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Summer fine-tuning for Obamacare

By Jay MacDonald ·
Tuesday, September 2, 2014
Posted: 6 am ET

It's been a busy couple of weeks behind the scenes for team Obamacare, which no doubt enjoyed a late-summer respite while other federal agencies stepped to the fore to field media questions concerning potential threats posed by ISIS and the Ebola virus.

As follow-up to the U.S. Supreme Court's Hobby Lobby ruling just nine weeks ago, the administration proposed a rule designed to help religious colleges and nonprofits opposed to contraception so they could further distance themselves from the process of providing that coverage to their employees.

© Julie Clopper/

A new work-around

Under the rule, these organizations would be allowed to inform the Department of Health and Human Services of their religious objections. HHS would then contact health insurance companies and arrange the birth control coverage for the employees at no cost to either the employer or the insured.

The organizations in question had previously been required to notify the insurers directly, which they felt made them complicit in providing services they deem morally objectionable.

The administration's health team also submitted a rule clarifying which privately-held companies would be excused from providing birth control due to their religious beliefs as provided for under Burwell vs. Hobby Lobby. Under the proposed rule, the company would be required to have a small number of owners or a minimum percentage of ownership held by a small group of people, and could not be publicly traded.

New money for Medicare doctors

Meanwhile, over at the Centers for Medicare and Medicaid Services, Team Obamacare no doubt enjoyed a rousing standing ovation (albeit from surgically-gloved hands) when it announced it will soon start to pay doctors to coordinate the care of Medicare beneficiaries.

Borrowing a page from health maintenance organizations (HMOs), Medicare will begin in January to pay monthly fees to those physicians who manage patients with two or more chronic conditions, such as heart disease, diabetes and depression. Studies have shown that this population suffers inordinately from fragmented care.

Two-thirds of Medicare beneficiaries have at least two chronic conditions and account for 93 percent of Medicare spending, according to HHS  statistician Kimberly Lochner. While some 30 percent of the 54 million Medicare beneficiaries are in HMOs, 70 percent are still in the traditional fee-for-service Medicare program.

Under the plan, the coordinating doctor will be expected to assess patients' medical, psychological and social needs, check that they're taking their medicines as prescribed, monitor the care provided by other doctors, and assist with transitions between home, hospitals and assisted living facilities.

For their coordinating services, physicians will receive about $42 per month, 20 percent of which will be paid by the patient.

The policy change is part of a larger Obamacare initiative to encourage "Accountable Care Organizations."

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Veteran contributing editor Jay MacDonald is co-author of "Future Millionaires' Guidebook."

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