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Cardiologists strongly back Obamacare, worry over rocky start

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Obama
BY RANSDELL PIERSON AND BILL BERKROT

(Reuters) - American cardiologists appear staunch in their support for President Barack Obama's healthcare reform, although some fear that its rocky launch could derail efforts to improve preventive care for needy patients.

The broad support for the Affordable Care Act, popularly known as Obamacare, emerged in interviews last week in Dallas with more than 20 cardiologists at the annual scientific sessions of the American Heart Association. The group has set an aggressive goal of reducing heart disease and deaths from heart disease and strokes in the United States by 20 percent by 2020.

Heart specialists say the key to achieving that goal is a greater focus on preventive care and access to medical services for more Americans. They view anything that gets more people tested and treated for high blood pressure, high cholesterol and atherosclerosis as a major improvement over treating heart attacks and strokes on an emergency basis.

The Affordable Care Act's emphasis on preventive care and increased access, as well as its ban on denying health insurance due to pre-existing conditions, accounts for much of the support in U.S. cardiology circles.

Some 7.3 million Americans with a history of cardiovascular disease are uninsured. They are expected to have access next year to treatment and preventive care under the new government-subsidized healthcare reform, said Dr. Elliott Antman, President elect of the American Heart Association.

"For people who have had a stroke who are uninsured, they're at 56 percent higher risk of dying from that stroke than patients who are insured," said Antman, a cardiologist at Brigham and Women's Hospital in Boston.

"So if we could deal with elevated blood pressure and cholesterol more effectively than we do now by chipping away at the barriers (to preventive care), just think how much progress that would be," Antman said.

Long a political target for Republicans who seek to delay or kill it, Obamacare faces a crucial test this weekend. The Obama administration has pledged to have major repairs in place to the HealthCare.gov enrollment website, which has been hobbled by technical problems since its launch on October 1.

Some of the doctors interviewed by Reuters said the website troubles, which have stymied efforts by millions of people to sign up for new health benefits under Obamacare, as well as uncertainty about how it will be implemented, have raised fears the program could be rolled back.

If Obamacare is derailed, either by political opposition or the administration's own inability to sign up enough people, "then we go back to the status quo ... and health outcomes will remain where they are or get worse because people don't have access to care," said Dr. Robert Talbert, a professor of pharmacy at the University of Texas at Austin.

"My take on this is we're already spending the money but it's not being used appropriately," said Talbert, referring to the costly use of emergency rooms for primary care.

Dr. Barry Franklin, director of preventive cardiology for William Beaumont Hospital in Royal Oak, Michigan, said uncertainty around Obamacare has rattled the medical community.

"It has already impacted hospitals, physicians and medical centers simply on the basis of uncertainty in terms of what will be the impact, how it will affect reimbursement," he said.

AVERTING HEALTH CRISES

Heart disease is by far the biggest killer in the United States, accounting for as many as one-third of all deaths. If serious advances in preventive care are not undertaken, the cost of treating heart disease alone could triple to $818 billion by 2030, according to the AHA.

Providing preventive care to more people is one focus of Obamacare, which assures free services based on age or risk factors, with no required co-payments if given by a network physician. Heart-related services include blood pressure and cholesterol tests, screening for abdominal aortic aneurysms and screening and counseling for obesity - a major risk factor for heart disease.

Nearly all Americans are required to have insurance under the new law, or pay a fine. About 7 million people are expected to enroll via online insurance exchanges in 2014. Another 9 million are likely to receive insurance through the law's expansion of the Medicaid program for the poor.

Dr. Lynn Mahony, who treats dozens of young adults, including some with hereditary heart defects, said many would be ineligible for treatment if Obamacare had not already enabled children to remain on their parents' insurance plans until age 26. "A lot of parents' policies had cut them off at 21."

"These children, when they become adults, will need ongoing regular cardiology follow-up, including surgeries, and without Obamacare they really often have no way to fund their care or procedures," said Mahony, a pediatric cardiologist and professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.

Once a child is diagnosed with an hereditary heart problem, doctors need to test the parents to see if they have the same condition and need potentially life-saving treatment for it.

"But much of the time, I'm unable to get the studies done because their parents have nohealth insurance," Mahony said. She expects that to change on January 1, when Obamacare fully kicks in.

Preventive care has been largely unavailable or haphazard for uninsured patients, according to Dr. Rose Kelly, a cardiac surgeon from the University of Minnesota in Minneapolis.

"They put their health last and then when they do get ill, they lose everything," Kelly said.

With the prevention push of Obamacare, she predicted far more patients will take care of themselves and not wait for a crisis before seeking healthcare.

"They'll get their blood pressure under control, and not show up for a stroke. I believe it will absolutely lower our healthcare costs."

Emergency rooms, which cannot turn away patients, for years have been the only resort for millions of Americans seeking primary care and emergency treatment. It is the most expensive type of care, creating a huge cost burden to hospitals treating uninsured patients who cannot pay.

"One of the good things is, after full implementation, there's potentially 30 million more paying patients. That's a good thing for hospitals and doctors," said Dr. Douglas Weaver, from Henry Ford West Bloomfield Medical Center in Michigan and a past president of the American College of Cardiology.

Several heart doctors said it remains to be seen if the ACA will work as well as they hope. But Dr. Nathaniel Reichek, director of research for St. Francis Hospital in Roslyn, New York, was by far the most pessimistic, saying that Obamacare could hasten a trend to cut payments to doctors for many services, threatening their ability to stay in practice.

"While the intentions are noble and some of the principles are very desirable, I'm concerned there's a disaster brewing," said Reichek.

Dr. Francisco Lopez-Jimenez, a Mayo Clinic cardiologist, sees Obamacare curbing the number of questionable surgical and diagnostic procedures and ensuring that they have proven their worth in clinical trials if they are to be reimbursed.

He expects Obamacare to intensify its prevention focus over time, for instance, possibly by encouraging greater use of cardiac rehabilitation after heart attacks.

The rehab, which includes exercise, diet and smoking cessation efforts, decreases the risk of another heart attack or death by 35 to 40 percent, Lopez-Jimenez said, but is currently used by fewer than one-third of patients.

"Old people and young people need to have healthcare, so they'll do better," said Dr. Ed McFalls, a cardiologist with the Veterans Administration Center at the University of Minnesota. "Let's stop arguing about an important principle: You take care of the old and you take care of the young and society pays for it."

(Additional reporting by Caroline Humer; Editing by Michele Gershberg and Dan Grebler)

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chenango28 December 04 2013 at 11:23 PM

I don't recall any politician, or anyone else that has said if you like your present plan you can keep it, but not saying that this does not apply to anyone 65, or over and has a private Medicare health plan. Are not a very large number of Americans who fit into that category combat veterans who fought to keep America FREE, in at least two wars, WWII, Korea & Vietnam ?

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richard_schott November 30 2013 at 4:02 PM

> and will push many of us who have chosen to continue in private practice, because we enjoy doing so, either into bankruptcy earlier retirement.
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> I still have vivid memories of patients at PGH (that's Philadelphia General Hospital for those who were born after 1960) sitting in huge waiting areas on rows of wooden benches, bringing their children and lunch bags, waiting for their number to be called so that they could go from one clinic to another to get very bad and fragmented care.
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> I know that there are many doctors, including some in high places, that have drunk the OC cool aid. We all might hope that they are right, but remember that Obama promised, "you can keep your insurance - PERIOD," and "You can keep your doctor PERIOD," and, oh, yes, that cost savings will be realized off of the backs of providers!
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> (As an individual, and not in any way to represent policy or position of the AMA or PAMED)
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richyalf December 15 2013 at 9:50 AM

You must rally be afraid of the future.

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richard_schott November 30 2013 at 4:01 PM

Yes, lets stipulate that we all want patients to have access to care including preventative care. It is noble for these cardiologists to express that interest. I'm sure that there are many, including in my own practice that still want to believe that this is the right way to go and that ObamaCare (OC) will provide great opportunities for physicians and will be good for all.

From a medical economics basis, including as it relates to cardiologists ability to provide care and get appropriate payments, they should recognize that those cardiac related preventative care services will be provided by primary care docs, NPs, and PAs through the "medical home," or more likely from hospital clinics and local pharmacies where patients will be seen only by mid-level providers.

None of these preventive services will require any cardiologists to be involved.

Here's how we all will be negatively impacted.

Low income working folks will go for lowest premiums and therefore opt for the Bronze plans which carry a 40% co-insurance charge on all costs except for preventative services up to a total of $12,700 / year for a family of 4 in addition to their premiums of about $8,000. There will be little subsidy for families with incomes above $40,000 and none above $62,000.

Not being able to afford the 40% co-pays, they will opt not to seek care until they are so ill that the will require E.D. and hospital care. Kida sounds like the way things are now!

Hospitals, not wanting to get stuck with uncollectable co-insurance charges, will require huge cash pre-payment, as many are already doing for those with high deductible plans.

Doctors will face the need to try to collect the 40% co-payment which these patients won't be able to pay, thus resulting in a "defacto 40% discount" off of their usual insurance payment.

In addition, if individuals sign up for OC, and fail to pay the premium, docs are on the hook for up to 60 days of free care! A fiscally savvy consumer will figure out that they can hop from plan to plan every three months, never pay a premium, yet get free care at our expense.

You better believe docs would think to opt out of participation, but, unfortunately, careful examination of your Par Agreements with major 3rd party payers reveals that they already include a clause that states that we will participate in new products, so we're stuck.

History has taught us that the cheapest plans that pay docs the worst will become the dominant plan. Why should anyone pay more, when the care is the same? Unfortunately, even the private market plans are now all identical to those on the OC Marketplace!

I predict that this will become the final nail in the coffin of private practice, as none of us are operating on a 40% profit margin. This will continue the trend of doctors opting for employed status, and hospital systems, which will also be strapped for funding under OC, will force docs into working in more efficient hospital clinic models (Continued)

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richyalf December 15 2013 at 9:49 AM

Lots of Tea talking points today. Glad you could make your assigned posts. This is like when the NRA stages a rally in towns where children have been shot to death. Your backward thinking is the kind of rhetoric which has allowed pollution to overtake the world. You sir, are a tool of the ultra rich much like feudal serfs were in the middle ages and working people in Wisconsin.

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frjohansen November 30 2013 at 2:06 PM

I think this is great they found the only 20 doctors in the country to support ACA. This reminds me of the 15 in the white coats who stood behind Obama at the White House when they announced the ACA. I think these people, the docs and the demo-rats, have all forgotten the pledge- 'first, do no harm'. Yes some different people will get health care, but they all fail to recognize or acknowledge the millions who have lost or had their healthcare disrupted. This is not about health care, it is about control of the folks. If this was about healthcare, they would address the cost(s) and tort reform.

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richyalf December 15 2013 at 9:44 AM

The current President of the American Heart Association concurs with this AHA statement. Next time read the entire article, you ignorant bot

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bcrnbs2 November 30 2013 at 12:01 PM

when will people accept the fact, their is an ACA , NOTHING AFFODABLE ABOUT IT..
EVERONE INSURANCE HAS WENT UP , YOUR GOING TO PAY FOR IT AND PAY MORE OR PAY A FINE, WHY THIS MAN IS STILL IN OFFICE IS BEYOUND ME

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luchiayoung November 30 2013 at 10:31 AM

I like the idea of listing physicians who are pro Obamacare, so we can choose physicians............

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holmes49 November 30 2013 at 10:30 AM

any self respecting leader by now would have fallen on his sword; but not this guy; he is in complete denial that his signature deal has fallen in the crapper--I pity the fool who will have to live this nightmare for the remaining three years of his term---ho ho ho

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timebomb1488 November 30 2013 at 8:20 AM

they shouldn't let this clown be President over a toilet stall. he'd flush himself. wait maybe they should.

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richyalf December 15 2013 at 9:38 AM

Idiots like you would have also opposed Social Security, the Voting Rights Act, and the right for women to vote.

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jmbc4us November 30 2013 at 7:03 AM

20 Doctors support it as millioms don't. Yea this is 3 World reporting again. This type of reporting is what you find in Russia, China and Cuba.

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Robert & Lisa November 30 2013 at 6:00 AM

This President should be removed from office because he has trampled all over the constitution which he SWORE to uphold.

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richyalf December 15 2013 at 9:39 AM

You must look cute wearing your white robes.

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