Re: New Health Reform Law Expands Medical Device Excise Tax to Class I Devices
Jim DeWees
Description
Collection
Title:
Re: New Health Reform Law Expands Medical Device Excise Tax to Class I Devices
Creator:
Jim DeWees
Date:
4/8/2010
Text:
In response to the latest NAAOP email regarding the Reform bill:
Well, the Reconciliation bill DID pass, and this reform is now law. And yet nothing was mentioned on this listserve about what happened in the reconciliation process....maybe that is because NOBODY out in the public knows truly what happened behind all the closed doors.
I find it ironic that over the past few months, NAAOP was strongly behind this reform, while essentially every prosthetist I have spoken with is NOT behind this bill. The Academy (and the leaders) were also in favor of this bill, while the members of the Academy that I have contacted (either by phone calls or emails) are not in favor of this bill. NAAOP was always posting things on here about how great this bill was, and finally, this last email from them raises these concerns and doubts now about what this bill does to help the amputees and brace users.
We all see how this bill will only have more control over what we are able to do, and who we are able to actually help or give service to, and what we will be paid for our services, etc. We also seem to realize that this bill will not actually do anything to make any insurance company behave better, or treat the patients or providers better. There is NO provision in the bill to cut insurance costs or lower any premiums. It only now forces EVERYONE to go and support companies like Anthem and other big insurance companies.
The language in the bill says that the insurance companies must accept anyone WITH a pre-existing condition. But, notice that the bill does not say that the insurance MUST treat this condition, or cover the condition. In states where Parity laws have passed (like Indiana), there are insurance companies that WILL offer an insurance policy to an amputee, AS LONG AS the amputee will sign a Voluntary Waiver of Benefits for the amputation or the affected limb. I know this happens, because this is MY own personal experience I am talking about. I have talked to the Dept of Insurance here about this practice, and yes, it is legal, and YES, the insurance companies do this all the time. The Dept of Insurance person even went on to say that with this new bill being passed (Reform bill), that it WILL be a standard practice that the insurance WILL offer a policy to anyone because they HAVE to do that....BUT, they can put a price tag on that policy that is SO expensive, that nobody could realistically afford it. AND, they will also make the patients sign a voluntary waiver of benefits for things that are pre-existing. And, this IS legal under the new bill, and existing laws.
As long as the insurance company offers the patients a policy, that is all that they are required to do. It is up to the patients to decide IF they can comply with the terms, like the price tag on the bill, or not. And, if they CANNOT afford that policy, then the patients must pay the $2250 annual fine to the government, and they will still NOT have any insurance....but only have less money available to take their children to the doctor to get the vaccines or medical care that they might need. That's about $200 a month per family goign to the government as a fine....which is $200 less a month to have for food, clothing, medicine, etc. This is REAL!!!! And, when people hear that the IRS is growing by about 14,000 employees so that they can enforce this fine, that makes the public even less happy about this bill and this change.
So will this bill mean that I will be able to go out and find a policy with whatever insurance company I choose, and expect that I can pay one month's premium (like $800) and then expect to be able to walk in and get a $14,000 leg the next week? I do NOT believe that will ever happen, EVER.
And, with the Medicare/Medicaid budget being slashed by $523 BILLION, and in the same bill adding 12 million more into the Medicaid benefits, we can ALL expect to see cuts in O&P in the medicare and medicaid programs.
If you don't think that is possible, just look at California and what they are doing, starting July 1, 2010. I was in California when this news hit the public. They announced that in order to balance their MediCal program, they will no longer have benefits or cover prosthetics in California. This was BEFORE there are additional cuts to the Medicare/Medicaid budget.
If California can do this, and demonstrate to other states that it IS a good technique to balance a budget, then other states will follow their model and do the same.
Sounds like great Reform to me so far....
But, there is so much more to this bill...
Let's look at the added taxes to Medical Devices, and what that will mean to us (as providers) and to us (as patients and beneficiaries). With the added taxes to medical devices (including some components), this will drive the costs UP for making the prosthetics.....and at the same time, reimbursements continue to go down for these devices. While the manufacturers CAN raise their prices for use to get their devices and to use them on patients, WE cannot raise our prices for Medicare, Medicaid, or any other insurance contract....once again either making us take a bigger loss in this process, or deciding to buy cheaper, inferior quality components to put on the patients. In the end, this really only adds more money for the BIG Government, and takes away from the quality of care that amputees are getting....which is totally against what this bill was designed to really do...which was to give access to cheaper, higher quality medical care for the patients.
I followed comments and emails from organizationg like NAAOP, and have even exchanged emails and phone calls with them, and was shocked to hear what they had to say. They are NOT in touch with the membership in most cases, but that is another issue. But these organization leaders defended the reform and were totally behind this.
If and when this bill goes into effect, and if WE see that it is hurting the amputees and our patients, then WE must hold the ones that supported this bill accountable. We must question them, and ask ourselves if WE agree with these leaders and the groups, and should WE financially support these groups? Should be belong to these groups?
I personally could never be a member of, or give money to, any organization that does NOT stand up to support the rights or benefits of the patients that I serve, or support the profession that I have dedicated my entire life to. We might differ on some of the details of a bill or policy, BUT, in a bill that is so massive and is going to change everything, we have to really become educated on what impact these bills have on our lives, and then support groups that are in line with your own views.
I am not saying to boycott anything or anyone, BUT, what I am saying is during these challenging times, we must make careful decisions about what we do support and who we support as well.
Our local congressman, who supports this bill, has been told numerous times by local healthcare providers that we are all educating our patients, one at a time, about what this bill will DO TO THEM. The patients are shocked, and cannot believe what is happening and how this bill was passed. In turn, these patients are educating their family members about what this bill will do to them, and so on. I know that here locally, we (the medical community) will make sure this congressman will NEVER get re-elected to this office here.
There are other issues about this congressman, like during the Town Hall Meeting that we had here, he told us a story (which must have been fiction...a real story), about how he went to lunch recently with the CEO of Anthem BC, and how he (the CEO) made $14.9 million in salary, and he got another $37 million as a bonus, and that this man makes SO MUCH money. Well, the funny part about this, is that HIS (the ceo) name is Angela Braly....and unless Angela has something surprising up her skirt, she is a SHE and not a HE. So, did this congressman (Baron Hill) really go to lunch with this guy or not? Or did he not realize that Angela is a female? She is married and has 2 teenage sons, and is in the news frequently here as a taget of being paid too much.
Oh well, that's just the kind of politician this Baron Hill is. He just can't seem to tell the truth about anything, not even a made up story about going to lunch.
Anyway, many healthcare providers are doing what it takes to make sure he doesn't win this seat again. And, hopefully many healthcare providers and disability groups will do the same in their own local areas, and make sure that we expose anyone who is making these decisions that are going to damage the quality of care that amputees (specifically in THIS group and listserve) have access to.
We do NOT want to see an entire nation follow the lead that CA has set in eliminating O&P for the beneficiaries.
Hopefully the leading organizations of this field will listen to the members, and get in line with the members.
Thanks
Jim DeWees, CP
_________________________________________________________________
The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail.
<URL Redacted>
Well, the Reconciliation bill DID pass, and this reform is now law. And yet nothing was mentioned on this listserve about what happened in the reconciliation process....maybe that is because NOBODY out in the public knows truly what happened behind all the closed doors.
I find it ironic that over the past few months, NAAOP was strongly behind this reform, while essentially every prosthetist I have spoken with is NOT behind this bill. The Academy (and the leaders) were also in favor of this bill, while the members of the Academy that I have contacted (either by phone calls or emails) are not in favor of this bill. NAAOP was always posting things on here about how great this bill was, and finally, this last email from them raises these concerns and doubts now about what this bill does to help the amputees and brace users.
We all see how this bill will only have more control over what we are able to do, and who we are able to actually help or give service to, and what we will be paid for our services, etc. We also seem to realize that this bill will not actually do anything to make any insurance company behave better, or treat the patients or providers better. There is NO provision in the bill to cut insurance costs or lower any premiums. It only now forces EVERYONE to go and support companies like Anthem and other big insurance companies.
The language in the bill says that the insurance companies must accept anyone WITH a pre-existing condition. But, notice that the bill does not say that the insurance MUST treat this condition, or cover the condition. In states where Parity laws have passed (like Indiana), there are insurance companies that WILL offer an insurance policy to an amputee, AS LONG AS the amputee will sign a Voluntary Waiver of Benefits for the amputation or the affected limb. I know this happens, because this is MY own personal experience I am talking about. I have talked to the Dept of Insurance here about this practice, and yes, it is legal, and YES, the insurance companies do this all the time. The Dept of Insurance person even went on to say that with this new bill being passed (Reform bill), that it WILL be a standard practice that the insurance WILL offer a policy to anyone because they HAVE to do that....BUT, they can put a price tag on that policy that is SO expensive, that nobody could realistically afford it. AND, they will also make the patients sign a voluntary waiver of benefits for things that are pre-existing. And, this IS legal under the new bill, and existing laws.
As long as the insurance company offers the patients a policy, that is all that they are required to do. It is up to the patients to decide IF they can comply with the terms, like the price tag on the bill, or not. And, if they CANNOT afford that policy, then the patients must pay the $2250 annual fine to the government, and they will still NOT have any insurance....but only have less money available to take their children to the doctor to get the vaccines or medical care that they might need. That's about $200 a month per family goign to the government as a fine....which is $200 less a month to have for food, clothing, medicine, etc. This is REAL!!!! And, when people hear that the IRS is growing by about 14,000 employees so that they can enforce this fine, that makes the public even less happy about this bill and this change.
So will this bill mean that I will be able to go out and find a policy with whatever insurance company I choose, and expect that I can pay one month's premium (like $800) and then expect to be able to walk in and get a $14,000 leg the next week? I do NOT believe that will ever happen, EVER.
And, with the Medicare/Medicaid budget being slashed by $523 BILLION, and in the same bill adding 12 million more into the Medicaid benefits, we can ALL expect to see cuts in O&P in the medicare and medicaid programs.
If you don't think that is possible, just look at California and what they are doing, starting July 1, 2010. I was in California when this news hit the public. They announced that in order to balance their MediCal program, they will no longer have benefits or cover prosthetics in California. This was BEFORE there are additional cuts to the Medicare/Medicaid budget.
If California can do this, and demonstrate to other states that it IS a good technique to balance a budget, then other states will follow their model and do the same.
Sounds like great Reform to me so far....
But, there is so much more to this bill...
Let's look at the added taxes to Medical Devices, and what that will mean to us (as providers) and to us (as patients and beneficiaries). With the added taxes to medical devices (including some components), this will drive the costs UP for making the prosthetics.....and at the same time, reimbursements continue to go down for these devices. While the manufacturers CAN raise their prices for use to get their devices and to use them on patients, WE cannot raise our prices for Medicare, Medicaid, or any other insurance contract....once again either making us take a bigger loss in this process, or deciding to buy cheaper, inferior quality components to put on the patients. In the end, this really only adds more money for the BIG Government, and takes away from the quality of care that amputees are getting....which is totally against what this bill was designed to really do...which was to give access to cheaper, higher quality medical care for the patients.
I followed comments and emails from organizationg like NAAOP, and have even exchanged emails and phone calls with them, and was shocked to hear what they had to say. They are NOT in touch with the membership in most cases, but that is another issue. But these organization leaders defended the reform and were totally behind this.
If and when this bill goes into effect, and if WE see that it is hurting the amputees and our patients, then WE must hold the ones that supported this bill accountable. We must question them, and ask ourselves if WE agree with these leaders and the groups, and should WE financially support these groups? Should be belong to these groups?
I personally could never be a member of, or give money to, any organization that does NOT stand up to support the rights or benefits of the patients that I serve, or support the profession that I have dedicated my entire life to. We might differ on some of the details of a bill or policy, BUT, in a bill that is so massive and is going to change everything, we have to really become educated on what impact these bills have on our lives, and then support groups that are in line with your own views.
I am not saying to boycott anything or anyone, BUT, what I am saying is during these challenging times, we must make careful decisions about what we do support and who we support as well.
Our local congressman, who supports this bill, has been told numerous times by local healthcare providers that we are all educating our patients, one at a time, about what this bill will DO TO THEM. The patients are shocked, and cannot believe what is happening and how this bill was passed. In turn, these patients are educating their family members about what this bill will do to them, and so on. I know that here locally, we (the medical community) will make sure this congressman will NEVER get re-elected to this office here.
There are other issues about this congressman, like during the Town Hall Meeting that we had here, he told us a story (which must have been fiction...a real story), about how he went to lunch recently with the CEO of Anthem BC, and how he (the CEO) made $14.9 million in salary, and he got another $37 million as a bonus, and that this man makes SO MUCH money. Well, the funny part about this, is that HIS (the ceo) name is Angela Braly....and unless Angela has something surprising up her skirt, she is a SHE and not a HE. So, did this congressman (Baron Hill) really go to lunch with this guy or not? Or did he not realize that Angela is a female? She is married and has 2 teenage sons, and is in the news frequently here as a taget of being paid too much.
Oh well, that's just the kind of politician this Baron Hill is. He just can't seem to tell the truth about anything, not even a made up story about going to lunch.
Anyway, many healthcare providers are doing what it takes to make sure he doesn't win this seat again. And, hopefully many healthcare providers and disability groups will do the same in their own local areas, and make sure that we expose anyone who is making these decisions that are going to damage the quality of care that amputees (specifically in THIS group and listserve) have access to.
We do NOT want to see an entire nation follow the lead that CA has set in eliminating O&P for the beneficiaries.
Hopefully the leading organizations of this field will listen to the members, and get in line with the members.
Thanks
Jim DeWees, CP
_________________________________________________________________
The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail.
<URL Redacted>
Citation
Jim DeWees, “Re: New Health Reform Law Expands Medical Device Excise Tax to Class I Devices,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 26, 2024, https://library.drfop.org/items/show/231387.
