A Surprising Health Insurance Option For Those Who Refuse ObamaCare

Merrill Matthews, Contributor

6/27/2013

The Democrats who dreamed up, wrote and rammed through ObamaCare are getting worried that millions of Americans, especially the young and healthy, will refuse coverage under the program.  Democrats are right to be concerned, but that doesn’t necessarily mean people will remain uninsured.  They may opt for a less-comprehensive and much more affordable policy instead.

Many of us in the health policy world warned Democrats that ObamaCare created a number of perverse economic incentives.  In most cases they simply refused to listen.  Now that the actuaries have started weighing in on the cost of coverage (here and here), pointing out that some young, healthy people could see their premiums more than double, ObamaCare backers are worried that millions of Americans will game the system.  That is, remain uninsured until they need coverage and then sign up.

Of course, our health insurance solons decided to put in a penalty (or is it a tax?) for being uninsured to try to encourage people to get in the system and stay in.  But the penalties are much less than the cost of coverage, especially in the first few years.  And thanks to President Obama’s demand that his law ignore actuarial principles that have existed for hundreds of years, people can get coverage even if they have a medical condition.

Oh, and the IRS has no authority to go after someone’s assets or wages in order to collect the penalty.  It only has the authority to deduct the penalty from a person’s tax refund at year’s end.  It won’t take long for people to figure out how to fix that problem by trying to ensure they have only enough withheld to meet their tax obligation.  Those who are uninsured and successful at hitting the tax mark will face no effective penalty.

But just because millions of Americans refuse to get ObamaCare-qualified coverage doesn’t mean they will be uninsured.  There are policies available now that would work very well for the ObamaCare avoiders.

Some of these policies are built on a life insurance platform rather than health insurance — which, incidentally, means they are outside ObamaCare’s long arm of regulatory control.

The customer buys a life insurance policy that pays up to $250,000 upon death, which I believe is the current maximum available for this kind of policy.

Along with life insurance coverage the policy includes what’s called a “critical illness” component.  If the policyholder needs, say, surgery, the insurer writes the policyholder a check based on a schedule.  Let’s say, for example, it’s $10,000.

The policyholder has $10,000 in hand to pay for the medical care — or, frankly, anything else since the money belongs to the insured — but the value of his life insurance benefit is reduced by the same amount, to $240,000.  Thus the critical illness component simply accelerates the benefit payout.

One existing policy pays 100 percent for heart attack, stroke, life-threatening cancer, major organ transplant, kidney failure, Alzheimer’s and paralysis, among other medical conditions.

The policyholder could also be part of a provider network that provides a discounted rate for the care — one of the most important current benefits of having health insurance.

How much would such a policy cost?  For one company, a 30-year-old male would pay $1,438 a year, and for a 50-year-old male it’s $3,234.

And remember, this isn’t just health coverage.  In the event of a tragic accident or illness, whatever is left of the benefit goes to the estate upon death.

If ObamaCare proves to be the train wreck that Democratic Senator Max Baucus fears — who, incidentally, is largely responsible for its current structure — then millions of Americans from all income categories may decide to opt out.  Many will still want something, at least until they get a major medical condition whereupon they can then go back into ObamaCare coverage.  And they can still keep their life insurance policy along with its critical illness benefits.  Good times!

And if the demand were large enough, other insurance companies would begin offering a range of similar policies in an effort to meet consumer demand — something health insurers operating under ObamaCare won’t be able to do because of the heavy hand of federal regulation.
See, that’s the amazing thing about markets.  They try to meet the needs of consumers rather than the wants and political aspirations of politicians.  And sometimes they can even undermine those political aspirations.
Merrill Matthews is a resident scholar at the Institute for Policy Innovation in Dallas, Texas.  Follow at http://twitter.com/MerrillMatthews

http://www.forbes.com/sites/merrillmatthews/2013/06/27/a-surprising-health-insurance-option-for-those-who-refuse-obamacare/?goback=%2Egde_4245113_member_253687813

Newly insured to deepen primary care doctor gap

By Ann Sanner / Associated Press

Posted: June 22, 2013 - 7:15 pm ET

Getting face time with the family doctor could soon become even harder.

A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal healthcare law next year. Doctors could face a backlog, and patients could find it difficult to get quick appointments.

Attempts to address the provider gap have taken on increased urgency ahead of the law's full implementation Jan. 1, but many of the potential solutions face a backlash from influential groups or will take years to bear fruit.

Lobbying groups representing doctors have questioned the safety of some of the proposed changes, argued they would encourage less collaboration among health professionals and suggested they could create a two-tiered health system offering unequal treatment.

Bills seeking to expand the scope of practice of dentists, dental therapists, optometrists, psychologists, nurse practitioners and others have been killed or watered down in numerous states. Other states have proposed expanding student loan reimbursements, but money for doing so is tight.

As fixes remain elusive, the shortfall of primary care physicians is expected to grow.

Nearly one in five Americans already lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected keep pace with demand. About a quarter million primary care doctors work in America now, and the Association of American Medical Colleges projects the shortage will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade. In some cases, nurses and physician assistants help fill in the gap.

The national shortfall can be attributed to a number of factors: The population has both aged and become more chronically ill, while doctors and clinicians have migrated to specialty fields such as dermatology or cardiology for higher pay and better hours.

The shortage is especially acute in impoverished inner cities and rural areas, where it already takes many months, years in some cases, to hire doctors, health professionals say.

"I'm thinking about putting our human resources manager on the street in one of those costumes with a 'We will hire you' sign," said Doni Miller, chief executive of the Neighborhood Health Association in Toledo, Ohio. One of her clinics has had a physician opening for two years.

In southern Illinois, the 5,500 residents of Gallatin County have no hospital, dentist or full-time doctor. Some pay $50 a year for an air ambulance service that can fly them to a hospital in emergencies. Women deliver babies at hospitals an hour away.

The lack of primary care is both a fact of life and a detriment to health, said retired teacher and community volunteer Kappy Scates of Shawneetown, whose doctor is 20 miles away in a neighboring county.

"People without insurance or a medical card put off going to the doctor," she said. "They try to take care of their kids first."

In some areas of rural Nevada, patients typically wait seven to 10 days to see a doctor.

"Many, many people are not taking new patients," said Kerry Ann Aguirre, director of business development at Northeastern Nevada Regional Hospital, a 45-bed facility in Elko, a town of about 18,500 that is a four-hour drive from Reno, the nearest sizable city.

Nevada is one of the states with the lowest rate per capita of active primary care physicians, along with Mississippi, Utah, Texas and Idaho, according to the Association of American Medical Colleges.

The problem will become more acute nationally when about 30 million uninsured people eventually gain coverage under the Affordable Care Act, which takes full effect next year.

"There's going to be lines for the newly insured, because many physicians and nurses who trained in primary care would rather practice in specialty roles," says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

Roughly half of those who will gain coverage under the Affordable Care Act are expected to go into Medicaid, the federal-state program for the poor and disabled. States can opt to expand Medicaid, and at least 24 and the District of Columbia plan to.

In Ohio, which is weighing the Medicaid expansion, about one in 10 residents already lives in an area underserved for primary care.

Mark Bridenbaugh runs rural health centers in six southeastern Ohio counties, including the only primary care provider in Vinton County. The six counties could see some of the state's largest enrollments of new Medicaid patients per capita under the expansion.

As he plans for potential vacancies and an influx of patients, Bridenbaugh tries to identify potential hires when they start their residencies—several years before they can work for him.

"It's not like we have people falling out of the sky, waiting to come work for us," he said.

State legislatures working to address the shortfall are finding that fixes are not easy.

Bills to expand the roles of nurse practitioners, optometrists and pharmacists have been met with pushback in California. Under the proposals, optometrists could check for high blood pressure and cholesterol while pharmacists could order diabetes testing. But critics, including physician associations, have said such changes would lead to inequalities in the healthcare system— one for people who have access to doctors and another for people who don't.

In New Mexico, a group representing dentists helped defeat a bill that would have allowed so-called dental therapists to practice medicine. And in Illinois, the state medical society succeeded in killing or gutting bills this year that would have given more medical decision-making authority to psychologists, dentists and advanced practice nurses.

Other states are experimenting with ways to fill the gap.

Texas has approved two public medical schools in the last three years to increase the supply of family doctors and other needed physicians. New York is devoting millions of dollars to programs aimed at putting more doctors in underserved areas. Florida allowed optometrists to prescribe oral medications — including pills — to treat eye diseases.

The federal healthcare law attempts to address the anticipated shortage by including incentives to bolster the primary care workforce and boost training opportunities for physicians' assistants and nurse practitioners. It offers financial assistance to support doctors in underserved areas and increases the level of Medicaid reimbursements for those practicing primary care.

Providers are recruiting young doctors as they gear up for the expansion.

Stephanie Place, 28, a primary care resident at Northwestern University's medical school in Chicago, received hundreds of emails and phone calls from recruiters and health clinics before she accepted a job this spring.

The heavy recruitment meant she had no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She'll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages.

Place said the federal law turned needed attention to primary care as a specialty among medical students.

"Medical students see it as a vibrant, evolving, critical area of healthcare," she said.

Even so, many experts say the gap between doctors and those gaining care under the health reforms in many parts of the country will not close quickly. Access to care could get worse for some people before it gets better, said Dr. Andrew Morris-Singer, president and co-founder of Primary Care Progress, a nonprofit in Cambridge, Mass.

"If you don't have a primary care provider," he said, "you should find one soon."

Read more: Newly insured to deepen primary care doctor gap | Modern Healthcare http://www.modernhealthcare.com/article/20130622/INFO/306229944#ixzz2XYxewIlM
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Part D was less popular than Obamacare when it launched

By Sarah Kliff, Published: June 21, 2013 at 2:00 pmE-mail the writer

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Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

Health and Human Services is in the opening throes of attempting to enroll millions of Americans in a brand new, and relatively unpopular, health insurance program. It’s a massive task only made more difficult by widespread opposition and political divisions.

But it is, as Sabrina Corlette puts it, “not the federal government’s first time at the rodeo.”

Eight years ago, the federal government rolled out Medicare Part D, a prescription drug benefit. For the first time ever, Medicare was launching a benefit administered exclusively through private health insurance plans. The benefit was not popular: In the spring of 2005, when enrollment efforts ramped up, polls showed Medicare Part D to be less popular than the Affordable Care Act. Fewer Americans felt they understood how it worked, too.

Corlette and her colleagues at Georgetown University’s Center on Health Insurance Reforms recently finished one of the more in-depth comparisons between the roll out of Medicare Part D in 2005 and the Affordable Care Act now.

“A few months ago, when we were out at forums and talking to reporters and policy experts, we kept hearing over and over again comparisons to Part D,” Corlette says. “The concerns about whether the federal government would be ready, whether plans would participate and will people know about it.”

They did not have to dig too deep to find similarities between the two, especially when it comes to concerns about participation in the new program and the cost of premiums. To start, neither was especially popular in the months prior to their launch. Part D was even less liked: 21 percent of the public had a favorable opinion of the program in April 2005 compared to 35 percent in April 2013 for the Affordable Care Act.

Americans felt like they didn’t understand Part D, either. And back in November 2005, nobody had any clue about whether costs would be affordable enough to entice seniors into the new program:

In advance of the program’s start, the Congressional Budget Office had projected that average premiums would be about $35 per month. But since this market for drug plans was new, there was uncertainty about the accuracy of this estimate. Actual premiums in the first year would be driven primarily by plan sponsors’ estimates of the cost of offering the benefit and strategies about how to approach a new market.

A year later, things didn’t seem much better. Just before the start of enrollment, in October 2006, “only one in five seniors expected to enroll in Part D.” The rest either hadn’t made up their mind, or thought they already had similar coverage.

Seniors, it turned out, were not exactly great at predicting their behaviors: 53 percent of Medicare beneficiaries ended up enrolling in the new benefit. The CBO was off by a bit too, with the average drug plan costing $29 per month rather than $35.

This isn’t to say the roll out went off without a hitch; it faced some pretty significant problems. Many seniors eligible for a low-income senior never received it, when federal agencies failed to share information on a timely basis. When seniors called the 1-800-Medicare phone number for help, a review found the agency “only responded to calls accurately and completely only about two-thirds of the time.”

Some of these problems got fixed: Medicare hired additional staff and increased training in an effort to improve the call centers. Some didn’t: Four years after the launch of Part D, research shows many seniors still missing out on the low-income subsidy.

So, what does this tell us about Obamacare? We know that, much like Part D, the health reform law faces a lot of uncertainty (this was also true, a few decades ago, of the original Medicare program itself). What we don’t know yet is how that uncertainty gets resolved, although we are starting to get some clues.

Premium bids on the health exchanges, for example, are coming in slightly lower than the Congressional Budget Office projections. Call centers are starting up right now, but it’s still hard to predict what call volume they will receive in the coming months.

The Obama administration has approached the health law’s launch a bit differently than Part D, especially when it comes to an outreach and education campaign.  Medicare Part D had a sweeping, year-long campaign that began well in advance of the program’s launch.

The Obama administration has decided to focus its efforts differently. It will do most of its outreach push in the late summer and early fall. The White House and its allies worry that if they begin their pitch too soon they’ll be selling a product that is nowhere near landing on the shelves.

“Medicare Part D started in the spring of 2005 with outreach,” Corlette says. “This time around, the administration has made a clear decision that they’re not going to fully launch until mid-summer. What’s hard to tell is how much of it is a resource issue. What I have heard communications experts say is that you can’t just say there’s a great new benefit, but no phone number to call for it.”

Corlette and her co-authors make the case that the health-care law is significantly more complex, which makes the roll out a bigger lift. While Medicare beneficiaries are a specific demographic (seniors over 65), the uninsured are more disverse. The Affordable Care Act requires more government systems to work together smoothly than Part D ever did.

“The IT issues for Part D were less complex but not insignificant,” Corlette says. “Particularly around the low-income subsidy and the information exchange that had to happen between Social Security and the state Medicaid programs. That was not uncomplicated and there were a lot of questions about whether that would be ready.”

Still, it does seem as if Medicare has learned some lessons from the Part D launch already. In 2006, the agency saw an influx of enrollees on Dec. 31, the last day of open enrollment. On Jan. 1, many showed up at the pharmacy looking for their medications but the pharmacists had no record yet of the coverage. This time, the Obama administration did things a bit differently.

“Now if you want your coverage to start on Jan. 1, you need to sign up by Dec. 15,” Corlette says. “They’re giving themselves a cushion to make sure that things are worked out, and trying to mitigate those kinds of problems.”

KLIFF NOTES: Top health policy reads from around the Web.

Could some Mississippi counties be left out of the health exchange? “Insurance Commissioner Mike Chaney says two insurers have announced offerings so far, planning to serve 46 counties. Unless more companies sign up or the existing companies expand their plans, consumers in the remaining counties won’t be able to buy health insurance through the online exchange. Coverage under those policies begins Jan. 1.” The Associated Press. Ed Note: It’s too early to say whether some Mississippi counties won’t have health exchange options. The health law includes two multi-state plans, which will sell most states next year, and could end up in Mississippi.

Health and Human Services expects its new Obamacare call centers to receive 42 million calls this year. “Within days, the company that handles a daily average of more than 60,000 calls about Medicare will be deluged by new inquiries about health insurance under the Affordable Care Act. The six Medicare call centers run by Vangent, a company based in Arlington County, will answer questions about the health-care law from the 34 states that opted out of running their own online health insurance marketplaces or decided to operate them jointly with the federal government.” Susan Jaffe in the Washington Post.

Michigan’s Medicaid expansion is still in limbo. “The Republican-dominated Michigan Senate adjourned Thursday without voting to provide medical insurance to hundreds of thousands of low-income adults under the federal health care law, prompting an uncharacteristically angry Gov. Rick Snyder to demand an up-or-down vote. ‘Take a vote, not a vacation,’ the Republican governor said during a late afternoon Capitol news conference in which he implored every state resident to ask GOP senators to vote on Medicaid expansion soon.” David Eggert in the Associated Press.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/21/part-d-was-less-popular-than-obamacare-when-it-launched/?wprss=rss_health-science&goback=%2Egde_2442148_member_252603243

Why a Health Insurance Penalty May Look Tempting

By ANNA BERNASEK

Published: June 22, 2013

OFTEN, when the government wants you to do something, it makes you pay if you don’t. That would seem to be the case with Obamacare, which penalizes companies for not providing health care. But in that penalty, there could be a paradoxical result: dropping health coverage could save companies a lot of money.

$11,429

Employer portion of family health benefit, average current cost

$2,000

Employer penalty for not providing benefits under Obamacare

Once new health insurance exchanges are up and running in October, companies with 50 or more full-time employees will face a choice: Provide affordable care to all full-time employees, or pay a penalty. But that penalty is only $2,000 a person, excluding the first 30 employees. With an employer’s contribution to family health coverage now averaging $11,429 a year, taking that penalty would seem to yield big savings.

Yet there may be costs in employee satisfaction, especially if companies don’t raise pay enough to keep workers whole when they buy insurance on the exchanges.

“No one wants to drop health insurance and have unhappy employees,” says Rick Wald, who heads Deloitte’s employer health care consulting practice.

Few experts see immediate, big changes to existing employer-sponsored coverage. But that may change in time. A generation ago, defined-benefit  pensions were prevalent. Not so today.

So why did the government set the penalty at $2,000?

Policy experts don’t agree on the rationale, and the White House didn’t respond to requests for comment. Perhaps the intent was to start a gradual shift from employer-sponsored coverage to the new exchanges. Or maybe the low amount was a compromise needed to pass the law.

Whatever the reason, the government is about to conduct a huge experiment in corporate decision-making.

Sources: 2012 Employer Health Benefits survey from the Kaiser Family Foundation and Health Research and Educational Trust; the Affordable Care Act

http://www.nytimes.com/2013/06/23/business/why-a-health-insurance-penalty-may-look-tempting.html?partner=rss&emc=rss&_r=2&goback=%2Egde_2442148_member_252606559&

DOMA ruling puts PPACA tax credits at risk

By Kathryn Mayer

June 28, 2013

Although the Supreme Court's Defense of Marriage Act ruling was considered a win by same-sex couples, some couples could actually lose out when it comes to benefits under the Patient Protection and Affordable Care Act.

The court on Wednesday overturned DOMA, requiring the federal government to recognize gay marriages. That ruling changes how federal benefits work, and also means big changes for PPACA.

Brian Haile, senior vice president for health care policy at Jackson Hewitt Tax Service, said in an analysis this week that same-sex couples with similar incomes could lose their eligibility for PPACA tax credits.

That’s because same-sex couples can now file their taxes as a married couple, combining both partners’ salaries into a single household income. At least that’s the case for those couples who live in states that have recognized same-sex marriage.

“For example, same-sex partners who each have an income of $40,000 may be eligible for the premium assistance tax credits under the ACA — but only if they remain single,” Haile wrote. “If they marry (in those states that allow same-sex marriage), then they would lose eligibility because their income would be over the threshold for a household of two.”

The tax credits under PPACA will be determined on a sliding scale based on income. Anyone earning from 133 percent to 400 percent of the poverty line qualifies for a tax subsidy to purchase health insurance. Premium tax credits take effect in January 2014, following an open enrollment period that begins in October of this year.

Other same-sex couples, though, may gain if two partners have significantly different salaries or if only one partner works. The combination of the two salaries into a total income for a two-person household might be low enough to qualify for a tax credit even if one higher-earning partner would not qualify alone.

Same-sex couples also might lose their access to tax credits if only one partner has access to insurance through their employer.

PPACA limits the tax credits to spouses and dependents who don’t have access to coverage. Even if the employer doesn’t subsidize spouse or dependent health coverage, the fact that a spouse has access may disqualify him or her from the tax credit program, Haile explained.

“Same-sex partners should understand some of the implications of marriage to their health insurance options under the ACA before they tie the knot,” he said. “Simply put, getting hitched affects their health care.”

http://www.lifehealthpro.com/2013/06/28/doma-ruling-puts-ppaca-tax-credits-at-risk?eNL=51cddb38160ba09924000005&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=105824905

Immigration Bill Lowers Hurdles for Foreign-Born Docs

John Commins, for HealthLeaders Media, June 10, 2013

Nestled in the massive immigration bill that's being debated now in Congress are a handful of provisions that could ease the process that allows foreign-born physicians to practice in underserved areas across the United States.

The sweeping Border Security, Economic Opportunity, and Immigration Modernization Act  (S.744) is more than 850 pages long and covers everything from border security to passport fraud. However, the sections dealing with revisions to the Conrad State 30 Program for recruiting foreign-born, but U.S. trained physicians could be of particular interest to rural and urban hospitals and physician practices that have had little luck recruiting U.S.-born physicians for their underserved patients.

"I am excited about this bill for many reasons, but the section on physicians is particularly good," says Carl Shusterman, a long-serving immigration attorney based in Los Angeles. "We've had the Conrad program since 1994 which allows each state to sponsor 30 foreign physicians each year to go to rural and urban medically underserved areas where they can't get Americans to practice."

"All in all it is a good program and over 1,000 physicians a year do get placed in these underserved areas," he says, "but like any program there are a bunch of flaws that we have being trying to correct for 20 years and this bill would correct most of them."

Shusterman says it's hard to predict if the bill will pass in the hyper-partisan Congress, where immigration is a divisive issue. The bill recently passed the Senate Judiciary Committee on a 13-5 vote and floor debate could begin this week.

"The Senate introduced over 300 amendments to the bill but I don't think any of them were concerning the physicians' part of the bill. That is relatively non-controversial," he says.

"What is controversial is it legalizes 11 million people that are undocumented. That's where the problem is as far as this passing. In the Senate I can almost guarantee it will get one pass by the end of the month. The big debate is will it get 60 votes or 70 votes. There are about five Republicans who are definitely on board and pretty much all the Democrats but if they can get 70 they figure that will have an influence on the House. If they can get about 30-40 Republicans in the House to sign on it's going to be a done deal, but that is the big 'if' now in the House of Representatives.'"

Shusterman provided a synopsis of the reforms proposed in the immigration bill.

Proposed Changes to the J Visas and Waivers:

·         The pending legislation would make the Conrad program a permanent part of the immigration law. J status for foreign-born physicians completing medical residencies/fellowships would be classified as a "dual intent" status, similar to H-1B and L-1s. 

·         A physician could no longer be denied J status on the ground that he or she did not intend to return to his country of origin. Spouses and children of J-1 physicians would no longer be subject to the two-year home residency requirement.

·         The number of Conrad waivers available to a state could be raised in increments of five depending on the usage of waivers in various states during the previous year. In addition, the number of J waivers available to physicians working in academic medical centers outside of medically underserved areas could be raised by three per year under certain conditions.

·         Physicians who received J waivers would no longer be required to work in H-1B status, but could work in any immigration status for which employment is authorized. To prevent foreign-born physicians from being exploited, J waivers would not be granted unless the physician's employment contract contained the following clauses:

1. The amount of "on-call hours" per week and the compensation for such;
2. The amount of malpractice insurance provided to the physician and whether the employer will pay for this;
3. All work locations, and a statement that the employer will not add work locations without the approval of the  state or federal agency requesting the waiver;
4. The contract may not contain a "non-compete" clause.

·         If a physician's J waiver were denied under the Conrad program because the state had used up all of its slots for the year, the physician could obtain a six-month work permit if he or she agreed to seek a J waiver from a state which has not used all of its J waivers. After that, the physician could extend his or her work permit from the time that the employer in the new state filed a Conrad waiver until the DHS either granted a change of status or denied the waiver application.

The proposed law also provides that when the U.S. Citizenship and Immigration Service determines that "extenuating circumstances" exist, the physician could change employers during the three-year required period of employment in an underserved area.

"This is important because some employers have taken unfair advantage of physicians who they have sponsored for J waivers," Shusterman says. "For example, some employers have failed to pay a physician at the prevailing wage or have insisted that a physician work outside of the designated medically-underserved area for 40 hours per week. If the physician does not claim 'extenuating circumstances,' he or she needs not only to complete the 3-year period in a medically underserved area, but also an extra year for each termination."

The proposed law would also do away with an impractical requirement that the physician begin working within 90 days of receiving the J waiver. Instead, the proposed law would require physicians to start working in 90 days only after the latter of the following three dates: 1) After the J waiver is approved; 2) After completion of graduate medical education or training; or 3) After receiving nonimmigrant status or an Employment Authorization Document.

Proposed Changes to H-1Bs and Green Cards

When a physician completes his or her residency/fellowship in cap-exempt H-1B status, and an employer has submitted a cap-subject H-1B petition on his behalf, his H-1B status would automatically be extended to Oct. 1st so that the physician does not become out-of-status or unemployable between July and October. However, if the physician's H-1B petition is rejected, denied or revoked, his or her status and employment authorization would terminate after 30 days, Shusterman said.

Physicians who qualify for National Interest Waivers by completing the five-year service requirement in a medically-underserved area or for the Veterans Administration would be granted green cards without regard to numerical limitations. This would occur whether a physician completed the five-year requirement before or after the enactment of the (Comprehensive Immigration Reform) bill.

The spouse and children of a physician would also be exempt from numerical caps whether the physician obtains a green card through an NIW or through Program Electronic Review Management, Shusterman said.

Per-country limitations would be eliminated for the employment-based green card categories, which would dramatically reduce the time that it now takes physicians born in India to qualify for green cards.

"All of these changes would make it considerably easier for internationally trained physicians to work and live in the United States, enhancing the overall number of physicians at a time when doctors are in short supply," Shusterman says.

S.744 Immigration Reform Bill

http://www.healthleadersmedia.com/content/COM-293056/Immigration-Bill-Lowers-Hurdles-for-ForeignBorn-Docs?goback=%2Egde_2442148_member_250693402

Today's Datapoint

55% … of enrollees in Medicare Advantage prescription drug plans, and 66% of MA-PD HMOs, pay no premiums, according to a new study by the Kaiser Family Foundation.

Quote of the Day

Medicare Advantage private-fee-for-service products “are dying a slow agonizing death” in the new ACA environment. “I would be surprised if there were any left in two or three years.”

— Actuary Brian Weible, a principal in Wakely Consulting Group, told AIS’s Medicare Advantage News.

According to a recent study:

• Almost 70% of Americans are on at least one prescription drug, and more than half take two
• 20% of patients are on five or more prescription medications
• The percentage of people who took at least one prescription drug in the past month increased from 44% in 1999-2000 to 48% in 2007-08

Source: Nearly 7 in 10 Americans Take Prescription Drugs, Mayo Clinic, Olmsted Medical Center Find," Mayo Clinic Press Release, June 19, 2013, http://www.mayoclinic.org/news2013-rst/7543.html

FACTOID

The number of patient visits at retail clinics is projected to account for 10% of non-primary care outpatient visits by the end of 2015, according to a new report.
Source: U.S. Retail Health Clinics Expected to Double by 2015, According to Accenture," Accenture Press Release, June 12, 2013, http://newsroom.accenture.com/news/us-retail-health-clinics-expected-to-double-by-2015-according-to-accenture.htm

NEWS INSIGHT

According to a recent online survey, the following percentages of adults were extremely/very interested in using services on a smartphone or tablet:

• 37% wanted to be able to ask their doctor questions
• 37% wanted to be able to book doctor appointments
• 36% wanted to be able to check the effects and side-effects of medicine
• 35% wanted to be able to receive the results of diagnostic tests
• 31% wanted prescription refill reminders

Source: "Lots of Americans Want Health Care Via Their Smartphone," Harris Interactive/HealthDay Press Release, June 18, 2013, http://www.harrisinteractive.com/NewsRoom/PressReleases/tabid/446/ctl/ReadCustom%20Default/mid/1506/ArticleId/1215/Default.aspx

FACTOID

Patients pay an average 23.6% of the amount that health insurers set for paying physicians, through the cost of co-pays, deductibles and co-insurance, according to the latest National Health Insurer Report Card from the American Medical Association.
Source: New AMA Study: Patients Responsible for Nearly One-quarter of the Medical Bill, American Medical Association Press Release, June 17, 2013, http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-17-national-health-insurer-report-card.page

Percentage Who Had Excellent or Very Good Health: United States, 1997-2012

Year	Percent
1997	68.5%
1998	69.1%
1999	68.7%
2000	68.3%
2001	68.4%
2002	67.4%
2003	67.5%
2004	66.5%
2005	66.5%
2006	65.9%
2007	66.0%
2008	66.0%
2009	66.3%
2010	65.7%
2011	65.6%
2012	65.8%

Source: CDC/NCHS, National Health Interview Survey, 1997-2012