6.29.2012

Health and Law – Patient’s Bill of Rights, PPACA and the New Changes to expect


Article by: Scott Hall
            June 28, 2012 a date that is now “infamous” in nature as today was the day the United Sta
English: West face of the United States Suprem...
English: West face of the United States Supreme Court building in Washington, D.C. Español: Edificio de la Corte Suprema de Estados Unidos en Washington, D.C. (Photo credit: Wikipedia)
Supreme Court upheld the constitutionality of the Affordable Care Act.  This topic is very controversial as many see this as a move to literally bankrupt our country’s businesses and citizens driven by taxes, cuts and unnecessary wording as well as confusing rhetoric by political leaders who both support and not support this Act to take effect within our country.  This presents a very unique chance to review what we already have in place in our health system, such as our Patient’s Bill of Rights, affordable care, government assistance or funded programs and review what may be in store in our future.  Coffee in hand, Truth Glasses on and here we go into the political hot bed of Law and Health (cough).


            When first the announcement was made that in a 5-4 vote the Supreme Court upheld the constitutionality of the ACA, the controversy and cry of “foul” roared through our airwaves.  Tax concerns, statements of policy and reminding the people of the courts role echoed across the board but at no time did anyone really take the time to analyze what we should already be aware exists within our communities.  While each state or community will have its own patient’s bill of rights, we will summarize what is known to help us see how our laws of health (cough) have evolved.  Winding back our time clock to around the 1970’s, we see in the earliest battles of patient’s rights that access and freedom to just go to the doctor of choice to get checked and consent to be treated further, basically giving us the right to say, ok, no I do not want treatment further or yes, please help me feel better, in support of the doctor patient relationship, even go so far as to say the relationship was not fiduciary.  Interesting, in the era of peace, love, harmony and equal rights, we also debated about whether or not we could just say, no thank you, I don’t want treatment. Again, generalized for content but this sparked the beginning of many health laws or regulations that affect each and every American today, keep this in mind next time you sign a consent to treat form, it’s a law that has been around for 40 years or so.

            In early 1973 the American Hospital Association issued a 12 point patient’s bill of rights and although it was general, it included: The right to receive respectful care, The right to be informed of your diagnosis or prognosis (imagine going to a doctor and NOT being told what is wrong, but given medicine anyway and without the internet or ability to check it out), The right to not participate in experiments (reference term “guinea pig” in relation) and The right to privacy and confidentiality (your doctor cannot reveal to your closest relative about your what condition your condition was in) as well as The Right to receive a reasonable response at time of service (no more waiting weeks on those ever important blood works).  The historical overview of these items are easily found at the New England Journal of Medicine and verified in any formal healthcare facility in the USA.  The debates and court systems have literally been inundated over the years with debates in healthcare from Euthanasia (Washington vs. Glucksberg) to Right to Life (Roe vs. Wade).  Health (cough) Law has made a path in our own history and whether or not we agree has been ruled upon, for constitutionality, not for purpose or reason, but for upholding constitutional law.

            It is almost enough to absorb and reflect a vast field of concerns for citizens as well as doctors who perform those tasks (or whose special education earns them the right to make adequate health decisions) that is, if we read it word for word, it would not make sense to us, however, none of us question those forms we sign when we sit down to be seen for (cough) whatever reason.  Almost no one considers something as simple as gasoline to be a major concern for health, unless one is doused in it and set a blaze; however, studies have shown long term exposure could cause cancer.  The author will not go into detail on this subject, not only would it deter the focus of our article, but would end up a totally different subject at its conclusion, rather we will consider the cause/effect side.

            Imagine visiting your physician with a lump in your throat that turns out to be “defined” as cancerous and requires surgery, treatment and you survive all the endeavors associated with it.  Then imagine having to switch health providers because your employer adopted a new one to save money, the rates are good, the copayments are reliable but there is a problem, your previous information showed you had cancer and under the new company, you are now a “high risk” patient, even if you never smoked or did anything intentional to cause your condition and thus must now pay twice what you were previously for the better coverage and they place limits on how much or how long the coverage exists or some other infringing parameter that leaves one feeling as though they have no choice but to pay to play.

            Another scenario may be the woman who suffers an stroke (TIA) due to her use of prescribed birth control products (a possible side effect) then after wards cannot get insurance not because she can no longer have her erratic cycle regulated by this medicine (yes, birth control is a MEDICINE) but is placed on a list of uninsurable persons, even though the stroke was mild, nothing major was affected, the terminology kills the chances of true freedom of care. Again, this author is generalizing but only for example purposes as these scenarios may be in fact ludicrous they may also be very real.  In 1998 a former President Bill Clinton took on the toughest challenge of any political office: Effectively Managing Medicaid and its end result another Patient’s Bill of Rights.

            Enter the Department for Health and Human Services who set out to intensify the rights to persons and patients and also incorporate some mind relief (citizen approved, 1998) in their care, by listing 8 or so rights, which are: The right to have access to accurate and easy to understand information about their health care provider, program or facility, The right to pick which ever provider (doctor or facility) gives them the best medical care, The right to emergency treatment without the worry of authorization or payment, The right to be informed of treatments and if unable to make those decisions, the right to designate family to assist, The right to private consultations and the right to file complaints against those providers including and not limited to waiting times (yep, you can legally complain about that 2 hour Dr. office visit and being seen 10 mins of it) all of these items were upheld and signed into practice as (cough) health parameters or laws and ordinances.

            14 years have passed since that date and as stated in our opening paragraph, June 28, 2012 is another very important date in our (cough, cough) health care laws.  In President Obama’s Affordable Care Act, the known Patient Bill of Rights gets a review and some additional parameters to add to the many facets our citizens currently enjoy in health care law, but before we go into that area, this author will make this statement: Health care whether it is over the counter or prescription, facilitated or home care is expensive. This author does not intend to debate the costs of the ACA, the cuts proposed or the reasons behind their own economic impacts, what will be focused upon are the cores of what is to come, along with a brief time line of when to expect those changes to be phased in or out.

            First, the Act’s official title: PPACA Patient Protection and Affordable Care Act, or informally known as “Obama Care” was signed into law on March 23 of 2010 and in conjunction with the Health Care and Education Reconciliation Act of 2010 and the 111th Congress became a central focus concerning the ever popular question of (cough) health care for American citizens.  The focus of debate, the “individual mandate” that inflicts a penalty upon persons who do not have coverage of employer type or governmentally provided to a minimal level of coverage unless your religious beliefs or financial situation does not afford otherwise.  Let’s cut through the mustard on this one, basically it means if you do not have minimal coverage in health insurance and can afford to get it, you pretty much have to unless your religion or personal financial health prevent you from doing as much. 

            Several interested parties began filing against the constitutionality of this mandate and the Supreme Court in a 5-4 decision upheld most of it, with a few exceptions including statements on the Medicaid penalties and various other items, but in essence ruled this as something under Congressional Control, specifically their taxing authority, thus throwing the ball back to congress who conveniently had a few senators express “outrage” at the ruling, probably because of the cuts, maybe because of the economic impact, but are we overlooking something important?  What happens next and where do we go from here?  The answers may surprise you in what will actually unfold and has unfolded already.
The New England Journal of Medicine
The New England Journal of Medicine (Photo credit: Wikipedia)

            These items became effective immediately: The FDA is now authorized to approve generic versions of biologic drugs and grant those manufacturers 12 years of use before generics can be developed (A Biologic drug is naturally synthesized and not chemically compounded such as vaccine’s, blood or therapeutic medicines and the like), Medicaid drug rebate is increased to 23%, The Indian Health Care and Improvement act is reauthorized, The FDA must come up with a standard that causes Chain style restaurants to display caloric, fat and nutrition content on packages, walls, vending machines and their associated places across the USA to name a short list of immediate implementations (in full effect by 2014).

            High lights and time line of what is: Effective July 2010 a 10% tax on indoor tanning facilities and a council set up for preventative health and promotion where the Surgeon General will oversee or chair the Board and if you were denied coverage based on preexisting conditions, insurers can no longer consider those parameters. Effective September 2010 enhanced methods of fraud detection are implemented, Medicare is expanded to include small or rural hospital facilities, companies who have employees in the 55-64 range of age can have those early retirees enroll in a temporary program to reduce premium costs, The Medicare part D coverage gap is set to be eliminated by 2020 and starts its reduction as of September.  Effective January 2011, Flexible Spending or Health Savings accounts no longer can be used to pay for non prescription items excluding insulin.  Effective January 2012, Employers must now list on the W-2 Tax forms the benefits they provided to their employees (this was postponed by the IRS by one year).

            The future provisions (highlights): August 2012, all new plans must cover certain preventative services (mammography, colonoscopy) without a deductible, co-payment or co-insurance.  Women’s Preventative Services such as wellness visits will also be covered without cost sharing. January of 2014 discrimination of benefits based on preexisting conditions where rate increases may be acceptable become are prohibited, Insurers are prohibited from establishing annual spending caps, children under 19 who have preexisting conditions no longer restricted to coverage. January 2015 doctor’s payments are adjusted according to quality of care and not volume of patients.  2017 states are encouraged to rewrite a health mandate that allows them to receive the benefits of savings in federal money and assistance.  Do any of these items seem important to our citizens or are we just collectively griping about federal money that our prestigious congress is losing or having to adjust on spending, will the rich stay healthy, will the poor be reduced to minimum care and other questions will surely be tested as these items unfold before our eyes.

English: President Barack Obama's signature on...
English: President Barack Obama's signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)
            In conclusion, it is easy to forget where our country was in regard to health care, patient rights and even what role our doctors had to and must now play in our own decisions.  In our changing world, we will all encounter: Colds, Flu’s, Broken Bones, Lacerations (cuts) and a variety of illnesses.  Smokers beware, in the PPACA if you have illnesses related to your condition; you are out of preexisting clauses so stop smoking soon or be faced to pay the high end of medicine and personal health (cough).  Our sharper readers will note the coughing inserts throughout this article, to find their source, visit your local library or higher learning institute and just listen and then let’s work together to reform health law into something that protects, preserves and prevents the loss of human life to unnecessary items and let’s extend that reach across the globe, we are of the same blood no matter what skin we put on and never forget what got us here in the first place – “Healthy” debate.

Further Readings including the Supreme Court Ruling of 2012 below:

            
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