Monday, March 27, 2017


Sections 10320 and 3403 of the Affordable Care Act (ACA) remain in force thanks to the calamitous Trump-Ryan campaign to repeal Obamacare in its entirety while omitting discussion whenever possible about aspects of the ACA where the Republicans would've been better off with debate and compromise. By not bringing the issue up independently, the Democrats joined hand-in-glove with their Republican opponents.

Sections 10320 and 3403 of the ACA enable a particularly harmful method of disallowing coverage of healthcare known as the Independent Payment Advisory Board (IPAB). The IPAB has often been linked to rationing of healthcare. Here's how it will work once it is installed as allowed by current ACA legislation.

The basic idea of the IPAB is to eliminate services from healthcare once it can be shown that such services are financial encumbrances to the program. In order to decide which diagnostic and treatment protocols qualify under this rubric, a special committee will be appointed. It will not be necessary to be a physician to get appointed, but it will be necessary to get a political appointment. The job is envisioned to pay about $165,000 per year. It will not be required for the committee to report to Congress which will happily divest itself of this controversial oversight. It is expected that the committee will be appointed in 2017 or 2018 or as soon as costs escalate beyond current levels.

An example is the restriction that Medicare recently imposed on cardiac pacemakers. The decision as to which patients should have pacemakers used to be up to one's cardiologist. No more. There is now an impediment, namely, Medicare itself. In the absence of specific findings mandated by administration authorities, pacemaker coverage can now be denied. Not the pacemaker itself, mind you, just its coverage under Medicare -- so, Dear Reader, if you are  among those whose concern about pacemakers is less than theoretical, here is the information you may need when the IPAB nixes your application: cardiac pacemakers cost about $6,000 on the open market. That does not include professional fees and other related costs.

This IPAB program has been called "rationing." It isn't rationing on a per se or individual basis. It is rationing across the board for entire classes of potential recipients. It's purpose is to stretch the ACA dollar since it is expected that the ACA's financial troubles will get worse sooner than expected given recent increases in policy costs and deductibles. This reasoning, cost reduction, is the same as California's approach to Utilization Review (UR) for Injured workers.

Injured workers on the wrong end of Utilization Review (UR) whose rejection of treatment is usually upheld by Independent Medical Review (IMR) will immediately recognize this technique as a denial of care mechanism. In a nutshell, Congress has now extended the ACA'S chief mechanism for "denial of care" and has managed to keep the public in the dark. No more! This writer urges all of us, injured worker or not, to make one's own legislator face this issue.

By way of recent history, the IPAB was initially aimed at Medicare's recipients -- it was called the IMAB (Independent Medicare Advisory Board) then. It got deleted from Medicare when thousands of Medicare recipients protested loudly enough for Congress to hear them.

My recommendation: whether or not one is an injured worker, but especially if one is an injured worker, the time to shout out for repeal of Sections 10320 and 3403 of the ACA has arrived.  This step can be taken without repeal of the entire ACA which would remain a separate issue. 

Tuesday, March 21, 2017


"We own it," that's what Rick Santorum, former presidential candidate and senator said with reference to the on-going Republican  proposed healthcare bill to replace Obamacare.

By now we know what the successful aspects of Obamacare (the Affordable Care Act, ACA) are that reflect the lifeline of the ACA as it now stands. 

The successful parts of the ACA include keeping children insured until age 26 and disallowing the exclusion from healthcare plans of persons with pre-existing conditions. On the other side of the ledger, once President Obama dumped the Public Option from the ACA, the greedy doors of the insurance companies swung open to raises in premiums and deductibles. In turn, as the cost of the ACA goes up, attempts to control costs raise their ugly heads.

Chief among these ugly heads is the Independent Payment Advisory Board (IPAB) which effectively, once it becomes operative, will facilitate the rationing of health care. Review of recent healthcare history shows that there was a predecessor to the IPAB known as the IMAB (Independent Medicare Advisory Board) which was deleted from Medicare because of public opposition by Medicare recipients. Unfortunately, a revised version of the IMAB wormed its way into the ACA as the IPAB -- if the ACA is repealed the IPAB goes down with it, unless, unless it is brought back to life by as yet unknown devotees willing to throw grandma under the bus. 

The IPAB's lease on life comes from Sections 3403 and 10320 of the ACA (this writer has sought repeal of both sections for the past 7 years, see articles from The Hill newspaper, 9/16/09, and POLITICO, 12/10/10 and 12/17/10). Once the costs of the ACA reach critical levels, these ACA sections allow the appointment of political operatives whose job will be to regulate costs by deciding which procedures and treatment protocols are too expensive to maintain -- not quite the death panels touted by some ACA opponents but too close for comfort.

At this moment in Congress, the deep divide is how much of Obamacare to keep, if any. It appears that complete repeal without adequate replacement will disenfranchise millions. On the other hand, if Obamacare maintains its lease on life, millions risk losing access to care because they'll not be able to afford the ever rising premiums and deductibles. 

Santorum in Congressional hearings points out that either way the blame or credit will fall upon the Republicans. If the proposed health care law fails, the Republicans risk losing seats in the midterm elections (sad to say how much this aspect rules Congressional thinking). So at the moment here's the scoop: Trump does not want the currently proposed bill to be called Trumpcare since its passage could replace the disastrous aspects of Obamacare with new equally disastrous effects. That's why in the glorious halls of Washington, DC, the current Republican proposal is wryly called Ryancare. 


The Hill newspaper,  Washington, D.C.,  "What Obama should've said about health reform," 9/16/09

POLITICO, "How to Ration Care without Using the R Word," 12/14/10

POLITICO, "I Will Insure that No Government Bueaucrat Gets between You and the Care that You Need," 12/17/10 

The Weinmann Report, "Affordable Care Act and the IPAB," 03/28/12,  (