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Monday, February 22, 2021
Cannabis Legislation Enacted in NJ
Monday, July 20, 2020
Coronavirus (COVID-19) - The workers' compensation community should support TTSI
The workers' compensation community should play an active role to contain the spread of COIVD-19. Labor, Industry and insurance companies must be encouraged to participate in contact tracing, testing and supported isolation [TTSI]. All reports of illness and incidents of COVID-19 should trigger reportable investigations that are co-ordinated with local and state health agencies. Communication with employees should be encouraged for testing, isolation and expansion of contact testing.
Tuesday, April 9, 2019
US FDA Moves to Further Regulate Marijuana Products
Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
Monday, January 18, 2016
Sanders Proposes Universal Health Care: The Path to Federalization
Thursday, June 25, 2015
The Path to Federalization: US Supreme Court Again Validates the Affordable Care Act
Saturday, February 7, 2015
Overturning Obamacare Would Change the Nature of the Supreme Court
In the first Affordable Care Act case three years ago, the Supreme Court had to decide whether Congress had the power, under the Commerce Clause or some other source of authority, to require individuals to buy health insurance. It was a question that went directly to the structure of American government and the allocation of power within the federal system.
The court very nearly got the answer wrong with an exceedingly narrow reading of Congress’s commerce power. As everyone remembers, Chief Justice John G. Roberts Jr., himself a member of the anti-Commerce Clause five, saved the day by declaring that the penalty for not complying with the individual mandate was actually a tax, properly imposed under Congress’s tax power.
I thought the court was seriously misguided in denying Congress the power under the Commerce Clause to intervene in a sector of the economy that accounts for more than 17 percent of the gross national product. But even I have to concede that the debate over structure has deep roots in the country’s history and a legitimate claim on the Supreme Court’s attention. People will be debating it as long as the flag waves.
But the new Affordable Care Act case, King v. Burwell, to be argued four weeks from now, is different, a case of statutory, not constitutional, interpretation. The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in...
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Friday, February 6, 2015
Republican Lawmakers Set To Unveil Health Law Replacement Plan
House Energy and Commerce Committee Chairman Fred Upton declined to give details on the plan. Some Republicans are pushing tax credits and deductions for health care, and others are pushing the idea of "portable" health coverage -- the ability to take your insurance from job to job. The Associated Press: GOP Lawmakers Ready A Plan To Replace Obama Health Care Law A Republican House committee chairman says he and two GOP senators are preparing to release a plan for replacing President Barack Obama's health care law. House Energy and Commerce Committee Chairman Fred Upton declined to discuss details Tuesday, but said the proposal will give Republicans a proposal that they can stand behind. The Michigan Republican said he, Senate Finance Committee Chairman Orrin Hatch of Utah and Sen. Richard Burr of North Carolina will unveil their proposal Thursday. (2/3) The Fiscal Times: New GOP Congress Develops Alternate Health Plans House lawmakers are planning to vote for a 60th time today to repeal the president’s health care law – a vote that’s legislatively pointless but politically symbolic. Many of the 47 GOP freshmen who were elected last November won at least in part because their constituents were anti-Obamacare. (Ehley, 2/3) |
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Friday, January 23, 2015
1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect
Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.
As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.
However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways.
When all these incentive programs are combined, the average bonus for large hospitals — those with more than 400 beds — will be nearly $213,000, while the average penalty will be about $1.2 million, according to...
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Monday, December 1, 2014
Suit on Health Law Puts Focus on Funding Powers
Today's post is shared from nytimes.com/ WASHINGTON — In mounting the latest court challenge to the Affordable Care Act, House Republicans are focusing on a little-noticed provision of the law that offers financial assistance to low- and moderate-income people. Under this part of the law, insurance companies must reduce co-payments, deductibles and other out-of-pocket costs for some people in health plans purchased through the new public insurance exchanges. The federal government reimburses insurers for the “cost-sharing reductions.” In their lawsuit, House Republicans say the Obama administration needed, but never received, an appropriation to make these payments to insurance companies. As a result, they contend, the spending violates the Constitution, which says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.” President Obama requested the money as part of the budget he sent Congress in April 2013, but Congress did not act on the request. Seeing the issue as an urgent priority, the administration began making the payments early this year, using money from a separate account established for tax refunds and tax credits. “The cost-sharing reductions are really important and valuable,” said Judith Solomon, a vice president at the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group. Under a standard insurance policy, for example, consumers might have to pay a deductible of $2,500 before the health... |
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Thursday, November 13, 2014
MEDICAL PAYMENTS PER CLAIM IN FLORIDA WERE TYPICAL OF STUDY STATES AND GREW AT A MODERATE RATE FROM 2007 TO 2012, SAYS NEW STUDY
- Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
- Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.
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Thursday, October 30, 2014
Threat of Lawsuit Could Test Maine’s Quarantine Policy
A nurse who cared for Ebola patients in Sierra Leone was headed for a legal showdown with the State of Maine on Wednesday over whether the state can quarantine her against her will. The dispute is heightening a national debate over how to balance public health and public fears against the rights and freedoms of health care workers, and troops, returning from West Africa. “This is a tipping point in this whole process,” the nurse, Kaci Hickox, said in an interview, one of several she did from her home in northern Maine on Wednesday, as state troopers and television trucks stood outside. “So many states have started enacting these policies that I think are just completely not evidence-based. They don’t do a good job of balancing the risks and benefits when thinking about taking away an individual’s rights.” But Maine’s health commissioner, Mary Mayhew, said at a news conference late Wednesday that the state was seeking an immediate court order enforcing a 21-day quarantine of Ms. Hickox after she declared that she would leave her home if state officials did not lift the restrictions by Thursday morning. “While we certainly respect the rights of one individual, we must be vigilant in protecting 1.3 million Mainers, as well as anyone who visits our great state,” Gov. Paul LePage, a Republican, said in a statement issued earlier in the day. In Maine and elsewhere, the fight over Ebola was poised to be one of the final defining... |
Thursday, October 2, 2014
Maine Rolls Back Health Coverage Even As Many States Expand It
NORTHPORT, Maine – By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare. Laura Tasheiko, 61, sits in her home in Northport, Maine (Photo by Joel Page for USA TODAY). But that was nearly six years ago, and the state Medicaid program was generous then. Tasheiko was eligible because of her modest income, and MaineCare, as it is called, paid for all of her treatment, including the surgery, an $18,000 drug to treat nerve damage that made it impossible to hold a paintbrush, physical therapy and continuing checkups. But while much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan. 1, just as the Affordable Care Act was being rolled out nationwide, MaineCare terminated her coverage, leaving her and thousands of others without insurance. Maine Gov. Paul LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers, which at least until recently, boasted one of the lowest rates of uninsured in the nation. Maine was the only state in New England, and... |
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Sunday, September 28, 2014
Debate Grows Over Employer Plans With No Hospital Benefits
Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. “There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.” Timothy Jost is pretty sure the whole thing was a mistake. “There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits. The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a... |
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Monday, September 8, 2014
Some Embattled Democrats Embracing Obamacare
Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
News outlets look at Democratic Sen. Mark Pryor's promotion of the health law in a campaign ad as a sign the law may be less radioactive. Meanwhile, Politico notes that 30 of the 34 House Democrats who voted against the law are no longer in office as the partisanship that it engendered grows. The Associated Press: Democrats Reframe Debate On Health Care The Hill: Dems Find Obamacare Ammo |
Monday, September 1, 2014
The Medicare Miracle
Today's post is shared fromPaul Krugman of the nytemes.com So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate. The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue. But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago. This is a really big deal, in at least three ways. First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these... |
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Sunday, August 31, 2014
Endless Assault on Health Care Reform
Today's post is shared rom nytimes.com The opponents of the Affordable Care Act make no secret of their consuming hatred for the law that has already provided health care to millions of lower-income people. From the beginning, they have tried everything they could to kill it. As one conservative scholar, Michael Greve, said in 2010: “I do not care how this is done, whether it’s dismembered, whether we drive a stake through its heart, whether we tar and feather it and drive it out of town, whether we strangle it.” Yet the challengers keep losing in Congress and in court. The latest jerry-built effort to destroy health care reform could be defeated in the full federal appeals court in the District of Columbia. In July, a three-judge panel of that court — taking a ridiculously crabbed view of a section in the law — ruled 2-to-1 that tax-credit subsidies are allowed only for those buying insurance on a health exchange “established by the state.” Therefore, it said, no subsidies for people in 36 states where the federal government set up the exchange because the states refused to do so. There is no evidence that Congress intended to make this distinction, which defies the law’s central purpose. In fact, this argument was rejected unanimously by a three-judge panel of the federal appeals court in Virginia. Now the fight has shifted to an arcane legal debate over whether the full appeals court in the District of Columbia should rehear the case or allow it to be appealed... |
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Wednesday, August 20, 2014
California Court Limits Caregiver Suits
The California Supreme Court has ruled that a home health aide may not sue a client with Alzheimer’s disease for an injury incurred on the job. The case is one of the first in the nation to assess legal remedies available to paid caregivers who work with Alzheimer’s patients at home. The facts: In September 2008, Carolyn Gregory, 54, was washing dishes in the home of Lorraine Cott, an 88-year-old woman with advanced Alzheimer’s. Without warning, Ms. Cott came up behind Ms. Gregory, knocked into her and began reaching toward the sink. As the caregiver struggled to restrain the older woman, a large knife Ms. Gregory was washing fell and sliced into her left hand. Ms. Gregory subsequently lost sensation in her thumb and two fingers and experienced considerable pain. Since Ms. Gregory was employed by a home health agency, she was entitled to redress for the injury under the agency’s workers’ compensation policy. The question at issue was whether she could sue Mr. and Mrs. Cott (both died last year) for negligence as well. In a 5-to-2 ruling, the California Supreme Court said the caregiver could not, citing a legal doctrine known as the “primary assumption of risk.” That principle holds that workers who perform jobs they know to be dangerous — firefighters and police officers are primary examples — cannot seek recompense from clients when bad things happen, as might be expected, on the job. “Those hired to manage a... |
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Monday, August 11, 2014
Addressing Caregivers’ Loss of Retirement Income
Earlier this month Representative Nita M. Lowey, Democrat of New York, introduced what she’s calling the Social Security Caregiver Credit Act, intended to increase retirement income for middle-class citizens who must reduce their work hours or leave the work force because of caregiving duties. It’s hard to feel optimistic about its passage in this political environment. I’m braced, even here, for a chorus of “How can we possibly afford that?” But you can’t really argue with the problem it tries to address. The toll that family caregiving can take isn’t only emotional and physical; it’s also financial, but not always in obvious ways. The groceries you pick up on the way to see your mother, the utility bills you quietly pay for your aunt — you’re aware of those. If you cut back your hours, turn down promotions or leave your job, as some caregivers feel forced to, you’re keenly conscious of your lost income. But I wonder how many people consider the ways that their own retirements, years down the road, may suffer. The pressures of caring for a disabled or dependent family member can reduce Social Security income for the rest of the caregiver’s life. And not by peanuts. A MetLife study in 2011, based on data from the national Health and Retirement Study, estimated that men who reduced work hours to... |
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Saturday, December 14, 2013
When Life Goes On, and On ...
The debate over a longer lifespan confronts many issued including medical costs, insurance coverage and quality of life. Workers' Compensation programs pay for lifetime care also in most instances. Today's post is shared from the NYTimes.org .
To the Editor:
Fundamentally, the goals of aging research are not dissimilar from efforts to prevent or treat Alzheimer’s or other chronic diseases in that they both seek to improve quality of life in the elderly. The difference is that interventions in aging may prevent not just one but a range of debilitating diseases simultaneously. The reality is that the world is rapidly getting older. With baby boomers leaving the work force, there won’t be enough workers to pay the ever-increasing Medicare costs of the retired. Extending health span will lower Medicare costs and allow aging people to stay engaged. Interventions that slow human aging will provide a powerful modality of preventive medicine: improving quality of life by keeping people... |
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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
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