Health Care Reform Bill Pros and Cons, Winners and Losers

President Obama Signs Health Care Reform Bill

Big business sees little to cheer about

“The health-care legislation hits companies in myriad ways, from stricter coverage rules to new taxes, which could change how they offer health care to employees” From stricter coverage rules to new taxes, which could change how they offer health care to employees. Yet, many larger businesses worry the measure will do relatively little to hold down their overall health-care costs, once a primary goal of the legislation, and could even force them up.- more from the Wall Street Journal here


Health care industry winners and losers

Drug makers win, hospitals get more patients but fear loss of federal dollars, and doctors lose. See the section below for the impact on health care payers.

Impact on Health Care Payers

With the legislation and the expected package of changes, insurers stand to get more than 20 million new customers. New health-insurance “exchanges,” where consumers can shop for policies, will provide an easy way to reach these new customers. And the penalty for people who don’t buy in is somewhat tougher than laid out earlier. more from WSJ here

Health Care Provider Impacts

Health Care Provider organizations weighed in after the vote, praising the reform. Rich Umbdenstock, president and CEO of the American Hospital Association called the vote “a historic and long overdue step” that will make “a real difference in lives of millions of Americans.” “Healthcare is at a tipping point and the shortcomings within our health care system can no longer be ignored,” Umbdenstock said. Mandy Krauthamer Cohen, executive director of Doctors for America said the new law would expand the coordination of care and strengthen the physician workforce.

“While no bill is perfect, I am hopeful today for the future of medicine because of the many ways this bill will improve healthcare in America,” she said. Groups that joined with Doctors for America in supporting the bill included the American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, American Medical Student Association, American Medical Women’s Association, American Muslim Health Professionals, Association of Clinicians for the Underserved, Committee of Interns and Residents/SEIU Healthcare, Doctors Council SEIU, Association of Physicians of Pakistani Descent of North America, HIV Medicine Association, National Medical Association, National Physicians Alliance, National Physicians Alliance-New York, National Doctors Alliance/SEIU Healthcare, Nurse Alliance/SEIU Healthcare, Student National Medical Association, and United Nurses of America-AFSCME. Read more here

Health Care IT Vendors Will Benefit if They Have Experience In . . .

Electronic Data Interchange, specifically EDI X12 HIPAA 5010 will gain ground as many health plans and providers do not fully grasp the impact of this change on their claims systems. HIPAA 5010 is required as a pe-curser to the ICD-10 (see below).

ICD-10 – The new medical coding standard must be used by all U.S. providers and insurance companies by October 2013. Experienced vendors who can guide these companies through the complex transition from ICD-9 will see increased business.

Health Care Information Exchanges   By 2014, exchanges that provide a more open market place for health care data as well as provider capabilities and pricing will become important. Experience in Enterprise Services Bus, Service Oriented Architecture (SOA) integration, electronic health records, as well as EDI and medical coding will be required.

Political Parties Pronounce Their Position

Reactions to the passage of the bill were predictable. 

Republican Reactions

Republican Congressman Kevin McCarthy blasted the House passage of the health care bill: “Today’s “historic” vote is a sad day. Washington failed America. The People’s House had a choice – vote to listen to the people and start over with a good bill, or dictate to the people that Washington knows best. 212 Democratic and Republican Members of Congress fought against the government takeover of health care, and voted to listen to America. However, 219 Democratic Members of Congress prevailed with passing an ideological agenda on a purely party line vote. Congress did not listen.” “This bill is a bad bill. It’s bad for our children who will inherit more debt, it’s bad for America’s job creators who will pay higher taxes, and it’s bad for Americans who are on a path to pay more taxes for Washington to control their healthcare. This bill contains $1.2 trillion in new spending at a time when America is borrowing 43 cents on every dollar it spends. Washington is once again stealing from our children’s generation.”

Democrat Discourse

Meanwhile Democratic Congresswoman Lois Capps praised the health care bill urging colleagues to vote for passage: “This moment has been a long time coming. I’ve worked on health care since coming to Congress and passing comprehensive reform has always been a major goal of mine. I’ve met with and listened to my constituents, along with countless doctors, nurses, hospital administrators, researchers, and other health care experts. They know that America’s health care system has many wonderful aspects: it can provide the most cutting edge care, cure diseases thought fatal only a few years ago, and devise new and exciting drugs, devices and treatments with mind numbing speed. But we also know our health care system’s problems are legion. Coverage is erratic, incomplete and can evaporate without notice; costs are out of control for consumers, businesses and taxpayers; and health outcomes are actually better in dozens of countries that spend far less per capita than we do. The legislation before us addresses these problems and will help ensure that affordable, quality health care is always available to all Americans. “…I will not argue this is a perfect bill because it is not. Most problematically, it lacks a public option, which would make the insurance market more competitive, ensure the greatest possible choice for consumers and bring down health care costs even more than the bill does already. More here from KVEC web site.

Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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