ObamaCare patients with serious pre-existing diseases could face expensive drug costs

People with serious pre-existing diseases, precisely those the president aimed to help with ObamaCare, could find themselves paying for expensive drug treatments with no help from the health care exchanges.
Those with expensive diseases such as lupus or multiple sclerosis face something called a "closed drug formulary."

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Dr. Scott Gottlieb of the American Enterprise Institute explains,"if the medicine that you need isn't on that list, it's not covered at all. You have to pay completely out of pocket to get that medicine, and the money you spend doesn't count against your deductible, and it doesn't count against your out of pocket limits, so you're basically on your own."
The plan had claimed it would rescue those with serious pre-existing conditions.
"So it could be that a MS patient could be expected to pay $62,000 just for one medication," says Dr. Daniel Kantor, who treats MS patients and others with neurological conditions near Jacksonville, Florida. "That’s a possiblity under the new ObamaCare going on right now."
In fact, one conservative group, Americans for Prosperity, is running an ad on exactly this subject, featuring a woman with lupus, an auto-immune disease.
She starts by saying, "I voted for Barack Obama for president. I thought ObamaCare was going to be a good thing."
But Emilie Lamb says she later got a letter saying her insurance was canceled because of ObamaCare, pushing her premiums from $52 to $373 a month.
"I'm having to work a second job, to pay for ObamaCare,” she adds. “For somebody with lupus, that's not an easy thing. If I can't afford to continue to pay for ObamaCare, I don't get my medicine. I don't get to see my doctors."
One of the problems is that drugs for some diseases such as MS do not have generic versions. So without cheaper alternatives and no help from ObamaCare, patients could face huge personal out-of-pocket bills, forcing some to skimp on their medications.
Kantor worries that "this may drive more patients" to not buy their medicines, "which we know is dangerous," he says. "We know MS can be a bad disease when you’re not treating it. When you’re treating it, for most people they handle it pretty well, but we know when you don’t treat (it), it’s the kind of disease where people end up in wheel chairs potentially."
In the commercial market, of course, drugs not on a preferred list would also be more expensive, but with a major difference, according to Gottlieb.
"You go outside that list, you have to pay out of pocket for it, but you do get some co-insurance, meaning the plans will pay some of the cost of that."
Some say ObamaCare hoped to do better on that problem but ran out of time. Matthew Eyles of Avalare Health, a consulting firm, says although officials wanted "to be able to make sure that all the systems were operational in 2014, they realized that they needed to give an extra year to get those systems changes in place."
Officials intend to try again next year.
Additional benefits cost more, though, meaning premiums would have to rise, or the networks of providers would shrink even further.

Medical Center won't let patients watch Fox News

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  Oct.2, 2013: A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this photo illustration. (Reuters)

I imagine the only thing worse than being forced to watch CNN inside an airport terminal is being forced to watch it in a doctor’s office.
So you can imagine my surprise when I discovered a Michigan health care facility, funded by federal tax dollars, blocked Fox News Channel from its waiting room television sets.
The president of Family Health Care directed staff to block Fox News after a board member complained about our network’s coverage of the Affordable Care Act, an employee told me.
“The board member complained that patients were turning the channel to Fox News,” said the employee who asked not to be identified for reasons related to the unemployment line. “They are pro-ObamaCare and they felt (Fox’s) stance did not mesh with our stance.”
Family Health Care is a private, non-profit business that operates community health centers in five Michigan towns. According to the employee, the health centers have ObamaCare facilitators on site to help people apply for the program.
The employee provided me a copy of an internal office memorandum that confirms the home of “Fair & Balanced” news is blocked.
“A while ago Kathy Sather had asked all sites not to air the Fox News channel on the public waiting room TV’s,” wrote a network manager in an email to staff members on Feb. 4. “Today I blocked the channel on both the medical and dental waiting rooms.”
Sather is president of Family Health Care.
“I did check with staff and they mentioned often the visitors are changing channels on the TV’s,” the network manager wrote. “I now have both TV’s blocking that channel, so the public won’t be able to change the station. If anyone asks for the TV to be put on that channel please let them know we cannot air that channel.”
That edict didn’t set well with the employee who contacted me.
“I feel like we are being manipulated,” the employee said. “Who are they to say you can’t watch something? If the patient wants to put on Fox they should be able to put on Fox.”
It’s almost impossible to believe, right? Surely, there must have been some sort of misunderstanding. What could possibly be so offensive about Fox News? I mean sure, Bob Beckel is known to use a few “colorful metaphors,” but he’s just a lovable curmudgeon. And who doesn’t love the Factor Word of the Day? We are a pithier nation because of the No Spin Zone.
So I reached out to Sather who promptly confirmed that Steve and Elizabeth and Brian were no longer welcome in the waiting rooms.
She said the health center had a responsibility to do everything humanly possible to “ensure a positive patient experience in the waiting room.”
“Simply put, several complaints have been brought to my attention asking that we not air the Fox News channel in our televised waiting areas,” Sather wrote. “I responded by addressing the issue promptly asking that the channel be blocked in response to those complaints.”
I can’t imagine a patient finding a more positive experience than watching Fox News Channel.
A few years ago my mother was hospitalized. Because of her medical condition she was unable to talk. One day I received a telephone call from my mother’s nurse. She told me that mom was thrashing about and throwing things at the television set. She couldn’t figure out why she was so rattled.
We went through a list of possibilities, until I suggested it might have something to do with the television show she was watching.
“Well,” the nurse replied, “When I walked in she was watching Fox & Friends, but after she fell asleep I changed the channel.”
Which channel, I asked?
“CNN,” she said.
“Sweet mercy,” I hollered into the phone. “Change it back to Fox News! And hurry – before she breaks the television set.”
My mother was not a big fan of CNN. She said that was one of the reasons she hated to fly. But she sure loved Fox News – especially when Shep would tell her what the game day temperature was in Oxford.
Back in Michigan, the employee told me Sather’s explanation is a bunch of “baloney.”
The employee said that there were no complaints from patients – only a board member of the organization.
“It’s all very politically correct,” the employee said. “This complaint thing is baloney. They don’t want anyone to get the idea that affordable care is not good.”
Surely there must be some way to reach a compromise. Maybe they could blur the Fox News logo. Or perhaps they could bleep out all the conservative words?
My suggestions fell on deaf ears.
“We are a health care provider, not a news analyst,” Sather wrote to me.”We are in no position to comment on the quality of news programming. We simply responded to a patient request.”
As it now stands, patients at federally-funded Family Health Care will not be allowed to watch Fox News Channel in their waiting rooms.
And you won’t believe what the health center is forcing patients to watch.
“CNN,” the employee told me. “Ugh.”
 By Todd Starnes

Cave In?

Insurance industry raises questions about new ObamaCare enrollment numbers being ‘inflated’

The Obama administration’s latest rosy scenario about 3.3 million consumers signing up for health care plans is facing skepticism from top insurance industry officials, who estimate that somewhere in the range of 10 to 25 percent of those “enrollees” actually have not yet paid their premiums and are not fully enrolled.
“The numbers are not as high as 3.3 million -- it’s lower,” one senior insurance industry source told Fox News. “Those numbers are inflated. The question is how much.”
Industry officials tell Fox that some insurance companies have privately reported up to 30 percent of enrollees have not paid up, while other companies believe a higher percentage of customers have taken care of their premiums. The senior insurance industry source suggested it averages out to roughly 10 to 25 percent of enrollees not yet paying into the system, and thus those individuals do not really have insurance.
Scenarios for not paying include people who went through the struggles of logging on to HealthCare.gov and eventually decided it was not worth it to go through the final steps of payment, and others who may simply not be able to afford the premiums. Industry officials believe others have gone through the process of choosing a plan and simply have not gotten around to writing a check, but eventually may make the payment to complete the process and wind up being a success story.
It’s hard to pinpoint precisely how many people have paid their premiums, since companies like Humana and United have not yet disclosed numbers. Aetna has said that 70 percent of their enrollees paid premiums in January, and of those who signed up before January, 90 percent paid their premiums. WellPoint has reported that a majority of its 500,000 enrollees have paid premiums but not a “vast majority” as of yet.
Insurance industry officials are also raising questions about whether the White House really does not know how many people have paid into the system, as White House Press Secretary Jay Carney has suggested.
Pressed by Fox on Wednesday about how many of the 3.3 million enrollees have paid premiums, Carney said the data rests with the industry. “It is a contract between an individual or – well an individual even representing his or her family – and a private insurance provider,” he said. “So insurance companies obviously have data about when those payments were made, but this would be no different from any other insurance contract that you would – you would purchase.”
A senior insurance industry source said the administration actually does have at least a rough idea of how many people have paid into the system because that determines who gets government subsidies, so the administration has to eventually know who’s paying into the system in order to make sure subsidies are going to the right people.
As a rough example, an industry source said if a consumer has to pay a $100 monthly premium for coverage and the government subsidy is worth $80, the consumer only pays the $20 difference to the insurance company. The $80 subsidy is later paid by the government directly to the insurance company, so the insurance companies have to show the administration who is paying into the system in order to get that reimbursement.
An administration official confirmed that the key federal agency involved does get some payment data, but stressed the administration is more focused on getting the payment system completed over the long term.
“CMS receives aggregate-level enrollment data on a monthly basis from issuers that are owed payments of marketplace financial assistance,” said the official. “However, enrollments on the individual level for all issuers will be measured in the long term” using documents known as 834 forms.
The official added that some health plans have already begun providing those forms, “which will eventually be the mechanism for making payment and reporting enrollment data as part of our automated system.” Once that system is fully operational, the official said, “we will determine the most appropriate way to make detailed payment information available.”

Democrats who oppose Keystone XL pipeline own shares in competing companies

Democrats who oppose the Keystone XL pipeline have thousands of dollars invested in direct competitors to the company looking to build the pipeline, public records show.
A recent environmental assessment by the State Department was seen as a step toward the pipeline’s approval, but Sen. Tim Kaine, D-Va., remains opposed to its construction.
“In my view, there is now enough evidence to conclude that construction of this pipeline is not in America’s long-term interest,” Kaine said in a statement on the review.
The freshman Democrat has between $15,000 and $50,000 invested in Kinder Morgan Energy Partners, according to his most recent financial disclosure. Kinder Morgan is looking to build a pipeline that would directly compete with Keystone.
Kinder Morgan is considering expanding its Canadian pipeline infrastructure with an expansion of the Trans Mountain Pipeline, which carries oil sands crude from Alberta to refineries and export terminals on Canada’s west coast.

Missouri Senate endorses bill that would nullify federal gun laws

JEFFERSON CITY, Mo. –  Missouri senators endorsed legislation on Tuesday that seeks to nullify U.S. gun restrictions and send federal agents to jail for enforcing such laws, though the measure would likely face a court challenge if it gets approved in the state.
Courts have consistently ruled that states cannot nullify federal laws, but that hasn't stopped Missouri and other states from trying.

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Sen. Brian Nieves, the Republican sponsoring the bill, said the legislation would protect law-abiding gun owners from federal encroachments and regulations. Missouri Republicans began pushing for the legislation following President Obama's call last year for increased background checks and a ban on assault weapons.
The legislation would subject federal agents to civil and criminal penalties for knowingly enforcing federal gun laws. Agents could face up to one year in prison and a $1,000 fine.
"This is primarily purposed to protect liberties of Missourians," said Nieves, of Washington.
The measure also would give school districts the option to designate personnel to carry a concealed weapon in school buildings after undergoing training. Opponents argue that provision would increase access to firearms, which could then lead to more instances of gun violence.
"I cannot support this legislation in good conscience," said Sen. Jamilah Nasheed, D-St. Louis. "Kids are killing kids in school."
An amendment was added to require school districts to hold a public meeting before allowing personnel to carry in buildings. That provision's sponsor said he hopes that would cause districts to think twice before letting guns in the classroom.
"I believe my parents would say we don't want our teachers to carry guns and our school board members would then have to look at the consequences of that decision," said Rep. Jason Holsman, D-Kansas City.
Holsman's amendment would also allow designated personal to choose to carry pepper spray instead of a weapon.
Another provision of the bill would let holders of concealed gun permits carry firearms openly, even in municipalities with ordinances banning open carry. It would also lower the minimum age to get a concealed weapons permit to 19, down from 21. Under the bill, health care professionals could not be required to ask or document whether a patient owns a firearm.
The Senate also approved an amendment sponsored by Nasheed that would give gun owners 72 hours to report a stolen firearm to law enforcement.
Democratic Gov. Jay Nixon vetoed a similar measure that the Republican-controlled Legislature passed last year.
Nieves' bill is less specific than last year's version about which federal laws it seeks to nullify. It removes references to the 1934 and 1968 gun control acts, while keeping generic references to fees, registration and tracking policies that are considered "infringements" or "have a chilling effect on the purchase or ownership" of guns and ammunition by law-abiding citizens.
The measure needs one more affirmative vote in the Senate before heading to the House.

House Republicans fighting Treasury Dept. effort to limit political activities of tax-exempt groups

Republican lawmakers are fighting back against what they call an effort by the Obama administration to silence the political speech of tax-exempt groups, including those originally targeted by the IRS. 
A House panel passed a bill Tuesday that would delay regulations by the Treasury Department designed to limit the political activities of so-called social welfare groups.
Treasury officials claim the regulations would help clarify vague rules about which groups qualify for tax-exempt status, but congressional Republicans believe the regulations are an attempt to legalize the targeting of conservative groups.
“Make no mistake about it: the Obama administration is doing this as a blatant attempt to silence political speech,” Rep. Tom Price, R-Ga., said in a statement.
The proposed regulations came after IRS officials acknowledged last spring that agents had improperly targeted Tea Party and other conservative groups for extra scrutiny when they applied for tax-exempt status.
The Ways and Means Committee voted 23-13 to pass a bill that would block the regulations for a year. It was a straight party-line vote, with Republicans in favor and Democrats opposed. The full House is expected to take up the bill after the House returns from its Presidents' Day vacation.
Committee Chairman Dave Camp, R-Mich., said delaying the regulations would give Congress and the Justice Department time to finish their investigations.
"The notion that the administration would rush forward with rules intended to remove these groups from the public forum is simply unacceptable," Camp said. "I have long made clear that this committee will fight any and all efforts to restrict the rights of groups to organize, speak out and educate the public."
Senate Republicans have embraced the effort but the bill has little chance of becoming law because Democrats oppose it. Democrats said the bill is little more than an election-year ploy by Republicans to rally the party base. They note that final regulations probably wouldn't be issued for at least a year, anyway.
"Unfortunately, the proposed regulations are being used by Republicans in Congress to renew a tireless campaign to turn the issue into a scandal that would pay political dividends," said Rep. Sander Levin of Michigan, the top Democrat on the Ways and Means Committee.
The regulations would apply to social welfare groups applying for tax-exempt status under section 501(c) 4 of the tax code. Under current regulations, these groups can engage in politics, but their primary mission cannot be to influence the outcome of elections.
"It is about disclosure," said Rep. Bill Pascrell Jr., D-N.J., a senior member of the House Ways and Means Committee. "Nowhere in the Bill of Rights does it say you have the right to say anything you want — and also not pay any taxes."
The current regulations have led IRS agents to ask groups intrusive questions about the amount of time they spend on activities that are potentially political.
The proposed rules would limit certain "candidate-related political activity,” but leave open the question of how much the activity would be restricted.
Limited activities would include voter drives and voter registration efforts, as well as ads that "expressly advocate for a clearly identified political candidate or candidates of a political party." Also included would be ads that mention a politician or a political party within 60 days of a general election or 30 days before a primary.
Republicans have raised myriad concerns in recent weeks about the status of the IRS controversy. The Justice Department has received complaints over the slow pace of the investigation and the discontent grew louder after officials announced last month they aren’t expecting criminal charges will be filed in the case.