freedom of choice. Conservatives must be on guard for this tendency. They mustalways push for health care reforms that emphasize breaking down barriers to free markets instead of merely setting up another, slightly more benevolent, set of guidelines that merely makes government-granted health coverage work slightly better than Obamacare.

It may very well be that a free market approach dramatically reduces the role of employers in the American health care system over time. Transitioning from a government dominated marketplace to a system that is more patient-centered and market-oriented will involve substantial change. But maintaining the government-created insurance model that priced many Americans out of affordable health care even before Obamacare would keep the momentum on the side of the progressives, sliding inexorably towards total government control. (For more from the author of “Why Job-Based Health Insurance Is Terrible for Americans’ Health and Wallets” please click HERE)

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After This State Blocked Online Eye Exams, a Health Care Startup Is Fighting Back

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A Chicago-based health care startup that allows customers to conduct eye exams from their homes and obtain a prescription is fighting back against a South Carolina law that prohibits the company from operating in the state.

Opternative, an online eye exam company, and the Institute for Justice, a public interest law firm, filed a lawsuit in South Carolina civil court last week arguing that a law passed in May violates the state constitution.

“Opternative wasn’t banned in South Carolina because there was anything wrong with their technology or because there was any public health or safety problem with their technology,” Robert McNamara, a lawyer with the Institute for Justice, told The Daily Signal. “They were banned because their technology interferes with the business model of established optometrists.”

Opternative, which was founded in 2012 and launched to the public in 2015, developed technology that allows customers to obtain a prescription for glasses and contacts without ever stepping foot in a doctor’s office.

Using Opternative’s technology, customers self-perform their own vision test for $40 using a smartphone and computer. The results of the exam, along with answers to a list of questions about the patient’s medical history, are then compiled and sent through Opternative’s platform to a state-licensed ophthalmologist, who reviews the information and writes a prescription.

Opternative currently operates in 39 states, but the company has been effectively banned in South Carolina.

There, state lawmakers passed the Eye Care Consumer Protection Law this year, which states that vision assessments “must not be based solely on objective refractive data or information generated by an automated testing device, including an autorefractor or other electronic refractive-only testing device, to provide a medical diagnosis or to establish a refractive error for a patient as part of an eye examination.”

The American Optometric Association pushed for the legislation, but Gov. Nikki Haley, a Republican, ultimately vetoed the bill and criticized it for using “health practice mandates to stifle competition for the benefit of a single industry.”

“If [the bill were] allowed to become law, South Carolina would become the eighth state to impose such a ban, putting us on the leading edge of protectionism, not innovation,” Haley continued.

The Republican-led state Legislature ultimately voted to override Haley’s veto, with the Senate voting 39-3 and the House voting 98-1.

“This bill is protectionist legislation at its worst,” Aaron Dallek, Opternative’s CEO, told The Daily Signal. “It protected the economic interest of one group of people over the interest of the citizens of the great state of South Carolina.”

According to a complaint filed with the state court, the lawsuit argues that the law keeps Opternative from exercising its right to “pursue an honest living free from arbitrary, irrational, and protectionist regulation.”

“The South Carolina Constitution protects people’s right to be free from arbitrary and unreasonable economic regulations, and it’s part of an ongoing trend we’ve seen in state courts of announcing that their state constitutions are going to give people stronger protections against this kind of arbitrary or protectionist economic regulation than you might see under the federal constitution,” McNamara said.

In response to the lawsuit, Barbara Horn, secretary-treasurer of the American Optometric Association and an optometrist in Conway, South Carolina, said Opternative and the Institute for Justice “are not concerned about the health care needs” of South Carolinians.

The American Optometric Association also filed a complaint with the Food and Drug Administration in April urging the agency to take action against Opternative.

“Having lost decisively in our state capital and still lacking any credible research or federal medical device approvals, they’ve come back to try to impose their profit-driven approach to health care on South Carolina,” Horn said on behalf of the organization regarding the lawsuit. “Their questionable legal tactics will cost the citizens of our state time and money—resources better invested in protecting the health of our patients.”

McNamara, meanwhile, said the South Carolina Legislature has carved out specific regulations and restrictions for eye care and optometrists, specifically.

In June—one month after the Legislature voted to override Haley’s veto of the Eye Care Consumer Protection Law—state lawmakers passed the South Carolina Telemedicine Act, which legalized telemedicine across the state.

The two laws, McNamara said, conflict with each other.

“That’s part of what makes the ban on Opternative’s technology unconstitutional,” he said. “What the state has essentially said is, ‘We don’t have a problem with telemedicine, and we trust doctors, as long as they’re meeting the standard of care, to choose what technology they want to use and choose how they want to incorporate the internet into their practice, except for ophthalmologists.’”

In addition to South Carolina, lawmakers in Georgia and Indiana passed bills this year prohibiting Opternative from operating in those states.

Dallek said the company “doesn’t make threats” regarding the potential for legal challenges to laws in those two states. However, he didn’t rule it out completely.

“We do believe that we have the right to defend our doctors’ right to offer affordable and convenient eye care services to their patients, and we’ll work with those states to try to correct any legislative restrictions on our services,” Dallek said. “If we have to, we’ll use the judicial system to defend our doctors’ constitutional right to their economic freedom.”

Challenges to Opternative’s technology underscore debates taking place in state legislatures nationwide and in the courts following the rise of technology companies like Uber and Airbnb.

In response to these new technologies, government officials at the local and state level have passed ordinances and laws regulating companies like Opternative.

McNamara said that no matter what the company or service is—be it eye care, ride-sharing, or mobile vending—the core issue remains the same.

“When you look at these fights, it’s always the same underlying phenomenon. Whatever the specific facts of the case are, it is always a legislature kowtowing to a powerful, private interest group at the expense of some new entrant, some entrepreneur, some innovator,” he said.

“I think a big solution to the problem is to persuade the courts to continue the growing trend of taking a serious look at regulations like this and standing up to the protectionists for protectionists sake,” McNamara continued. (For more from the author of “After This State Blocked Online Eye Exams, a Health Care Startup Is Fighting Back” please click HERE)

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Controversial Proposal for Nurses Could Expand Access to Care for Veterans

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For years, state and federal policymakers have discussed proposals to expand the role of advanced practice registered nurses, with major physician groups like the American Medical Association squaring off against nurse organizations like the American Nurses Association.

But a proposed rule from the Department of Veterans Affairs to allow nurse practitioners, nurse midwives, and clinical nurse specialists to practice independently of physicians has brought the debate to the national spotlight and sparked an unprecedented response from the public.

“To use advanced practice registered nurses to their full authority, it improves access and enables the delivery of high-quality care, and that’s good for everybody,” Marla Weston, CEO of the American Nurses Association, told The Daily Signal. “It’s good for the health care system, and it’s good for people in all sorts of ways.”

Advanced practice nurses have master’s, post-master’s, or doctoral degrees and have to adhere to scope of practice regulations, which are parameters set by state boards, legislatures, and the government that dictate the services providers can give to which patients and in what settings.

In Arizona, for example, nurse anesthetists cannot provide anesthetics unless they’re “under the direction of and in the presence of a physician or surgeon.”

Groups like the American Nurses Association and the American Association of Nurse Anesthetists have long called on state lawmakers to expand the scope of practice for registered nurses or grant full practice authority.

But up until 2010, states were slow to react.

That year, the Institute of Medicine, after launching a two-year initiative with the Robert Wood Johnson Foundation in 2008, released a report examining the future of the nursing profession. Included in that report was an analysis of the legal barriers in place across many states that make it difficult for advanced practice registered nurses to use the full scope of their training and education.

The report recommended state policymakers lift some of these constraints to expand the scope of practice for advanced registered nurses, which the Institute of Medicine said would improve care for patients.

“Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training, and competence,” the Institute of Medicine concluded.

In the wake of the report, states began to act, with legislators debating laws that would allow advanced practice registered nurses like nurse practitioners and nurse anesthetists to practice independently.

Today, 21 states and the District of Columbia have granted nurse practitioners full practice authority, according to the Robert Wood Johnson Foundation.

Lawmakers in Nebraska and Maryland were to most recent to do so, passing legislation last year that allows nurse practitioners to practice independently of a physician.

And 40 states and the District of Columbia don’t have a physician supervision requirement for nurse anesthetists on the books, according to the American Association of Nurse Anesthetists.

Heading into 2017, lawmakers in Tennessee and Arizona are gearing up to address the scope of practice for advanced practice registered nurses.

A coalition of these nurses in Arizona lobbied the state legislature last year, urging them to expand nurses’ authority and change language requiring nurse anesthetists to provide anesthetics under “the direction of and in the presence of a physician or surgeon.”

But after medical associations worked to stop the original bill, it was ultimately defeated.

Ali Baghai, a nurse anesthetist working in Tempe, Arizona, and the former president of the Arizona Association of Nurse Anesthetists, said advanced practice nurses plan to take a more piecemeal approach to legislation next year.

“APRNs and [nurse anesthetists] provide high quality, safe, and cost effective health care,” Baghai told The Daily Signal. “It’s been proven for decades, and we just want legislation that lets us do our jobs and take care of patients.”

A National Debate

Though advanced practice nurses have seen success at the state level in expanding the scope of practice for nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists, their efforts have not been met without resistance from medical associations and physician advocates.

And in no place is that split between the nursing community and physicians more evident than at the VA, where a proposed rule to grant full practice authority to advanced practice nurses led to one of the largest responses to a federal regulation, with more than 178,000 comments submitted to the government via the regulations.gov website.

“The best way to honor our commitment to our veterans is to modernize the VA and eliminate unnecessary regulations that only impede our ability to provide them quality care,” Michael Smith, a former clinical specialist in the Army, wrote in a comment to the VA supporting the proposal. “Lifting the restrictions on nurse practitioners is a great place to start.”

Other veterans, meanwhile, opposed the VA’s rule.

“I’m a veteran: I put my life on the line in service to my country, and I believe that I deserve quality health care,” Sean Malin wrote in a separate comment. “I oppose any mandate that would force the best trained physicians out of the operating room.”

The VA announced its proposal in May, and the rule would extend to nurse practitioners, nurse midwives, and clinical nurse specialists while they’re employed by the VA.

A spokeswoman for the VA said officials are hoping to finalize the rule by January.

In its initial notice, the government said that granting advanced practice nurses full practice authority would “increase veterans’ access to VA health care by expanding the pool” of qualified health professionals.

And supporters of the proposal like the American Nurses Association and American Association of Nurse Anesthetists agree.

“One of the things that we know has historically been an issue or been an issue recently is access to care,” Weston said. “One of the things that would happen in an immediate way is that access would increase dramatically. That will be good for the VA and good for our veterans.”

Before the American Nurses Association, Weston worked at the Department of Veterans Affairs in the Veterans Healthcare Administration in both the Office of Nursing Services and the Workforce Management and Consulting Office.

In addition to increasing veterans’ access to care, expanding nurses’ authority would put the VA in line with other government entities that have already done so, supporters said. Currently, advanced practice nurses serving in the armed forces and working with the Indian Health Service can practice independently.

“It doesn’t make sense to say, ‘OK, it’s alright for the military, all branches. It’s alright for the Indian Health Service to do this. But in the VA? No,’” Cheryl Nimmo, president of the American Association of Nurse Anesthetists, told The Daily Signal.

“Does the quality change? No,” she continued. “If a [Certified Registered Nurse Anesthetist] decides they want to retire from active duty military and work in the VA, suddenly they’re not as safe as they were for their first 20 years? It doesn’t make any sense.”

Nimmo, who served in the Army Reserve for 10 years, and the American Association of Nurse Anesthetists are among a long list of organizations like the AARP and the Federal Trade Commission, Republican and Democrat members of Congress, and military groups supporting the Department of Veterans Affairs’ proposal.

Those supporters say that allowing advanced practice nurses to work independently would alleviate the issues plaguing the VA, like shortages of doctors and long wait times for veterans to see physicians.

According to the VA’s data, more than 507,000 veterans were waiting at least 30 days for an appointment, as of Sept. 15.

“This is a sensible, productive, quality way to fix the problem,” Nimmo said.

But on the other side of the proposal are large doctors’ groups lobbying hard against it. Those groups believe the rule is “unprecedented” and say expanding nurses’ authority would impact the standard of care.

“We feel this proposal will significantly undermine the delivery of care within the VA,” Dr. Stephen Permut, board chair of the American Medical Association, said in a statement in May. “With over 10,000 hours of education and training, physicians bring tremendous value to the health care team.”

Like the American Medical Association, the American Society of Anesthesiologists was vocal in opposing the VA’s proposal, calling it “dangerous.”

“Americans understand that it would be wrong to lower the standard of care provided to these men and women who have bravely served our country,” Dr. Daniel Cole, the group’s president, said in July. “We expect the VA will listen to the comments of veterans, their families and the American public who care about the quality of health care in the VA system and abandon this dangerous proposal that runs country to the VA’s own strategy to deliver high-quality, Veteran-centered care.”

Access to Care

Despite the concerns from physicians groups, nurses with advanced training point to their level of education and experience as arguments in favor of proposals to expand their scope of practice.

While physicians and physician groups have said that there is a substantial difference in the levels of education for doctors and advanced practice nurses, both Nimmo and Weston disagreed.

“The standards are very high, and we study the exact same things with the exact same textbooks,” Nimmo said specifically of nurse anesthetists. “Sometimes, they even take the same classes together.”

“If you’re putting the patient first, and if you’re putting the patient at the center of all of this and trying to do the best thing you can for the patient, the pushback is not understandable to me,” she continued, speaking to the opposition from physician groups.

Over the last few years, research has emerged suggesting that expanding the scope of practice for advanced practice nurses can help expand access to underserved populations, especially those living in rural communities.

“The reality is the research is on our side,” Baghai said. “We provide high quality, safe care.”

According to the National Conference of State Legislatures, which tracks scope of practice, 11 percent of the country’s physicians work in rural areas, but 20 percent of the population lives there.

Additionally, no studies suggest that advanced practice nurses deliver care that is of a lesser quality or less safe than that delivered by physicians, according to the Institute of Medicine.

“We are able to provide this much needed service to Americans,” Nimmo said. “It has been historically the norm that advanced practice registered nurses have taken care of patients in rural communities. It increases access for those people.”

“They might not have the time or the wherewithal to get themselves to an urban area for care,” she continued. “This provides the care to them right in their own neighborhood.”

Many groups supportive of expanding the scope of practice point to the floods of Americans—more than 17 million more, according to the National Conference of State Legislatures—that have become newly insured since Obamacare’s implementation as another reason advanced practice registered nurses should be able to work independently of physicians.

While more people are accessing the health care system through primary care providers instead of emergency rooms, there hasn’t been an increase in the number of physicians, the National Conference of State Legislatures found.

Allowing advanced practice registered nurses to work independently of physicians would help serve the growing population of people who are newly insured, Weston said.

“One of the ways the health care system would work the best is to have advanced practice nurses function at full practice authority in all states,” she told The Daily Signal. “It improves access to high quality health care.” (For more from the author of “Controversial Proposal for Nurses Could Expand Access to Care for Veterans” please click HERE)

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‘Do No Harm Act’ Will Force Christian Doctors To Perform Sex Change Operations

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Reps. Joe Kennedy III (D-Mass.) and Bobby Scott (D-Va.) introduced the Do No Harm Act Wednesday, which would amend the 1993 Religious Freedom Restoration Act (RFRA) to specify that religious exceptions should not apply to “protections against discrimination or the promotion of equal opportunity” and “access to, information about, referrals for, provision of, or coverage for, any health care item or service.”

The legislation is intended to “clarify that no one can seek religious exemption from laws guaranteeing fundamental civil and legal rights.”

The bill emphasizes that RFRA should not be interpreted to “authorize an exemption from generally applicable law that imposes the religious views, habits, or practices of one party upon another” or authorize “an exemption from generally applicable law that imposes meaningful harm, including dignitary harm, on a third party.”

Kennedy claimed in announcing the bill that “the Religious Freedom Restoration Act has become a vehicle for those seeking to impose their beliefs on others or claim that the tenants of their faith justify discrimination.”

“The Do No Harm Act will restore the balance between our right to religious freedom and our promise of equal protection under law,” he argued. (Read more from “‘Do No Harm Act’ Would Forbid Christian Doctors Objections to ‘Any Healthcare’ Service” HERE)

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Bills on the Move Dealing With Parental Rights, Faith-Based Health Care Options

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In Alaska’s State Legislature this session, lawmakers face myriad bills of concern to Alaskan Catholics. Following is an update on several bills moving through the legislative process, including dates of upcoming hearings.

For more information and to contact your legislators, go to akleg.gov or call 800-478-4648. To follow Catholic Anchor reports, including news updates on public testimonies and bill hearings, go online to CatholicAnchor.org.

The current legislative session runs until April 19.

CONTRACEPTION MANDATE

In an effort to force health insurance companies and private business owners in Alaska to provide coverage for the “full range” of prescription and over-the-counter contraceptives, sterilizations and contraceptive-focused exams, Anchorage Democrat Rep. Matt Claman has introduced House Bill 345.

House Bill 345 would force health care insurers operating in the state to cover the contraceptive Pill, so-called “emergency contraception” and IUDs (inserted in outpatient procedures) — all of which can cause early abortions of living human embryos.

A companion bill, Senate Bill 156, has been introduced in the Alaska Senate by Anchorage Democrat Sen. Berta Gardner.

FAITH-BASED HEALTH CARE OPTIONS

Senate Bill 18 would exempt religious-based health care sharing ministries (HCSMs) from being regulated as health insurance in Alaska. A distinctive and attractive aspect of HCSMs for many Catholics and non-Catholic Christians alike is that HCSMs are not subject to federal or state contraceptive or abortion mandates.

Sponsor: Sen. John Coghill

Status: The bill was introduced last year and referred to the Committees on Health & Social Services and Labor & Commerce. As of press time, the bill had passed out of the Labor & Commerce Committee and was referred to the Rules Committee.

PARENTAL RIGHTS IN EDUCATION

Senate Bill 89 seeks to ensure a parent has the right to direct the education of his or her public school child, including the right to object to and withdraw the child from state-mandated tests, and from activities or classes on sexual matters which parents find objectionable. The bill also would prohibit public schools from administering student questionnaires that inquire into personal or private family affairs of the student. And the bill would prevent school districts from contracting with an abortion services provider for course materials or to provide instruction relating to human sexuality. According to the Catholic Catechism, “Parents have the first responsibility for the education of their children.”

Sponsors: Sens. Mike Dunleavy, Cathy Giessel, Charlie Huggins, Bill Stoltze, Pete Kelly, Anna MacKinnon, John Coghill, Kevin Meyer

Status: The bill is set for a vote by the full Senate on Friday, Feb. 26.

RESTRICTING ABORTION PROVIDERS FROM PUBLIC SCHOOLS

A bill to restrict Planned Parenthood and other abortion providers from teaching or distributing materials in Alaska’s public schools has been introduced in the Alaska Legislature.

Introduced by Senator Mike Dunleavy, Senate Bill 191 will provide for civil penalties and the revocation or suspension of teacher certificates for those instructors who violate the proposed law by inviting abortion providers and their legal affiliates into classrooms for instructional purposes.

Senate Bill 191 states that abortion providers may not “present or deliver any instruction or program on any topic to students at a public school. Abortion providers that violate the proposed law would be “liable to civil action for a penalty of $5,000 or actual damages, whichever is greater, plus costs and reasonable attorney fees, to each aggrieved student or the student’s estate.” Additionally, a school board member who violates the proposed law would note be eligible to receive state funds on or after the date of the violation.

For more information about the bill go to akleg.gov and enter SB 191.

A companion bill, House Bill 352, has been introduced in the Alaska House by Rep. Lynn Gattis.

PLANNED PARENTHOOD TAKES NOTICE

Planned Parenthood in Alaska has taken notice of recent legislative proposals to restrict abortion providers from public schools and is taking an active role in pressuring lawmakers to reject such legislation.

The state’s largest abortion provider has lobbied hard against SB 89, which would restrict their access to public school students and give parents the option to pull children from unwanted sex education classes. Likewise the abortion provider has lobbied hard against SB 191 which bans abortion providers from access to public school classrooms.

In multiple emails to its supporters, Planned Parenthood has attempted to inundate lawmakers with emails and phone calls opposed to the legislation that would roll back Planned Parenthoods influence in public schools.

HOW TO TAKE ACTION

For information about public hearings and upcoming action on certain bills, go to https://akleg.gov/index.php and type in the name of specific bills at the top of the page.

Information on how to read bills and follow their progress through is available at https://akleg.gov/start.php.

To contact a senator or representative, click here: https://akleg.gov/docs/pdf/doso/DosoALL.pdf#page=12

(For more from the author of “Bills on the Move Dealing With Parental Rights, Faith-Based Health Care Options” please click HERE)

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New HHS Documents Reveal Security Concerns, Healthcare.gov Had No ‘Authorization to Operate’

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[Earlier this week,] Judicial Watch released over 1,000 pages of new documents that show federal health care officials knew that the Obamacare website, when it launched in 2013, did not have the required “authorization to operate” (ATO) from agency information security officials. These documents, obtained from the U.S. Department of Health and Human Services (HHS), come in two productions of records: a 143-page production and an 886-page production. The email records reveal that HHS officials had significant concerns about the security of the Healthcare.gov site leading up to its October 1, 2013, launch.

Judicial Watch obtained the HHS documents in response to a court order in a Freedom of Information Act (FOIA) lawsuit (Judicial Watch v. U.S. Department of Health and Human Services (No. 1:14-cv-00430)). The lawsuit was filed in March 2014, after HHS failed to respond to a December 20, 2013, FOIA request seeking the following information:

All records related to the security of the healthcare.gov web portal including, but not limited to, studies, memoranda, correspondence, electronic communications (e-mails), and slide presentations from January 1, 2012 to the present.

On September 21, 2013, 10 days before the launch of the Obamacare website, Centers for Medicare and Medicaid Services (CMS) Information Security Officer Tom Schankweiler discussed with Deputy Chief Information Officer Henry Chao 17 initial “moderate” security issues findings and two “high” security issues. Two high findings and 3 moderate findings were resolved, according to the documents. The emails also show that a separate security analysis found 17 “high” security issues, prompting Chao to ask, “What are we actually signing off on…?” Schankweiler responded that the numerous security issues resulted in CMS Security Officer Teresa Fryer’s refusing to approve the “ATO” (Authorization to Operate), something he indicated he found out belatedly.

The documents also show that on September 30, 2013, the day before the website launch, Blue Canopy, a contractor that was testing the security of the Healthcare.gov system, reported that the “parsing engine did not properly handle specially crafted messages.” The vendor added, “As a result, consumption of these messages would cause the service to crash.” (Read more from “New HHS Documents Reveal Security Concerns, Healthcare.gov Had No ‘Authorization to Operate'” HERE)

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Alaskan Crossroads: Massive Medicaid Expansion will Only Result in Misery [+video]

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It has come to my attention that the republican controlled legislature is seriously considering supporting the governors call for an expansion of the Medicaid program here in Alaska.

An expansion of Medicaid will usher in the necessity for new revenue streams in order to pay for this program. We are seriously looking at a substantial fiscal shortfall now. The last thing we need to do is to expand any programs which would put an extra financial burden on the citizens of this state. (“Alaskan Crossroads” continues below)

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Listen to the Foundation for Government Accountability Skewer Governor Walker’s Medicaid expansion plan:

The Joe Miller Show broadcasts weekdays from 2 p.m. to 4 p.m. Alaska Time (6 p.m. to 8 p.m. EST), on 1080 AM and 95.1 FM, Anchorage. It is also carried via live streaming at JoeMiller.us. Podcasts from prior shows are found HERE. If you’d like to advertise on or sponsor The Joe Miller Show, please email [email protected]
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Before we remotely consider expanding the federal Medicaid program, perhaps we should demand the federal government fully fund their own mandated health care programs.

As an example, the Indian Health Services through the BIA is currently being funded at approximately 55%. The inability of the federal government to fully fund a medical program they are 100% obligated to, is putting massive pressure on ANMC and native health services throughout the state. Currently ANMC is unable to field the personnel they need so many doctors and nurses in their organization are met with massive overtime and are not compensated at the level of other health services in the area. ANMC is having a very difficult time recruiting and training personnel to stay in their ranks specifically due to the shortcomings of funding through Indian Health Services.

Additionally, Medicaid expansion into the native community is clearly a mechanism to absorb the Indian Health Services into Obamacare. It is a method the Obama administration is using to drive up Obamacare numbers in order to preserve President Obama’s legacy with his signature legislation.

Certainly, it would be far more advantageous for the State of Alaska to demand that the Federal Government fund their own programs fully before they come selling other programs when they clearly intend to transfer the financial burden to us.

Here are just a few questions I would like every state legislator to answer before they consider voting to expand Medicaid:

1. Do you know the amount the State of Alaska will currently be forced to pay based on the shortfall?

2. Do you know the amount the State of Alaska will pay in two years when this program goes to 90% funded?

3. Do you know the rate of decrease over the next ten years regarding the federal government’s commitment?

4. Do you know the penalty of “opting out” if this program becomes economically unsustainable at a state level.

5. What additional revenues are you planning in order to meet the increased obligations?

6. Do you know this program may have an adverse effect on employers dropping healthcare on employees who qualify?

7. Do you know the rate Medicaid will pay and if medical institutions and doctors will accept patients at a lower level of reimbursement?

8. Are you aware of the substantial administrative costs passed to the medical profession in order to implement such program?


Any legislator who votes for expansion is voting to either implement a state income tax or raid the PFD in order to sustain this program. Their term in office may recede into the historical library of the legislature, but Alaskan’s will be forced into paying this government expansion of healthcare in perpetuity.

It is my considered opinion that expanding Medicaid in Alaska is a short sighted gain for a long term loss. Within a very short period Alaskans will be paying for additional revenues to comply to the federal mandate of matching funds. It will be economically impossible to “opt out.”
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Michael Chambers is a former educator in Alaska, currently the Chair of the Alaska Libertarian Party, Chair of United for Liberty, and a self employed professional artist.

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How This New Obamacare Regulation Will Drive Up Your Health Care Costs Significantly

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Photo Credit: The Daily Signal America’s doctors, already struggling with the Affordable Care Act’s regulatory burdens, could face another round of red tape—which means higher costs for ordinary Americans.

The new round of red tape is the government-mandated implementation of the International Classification of Diseases tenth revision (ICD-10). The new system, delayed last year, goes into effect Oct. 1, 2015.

The ICD-10, created and maintained by the World Health Organization (WHO), is the latest version of the medical coding system doctors use to file claims for reimbursement with Medicare and insurance. (When you see a doctor, a code associated with your diagnosis determines how much your insurance will be billed.) The ICD-10 will replace the existing coding system (ICD-9), for medical diagnoses and inpatient procedure coding.

The new version of the ICD will increase the number of codes from 18,000 to 155,000. There is also a lot of unnecessary (not clinically relevant) data doctors must document to remain compliant.

While most Americans have probably never even heard of the ICD-10, if you go to the doctor or hospital you will be affected by it, in one way or another. For instance, the reimbursement your doctor receives is based on the code of the disease you were diagnosed with. (Read more about the increasing health care costs HERE)

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