Have a vacation scheduled and so, as is true for many of us, have to work twice as hard to get out and then twice as hard once I get back. Here are some questions over the last several weeks I have gotten that I will respond to in 8 Ball format:

1) Massachusetts insurance exchanges are costing a lot of money and have high deductible and copays. Will ObamaCare (assuming it isn’t completely overturned) be too expensive to make a difference?

Answer: Not Likely. That is why there are “levels of insurance” and subsidies for low income individuals…From Kaiser Family Foundation:

To help low to moderate income individuals purchase coverage through the Exchanges, subsidies for premiums, in the form of refundable and advanceable tax credits, will be available starting in 2014 for individuals and families with incomes from 133% to 400% of the federal poverty level (FPL). The premium credits will be tied to the second lowest cost Silver plan in the area and will be set on a sliding scale so that the premium contributions are limited to percentages of income for specified income levels (e.g., for incomes up to 133% FPL, the premium contribution will be limited to 2% of income). (The poverty level is $22,050 for a family of four in 2009 and early 2010. See “What benefits will be offered through the Exchanges,” below, for information about the Silver coverage level. See also the Kaiser Family Foundation report on Explaining Health Care Reform: Questions About Health Insurance Subsidies.)
Question: Should hospitalists be counted as primary care physicians?
Answer: My answer is no. A hospitalist was likely trained as a primary care doctor but has a practice completely focused on helping a hospital run more efficiently. Not only are they not practicing primary care, but they need to worry about future employment. From a friend of mine quoting from the PCPCC:
Denmark has gone from something like 135 hospitals in the entire country down to 30 some odd, purposefully, with the development of a vigorous, robust primary care infrastructure, and with improvement in population health outcomes as a side effect!
Question: Will Alabama Medicaid survive?
Answer: Try again later. Dr Don Williamson, the state’s acting Medicaid Commissioner, predicted that the state’s Medicaid program could collapse if voters in September reject a plan to take money from a state savings account.From the article:

Voters will go to the polls Sept 18 to decide a proposed constitutional amendment that would prop up the ailing state General Fund by giving it up to $198.8 million from the Alabama Trust Fund.

“The budget without the (constitutional amendment), there is no way you can build a Medicaid program that is going to be compliant with federal law,” Williamson said.

From the first comment on the story:

In today’s economic climate, these nice to do things just aren’t sustainable. I suggest rugged individualism be substituted in its place.

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