HHS Spending $800K on Studies to Help Family Planning Clinics Survive Obamacare

    Despite the Obama administration's insistence that everyone -- the government, insurance companies, doctors, medical providers, and consumers -- will reap benefits from Obamacare, a recent grant proposal by the Department of Health and Human Services (HHS) suggests that the agency does have concerns about the ongoing financial viability of one player in the health care market: so-called family planning centers.
    HHS intends to spend up to $800,000 to fund studies to "conduct data analysis and related research and evaluation on the impact of the Affordable Care Act (ACA) on Title X funded family planning centers." At least part of the concern centers on the ACA's provision that allows those 26 and under to stay on their parents' insurance, and how confidentiality considerations may impact the ability of Title X centers to cover their costs.
    The Title X program, which began in 1970 as part of the Public Service Health Act, is "the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services."  Included are contraceptives, breast and cervical cancer screening, pregnancy testing, screening/treatment for sexually transmitted infections (STIs), and HIV testing. Although Title X funds may not be used for abortion, many Title X centers provide abortions using funds from other sources. For instance, Planned Parenthood clinics perform over 300,000 abortions each year, and that organization is the only Title X provider actually listed by name on HHS's Title X website home page:

Services are provided through state, county, and local health departments; community health centers; Planned Parenthood centers; and hospital-based, school-based, faith-based, other private nonprofits.

     The studies that HHS's Orwellian-sounding Office of Population Affairs is soliciting fall into two categories.  The first seeks to assess the national impact, primarily financial, of Obamacare on Title X centers.  The second seeks a qualitative analysis on the impact of the Title X centers providing confidential services. Preserving confidentiality for Title X clients can hurt the centers' ability to be reimbursed for services due to the reporting requirements of state laws and regulations, as well as insurance company rules.  HHS is hoping to acquire case studies on how various Title X centers have managed to overcome this obstacle in order to share those techniques and strategies with other Title X providers.
    The financial concerns of family planning centers center on two areas.  First, HHS has been fielding complaints from family planning centers about "significant challenges" they are facing "negotiating adequate payment terms" with Marketplace private health plans.  On top of this are "continuing challenges" with Medicaid's "varying reimbursement policies around onsite dispensing of contraceptives and education and counseling[.]"  Mandated free contraceptives has been one of the highest profile and most controversial parts of Obamacare, but ironically that increased availability may end up financially harming the very family planning centers that are a significant provider of those contraceptives -- particularly to low income clients.
    The second category of studies looks for ways to mitigate the impacts of confidentiality requirements on family planning centers that can hamstring efforts to secure reimbursements, a problem that Obamacare will only exacerbate.  Since Obamacare aims to increase use of private insurance through the marketplaces, family planning centers will likely see an increase in difficulties obtaining reimbursements without the Explanations of Benefits (EOB) required by insurers.  Since claims details are available to the policy holders, clinics are often not able to file claims for family members wishing to keep their treatment at a family planning clinic private from a spouse or a parent.
    HHS says that "[f]ifty percent of family planning clients are under the age of 25," and under Obamacare, millions of young adults ages 19-25 are now able to remain on their parents' policies.  But along with that coverage comes a lack of privacy for those young adults who may not want their parents to know of their contraceptive use, HIV testing, or treatment for STIs.  HHS says that in "the long term, this practice [of not billing to maintain confidentiality] may result in unsustainable revenue losses for Title X centers."
    To help family planning centers, HHS would like these studies to find ways the clinics can deliver "services confidentially while being able to bill insurance for the visit," which would likely require suppression of EOBs and claims history:

Title X centers regularly forego billing for clients that request confidential services. They are generally unable to negotiate EOB and claims history suppression with issuers because of State laws and regulations. OPA [Office of Population Affairs] is requesting case studies and other qualitative data to identify mechanisms where Title X providers have successfully provided services confidentially while being able to bill insurance for the visit. The specific regulatory issues are not well understood and potential solutions have not been identified.

    HHS is also looking for these studies to provide the following:

• An analysis of statutes, regulations, or other policies (such as issuer or provider policies) across the U.S. that affect the ability of Title X providers to bill insurance when services are requested confidentially. Such an analysis should discuss both challenges as well as potential policies that could serve as best practices. 
• An analysis of successful business practices (such as contract negotiations) or issuer policies, business practices or other mechanisms that have resulted in the ability of centers to successfully bill insurance while maintaining client confidentiality. 
• If “best practices” are located as part of the study, provide an evaluation of the impact to the Title X center’s revenue as a result of the practice. 
• Based on the findings of the initial case studies, an intervention to test whether solutions (or “best practices”) can be implemented at other centers and an evaluation of such implementation in terms of the impact to revenue. Applicants should propose a methodology for an intervention.

    Grant applications from public or non-profit private entities interested in doing the studies are due by April 24, 2014.  Awards will be from $250,000 to $400,000 per year, and may be approved for a project extending up to three years, depending on the availability of grant funds in future years.


Note: A version of this article first appeared at The Weekly Standard.

Young and Healthy: The Obamacare Paradox

    One of the selling points of the Affordable Care Act was that the requirement that everyone would have to purchase health coverage, even those who were young and healthy.  The dollars brought into the system by those least likely to need medical care were going to help pay for others, including those with pre-existing conditions, who need more care.  But beyond the mandate with its relatively low penalty, how could the young and healthy be convinced to sign up?  Low premiums, of course.  But herein lies the contradiction.  How can young people, even healthy young people, paying very low premiums possibly contribute enough to the system to sustain it for the less healthy?

    A recent example from Organizing for America shows the challenge faced by the law's supporters.  The item is entitled I found my golden ticket (well, platinum) and tells the story of self-professed "young and healthy" Eva Juni:

I'm young and healthy—something I'm grateful for every day. But it was a long road to get here: I've struggled with clinical depression since I was 12 years old, and have been on anti-depressants ever since.  

Look: I'm a healthy person, and I make healthy decisions. That includes taking care of myself—and it should include taking care of my mental health. Staying healthy isn't just about your body—it's about your brain, too. It's easy to discount the importance of mental health when talking about overall health care, but it shouldn't be.  

I've worked hard to get to where I am today, and I'm proud to say that I'm stable and have been for a long time. But affording that stability—at least for the past few years—has not been easy. I, like many young Americans, was lucky to be covered under my parent's plan until age 26. While I was extremely relieved to be able to receive medical coverage, the plan didn't cover all that I needed it to: My mental health medication still cost nearly $250 a month.

    Even on her parent's plan, Eva was paying $3,000/year for her depression medication, and that does not even include the cost of the premium.  Then, Eva turned 27, and her stress really began:

So, when I aged off my parent's plan, I had to make a tough decision: Buy a health care plan that didn't cover my medication and pay hundreds more on top of it, or go without coverage and put the money toward paying for my treatment? Most plans I could afford only covered catastrophic events anyway, so I went without coverage for eight long months—eight stress-filled months, where even the smallest mole was terrifying because of what it could be.

    Even though there were some plans, granted most of them for "catastrophic" coverage, that Eva admitted she "could afford", she chose to forego coverage for eight months until the Obamacare exchanges opened up.  Against the odds, Eva managed to use the exchange to obtain coverage, and not just any coverage:

Luckily, when the health care marketplace opened up, I found my golden ticket—well, platinum, really. My new platinum plan is just $45 a month, thanks in part to the fact that I qualify for financial assistance—and my medications are just $28. It blows my mind that this is available to me, especially after struggling with coverage even in the best of circumstances for the last few years.

    Now, instead of $3,000/year for medication (plus thousands more for a premium,) Eva is paying $73/month, or $876/year for top-of-the-line platinum coverage, which includes her medication.  And who is paying the $2,124 difference?  "Financial assistance," a euphemism for the US taxpayer.  Obviously, Eva is not the kind of "young and healthy" person that Obamacare's supporters have been talking about.
    Eva concludes her story with the following observation:

I was amazed by what I found on the marketplace—and you could be too. Check it out. You could be pleasantly surprised (or, in my case, just plain blown away).

    I imagine Eva is not the only one who will be "just plain blown away" by her story.

Government Remains Silent on Emergency, No-Bid Obamacare Financial Management Contract

    Even before the October 1 launch, concerns were mounting over the ability of the government to handle the implementation of the Affordable Care Act (ACA), or Obamacare.  Though many expressed those concerns publicly, insiders at the White House, Health and Human Services (HHS), and the contractors hired to design and run the site and its programs were largely silent about potential pitfalls, or at least downplayed them.  However, some internal memos and reports have since come to light as the "glitches" mounted.  But at least one red flag is hiding in plain sight, and the impacts of the serious concerns expressed in an HHS document first reported on by THE WEEKLY STANDARD on September 16 are still looming against a fast-approaching January 1 deadline.
    In testimony before Congress on Tuesday,  Deputy Chief Information Officer Henry Chao for the Centers for Medicare and Medicaid Services (CMS) addressed a heretofore largely overlooked element of the federal government's role in Obamacare's ongoing functions: what happens beginning in 2014.  The website roll out problems have obscured the larger issue of the ongoing responsibilities of CMS.  But, as Politco reports, Chao spoke to some of those issues on Tuesday:

Financial management tools remain unfinished, he said, particularly the process that will deliver payments to insurers... 

The functions need to operate correctly so insurers can enroll the right people in the right plans. That process, called reconciliation, has to work so people can get the care they seek starting as early as Jan. 1. 

...“back office” functions, including accounting and payment systems, were not yet complete.

    Last Thursday, President Obama said that the problems of Healthcare.gov stem from the fact that it is "very complicated.  The website itself is doing a lot of stuff."  While there may be room for debate about whether Healthcare.gov rivals Amazon or Travelocity in complexity, arguably the real work of the ACA still lies ahead: this financial management of ACA functions over the long haul to which Chao referred.  While the current functions of the website may be complex, the financial management functions that CMS needs to have in place by January 1 are far more involved.  Details of these functions and the concerns CMS expressed about its readiness and ability to carry them out are contained in a Justification and Approval that accompanied the awarding of a no-bid, emergency contract to Novitas Solutions, Inc. in early August of this year.
    THE WEEKLY STANDARD in September reported the $11.6 million contract award, noting that in early August CMS had recognized that the "specialized financial management services and expertise are needed beyond what was initially anticipated and beyond CMS' currently available resources," and that development and testing, at that point less than two months from the October 1 launch and less than five months from the January 1 effective date of new coverage, were "already minimally two months overdue."
    The document is remarkable both for its dire warnings and its candor. CMS disclosed that the need had "reached an unusual and compelling level of urgency. The prospect of a delay in implementing the Marketplace by the operational date of January 1, 2014, even for a few days, would result in severe consequences, financial and other..." and "...if payments are not made and debts are not collected, with critical consideration given to timeliness, accuracy and integrity, the Agency's implementation and operation of the Marketplace and the Affordable Care Act will certainly be jeopardized."  These statements are part of a rather lengthy narrative describing the tenuous position in which CMS found itself, but it is worth an extended look to appreciate the magnitude of the task with which CMS believed it was faced and the level of CMS's concerns regarding the dire circumstances that would likely result from any further delay [emphasis added]:

Since enactment of the Affordable Care Act and establishment of the new Marketplace, CMS has been actively developing and refining new and existing procedures and requirements to ensure the successful implementation and operation of the new, complex Marketplace. Throughout every phase of implementing such a large and dynamic program of a kind that has never been done before and as requirements and procedures are being developed and are emerging, CMS continues to learn, evolve and gain insight. As the deadline for implementing the new Marketplace nears, the Agency has been assessing and testing its plan and solution for implementing the new Marketplace. With every unknown and variable encountered, CMS has been leveraging resources and changing, refining and retesting its solution, to not only ensure that the Marketplace is operational on January 1, 20l4, but to ensure that this vital part of the Affordable Care Act is operating effectively and efficiently with as little complication as possible. CMS has recently learned that specialized financial management services and expertise are needed beyond what was initially anticipated and beyond CMS' currently available resources... 

With the impending and mandated October 1, 20l3 Marketplace enrollment and January 1, 2014 go-live deadlines nearing, CMS' need for contractor-provided financial management services has reached an unusual and compelling level of urgency. The prospect of a delay in implementing the Marketplace by the operational date of January 1, 2014, even for a few days, would result in severe consequences, financial and other. The effect of those consequences would most importantly be measured by the impact to the estimated millions of Americans and small businesses that have no health care today or access to affordable health care. Furthermore, if payments are not made and debts are not collected, with critical consideration given to timeliness, accuracy and integrity, the Agency's implementation and operation of the Marketplace and the Affordable Care Act will certainly be jeopardized.
In addition to the urgent and compelling nature of this requirement and the potential for financial and other harm to the Government if the Marketplace is delayed, regrettably CMS does not have enough time to conduct a full and open or limited competition. Acquiring contractor financial services to assist CMS in developing and testing its Marketplace financial activity implementation solution is already minimally two months overdue; therefore, the contractor will be working under an accelerated and fast-tracked schedule...

    The document goes on to describe how CMS arrived at the decision to award the no-bid contract to Novitas, a contractor that already does a considerable amount of work for CMS.  The approval was signed by no fewer than nine CMS officials, up to and including  Chief Operating Officer A. Michelle Snyder.
    The type of work to be done by Novitas is quite extensive and is itemized in the project description:

The contractor shall provide financial management, accounting and reporting services in support of CMS' administration and oversight of the Marketplace financial activities and functions using CMS' accounting system, the Healthcare Integrated General Ledger Accounting System (HIGLAS) to include: accounting, printing and mailing, tracking of accounts receivable and accounts payable, documenting funds collected by CMS, data validation, activity reporting, debt management functions, application of receipts to appropriate transactions, referral of debt to the Department of the Treasury (Treasury), specified batch payment functions in HIGLAS, and systems interface testing and support for HIGLAS functionality.

     The contract announcement and accompanying documents are not completely clear how these activities translate into functions to carry out the ACA and support Healthcare.gov. For example, regulations governing the marketplaces say that an "Exchange may establish a process to facilitate through electronic means the collection and payment of premiums to QHP issuers."  It remains unclear if Healthcare.gov offers such a facilitation process yet, or if that feature will be activated later. (Maryland recently announced that its state-run exchange was indefinitely suspending the bill-pay feature.)
    In any case, as another example, CMS will be responsible for facilitating the payment of the advance tax credits for consumers receiving government subsidies for their plans.  The regulations describing that one function alone reveal a complex formula to determine how, when, and to whom the funds should be remitted, and notifications and other requirements regarding the disposition of the credits.
    However, since the exact nature of the contractor's work remains unclear, we contacted CMS on September 26 to ask for clarification on the contract, and how the work related to the ACA and its functions.  The following email was received in reply:

    However, despite repeated followup email requests, no further information has been received from Mr. Olague or anyone else at CMS in the seven intervening weeks.  A similar email to the contractor, Novitas, was answered promptly, but the company declined to provide further details and referred questions back to CMS.
    The lack of proper operational and security testing of Healthcare.gov that was revealed in the last month and a half give rise to serious questions about the readiness of other areas under CMS's purview related to Obamacare.  Though the agency acknowledged back in August that development and testing were "already minimally two months overdue," there has been no  publicly available update on the status of the Obamacare financial management system until Chao's rather vague testimony on Tuesday that the system may be 60% or so complete.  Without some level of transparency from CMS, the public has no way of knowing if CMS's warnings of "severe consequences, financial and other" will materialize, or whether concerns that the "Agency's implementation and operation of the Marketplace and the Affordable Care Act will certainly be jeopardized" have been adequately addressed.


Note: A version of this article first appeared at The Weekly Standard.

Maryland Obamacare Exchange Suspends Bill Pay Option

    The insurance marketplaces established by the Affordable Care Act, or Obamacare, have been billed as a one-stop shopping experience.  However, in Maryland, two stops will be needed, at least for the time being.  Originally, individuals had been told that they would be able to make their first payment through the Maryland Health Connection, but this option has been suspended indefinitely, per a press release last Friday:

Bill payment. Accepting payment is not required of a state-based marketplace, and the Board approved deferring this option until after the core items are addressed. The ACA requires insurance carriers to be ready to accept the first payment from consumers, and our carriers are prepared to bill and receive the first payment from our enrollees.

    Although bill payment is optional for individuals per the Affordable Care Act, we reported back in September that, according to Betsy Charlow (communications manager for the Maryland Health Connection,) "employer bills get handled by Maryland Health Connection (federal requirement)," and not just the initial paymen, either.  Ms. Charlow went on to say that "the employer would not get multiple bills. The SHOP would aggregate all carrier bills so the employer can make one payment. The Maryland Health Benefit Exchange would then distribute payment to the appropriate carriers on behalf of the employer."
    If the exchange has delayed even the relatively simple feature of accepting initial payments from individuals to be remitted to insurance carriers, the more complex aggregation of premium billings from multiple carriers and the collection and distribution of those dollars on an ongoing basis will certainly require far more resources and planning.  As I reported at The Weekly Standard, the launch of SHOP in Maryland has been postponed until April 1, 2014.  The Maryland board is counting on the additional three months to make sure that the opening of the SHOP Marketplace does not mirror the debacle that accompanied the debut of the individual insurance exchange.

New Website to Answer Obamacare Questions for Businesses Crashes on First Day [TWS]

    Thursday morning, the White House announced a new website to answer questions from businesses about ObamaCare.  Valerie Jarrett announced the launch in a blog post entitled "A One-Stop-Shop on the Health Care Law for Businesses Big and Small."  However, within two hours, the website had crashed, giving users the following error screen:

    With the launch of the exchanges coming up October 1st, the Obama administration has less than two months to show the public it is ready to handle the transition.  This latest snafu will not do much to instill confidence.

Update: The website was operational again after about 1/2 hour.

Note: A version of this article first appeared at The Weekly Standard.

CBO on ObamaCare: Uninsured Remain Above 30 Million Through 2023

    When the most recent Congressional Budget Office (CBO) report on the Affordable Care Act came out last week, most media outlets, particularly conservative ones like the Washington Examiner, focused on the doubling of the costs of the program since it was first scored in 2010.  Philip Klein writes:

When President Obama was selling his health care legislation to Congress, he declared that “the plan I’m proposing will cost around $900 billion over 10 years.” But with the law’s major provisions set to kick in next year, a new analysis by the Congressional Budget Office projects that the law will cost double that, or $1.8 trillion. 

    While the cost increase is certainly noteworthy and was predicted by the opponents of the legislation, the CBO report includes a second aspect of the effects of ObamaCare, or perhaps more appropriately the lack of effect.  Besides the promise that ObamaCare would help control costs, the elimination of barriers to obtaining health insurance to the current uninsured was one of its largest selling points.  It is interesting to note then that under CBO projections, the number of uninsured in the country never drops below 30 million.  Under the heading "Uninsured Under the Affordable Care Act", here are the projections for next decade for "Number of Uninsured Nonelderly People":

2013 - 55,000,000
2014 - 44,000,000
2015 - 37,000,000
2016 - 31,000,000
2017 - 30,000,000
2018 - 30,000,000
2019 - 30,000,000
2020 - 30,000,000
2021 - 31,000,000
2022 - 31,000,000
2023 - 31,000,000

    Also according to CBO projections, this level of uninsured persons persists despite the increase of those on Medicaid and CHIP (Children's Health Insurance Program) from 36,000,000 in 2013 to 47,000,000 in 2023.  Not even the heavily subsidized exchanges will apparently be able to shrink the uninsured population. By 2023, the number of subsidized exchange enrollees is projected at 20,000,000 with an average subsidy of $7,900 for a total of $158 billion.
    It is unclear from the CBO report exactly who these continued uninsured are and how they will obtain healthcare.  But assuming the CBO's projections are accurate, it seems fair to speculate that when the number of uninsured plateaus at 30,000,000 for several years or even begins to increase again, calls will begin afresh for healthcare reform that will provide insurance to those chronically uninsured.  And if ObamaCare's detractors are correct that the law will not lower costs and improve healthcare in the ways promised, the same reasons may be resurrected to push for ObamaCare II: the uninsured clogging emergency rooms, neglecting preventive care, and driving up costs for the rest who are "playing by the rules."
    The reviews coming in so far on ObamaCare are decidedly mixed, and full implementation is still seven months off.  It will be years before the story plays out.  If the Democrats still control the White House after 2016, those uninsured will be on display as 30,000,000 reasons to "finish what we started."  And as everyone knows, the sequel is never as good as the original.

White House: Nothing Says Happy Mother's Day Like Free Birth Control

    As part of the White House campaign to push the Affordable Care Act by linking it with Mother's Day, the White House tweeted this today:

Thanks to the #ACA, 1 in 3 women under 65 gained access to preventive care—like birth control—with no out-of-pocket costs. #HappyMothersDay
— The White House (@whitehouse) May 10, 2013

    And kids, you don't even have to wrap it.

The Tipping Point

    Much has been written about the 2,700 pages of Patient Protection and Affordable Care Act of which Nancy Pelosi famously said before its passage, "We have to pass the bill so that you can find out what is in it."  I have posted several times recently about various proposed regulations regarding ObamaCare that are beginning to be issued at an increasing rate as implementation draws near.  Here is a passage from a single 81-page document containing some of those proposed regulations for the IRS, the Labor Department, and the Department of Health and Human Services:

    The Department of Labor regulations are proposed to be adopted pursuant to the authority contained in 29 U.S.C. 1027, 1059, 1135, 1161–1168, 1169, 1181–1183, 1181 note, 1185, 1185a, 1185b, 1185d, 1191, 1191a, 1191b, and 1191c; sec. 101(g), Public Law104–191, 110 Stat. 1936; sec. 401(b), Public Law 105–200, 112 Stat. 645 (42 U.S.C. 651 note); sec. 512(d), Public Law 110–343, 122 Stat. 3881; sec. 1001, 1201, and 1562(e), Public Law 111–148, 124 Stat. 119, as amended by Public Law 111–152, 124 Stat. 1029; Secretary of Labor’s Order 3–2010, 75 FR 55354 (September 10, 2010).
    The Department of Health and Human Services regulations are proposed to be adopted, with respect to 45 CFR Part 146, pursuant to the authority contained in sections 2702 through 2705, 2711 through 2723, 2791, and 2792 of the PHS Act (42 U.S.C. 300gg–1 through 300gg–5, 300gg–11 through 300gg–23, 300gg–91, and 300gg–92) prior to the amendments made by the Affordable Care Act and sections 2701 through 2763, 2791, and 2792 of the Public Health Service Act (42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92), as amended by the Affordable Care Act; with respect to 45 CFR Part 147, pursuant to the authority contained in sections 2701 through 2763, 2791, and 2792 of the PHS Act (42 U.S.C. 300gg through 300gg–63, 300gg–91, and 300gg–92), as amended by the Affordable Care Act.

    Did you catch that?  Here, let me repeat it:

     The Department of Labor regulations are proposed to be adopted pursuant to the authority contained in 29 U.S.C. 1027, 1059, 1135, 1161–1168, 1169, 1181–1183, 1181 note, 1185, 1185a, 1185b, 1185d, 1191, 1191a, 1191b, and 1191c; sec. 101(g), Public Law104–191, 110 Stat. 1936; sec. 401(b), Public Law 105–200, 112 Stat. 645 (42 U.S.C. 651 note); sec. 512(d), Public Law 110–343, 122 Stat. 3881; sec. 1001, 1201, and 1562(e), Public Law 111–148, 124 Stat. 119, as amended by Public Law 111–152, 124 Stat. 1029; Secretary of Labor’s Order 3–2010, 75 FR 55354 (September 10, 2010).
    The Department of Health and Human Services regulations are proposed to be adopted, with respect to 45 CFR Part 146, pursuant to the authority contained in sections 2702 through 2705, 2711 through 2723, 2791, and 2792 of the PHS Act (42 U.S.C. 300gg–1 through 300gg–5, 300gg–11 through 300gg–23, 300gg–91, and 300gg–92) prior to the amendments made by the Affordable Care Act and sections 2701 through 2763, 2791, and 2792 of the Public Health Service Act (42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92), as amended by the Affordable Care Act; with respect to 45 CFR Part 147, pursuant to the authority contained in sections 2701 through 2763, 2791, and 2792 of the PHS Act (42 U.S.C. 300gg through 300gg–63, 300gg–91, and 300gg–92), as amended by the Affordable Care Act.

    If ObamaCare is not the tipping point for government overreach, then the beast may have grown too large to ever tip.  The very idea that anyone could even write the above paragraphs and retain his sanity, much less that anyone could ever hope to decipher, understand, and enforce the regulations, is ludicrous.  It is difficult to say what can be done to move the public to revolt against this nonsense.  Perhaps the Congress should pass a bill requiring doctors' offices to hand out a copy of the Patient Protection and Affordable Care Act (and accompanying regulations) to each patient to read along with the unavoidable clipboard of documents to read, fill out and sign that every doctor requires.

    Or will the answer come through the wallet from where most revolutions trace their origins?  I noticed this sign which, from the date, was posted shortly after ObamaCare passed in 2010:

    Doctors, as altruistic as we would like to believe them to be, are in the business to make money, without which they cannot stay in business.  Whatever a 2,700 page law (and accompanying regulations) might say, there will always be loopholes.  How much of the American people's money will have to be sucked into those loopholes before Washington hears a collective "Enough!"?

Happy Mother's Day From The Affordable Care Act

    I would like to take credit for the title of my post, but the White House beat me to it.

    Yes, nothing says "Happy Mother's Day" like a political statement about an increasingly unpopular piece of legislation during an election year.  Act now to reserve your Dodd–Frank Wall Street Reform and Consumer Protection Act Father's Day cards!