Posts Tagged ‘doctor shortage’

U.S. Trying to Find More Doctors to Send to Disaster Areas

October 14, 2017

Hurricane Maria left Puerto Rico’s hospitals in bad shape

Volunteer doctors organize medical supplies during a visit to a shelter to check refugees in the aftermath of Hurricane Maria in Humacao, Puerto Rico, on Oct. 2.
Volunteer doctors organize medical supplies during a visit to a shelter to check refugees in the aftermath of Hurricane Maria in Humacao, Puerto Rico, on Oct. 2. PHOTO: RICARDO ARDUENGO/AGENCE FRANCE-PRESSE/GETTY IMAGES

A U.S. government program that sends doctors and nurses to disaster zones says it needs more health-care workers, as relief efforts during this hurricane season are near the end of a second month with no end in sight in Puerto Rico and the U.S. Virgin Islands.

The National Disaster Medical System, which recently wrapped up big deployments to hurricane-ravaged areas in Texas and Florida, says it will start recruiting more medical professionals in the next few weeks.

“We’re far from the recovery stage of this event,” Robert Kadlec, a U.S. Department of Health and Human Services assistant secretary, said Thursday of Hurricane Maria’s devastation. The storm largely destroyed Puerto Rico’s power grid, leaving half the local hospitals without power, and downed its communications network. The federal health agency oversees the program that temporarily hires health-care workers for what are typically two-week rotations.

The U.S. teams, which set up temporary hospitals and clinics, are helping relieve the strain on Puerto Rican hospitals. Nearly half of the local hospitals are depending on sometimes unreliable generators for power. Generator failures have forced recent evacuations at two hospitals. And others suffered storm damage that crippled operations, said Jaime Pla Cortes, executive president of the Puerto Rico Hospital Association, in an interview.

“Everybody has to improvise,” Mr. Pla Cortes said. “The nurses and the doctors are tired, they are working full time.”

The National Disaster Medical System entered the hurricane season understaffed, system director Ron Miller said, adding that the U.S. Office of Personnel Management recently authorized expedited hiring.

Since Hurricane Harvey hit Texas in late August, the federal system has deployed more than 40 36-person teams to Texas, Florida and Puerto Rico, plus several smaller teams, including some with logistics personnel, veterinarians and morticians. The system has also dispatched one team to California in response to the state’s wildfires.

The prolonged response is a “huge anomaly” for the system, Mr. Miller said. Two-week rotations have occasionally stretched into a month, he said.

The program has enough teams to deploy through mid-November, he said. The U.S. program set up a temporary hospital in San Juan and dispatched teams to hubs around Puerto Rico, Dr. Kadlec said.

To fill open positions, the system has relied on medical staff from the Department of Defense and Department of Veterans Affairs, the latter of which has 73 staffers helping in Manati, Puerto Rico.

Other American health-care workers are traveling to Puerto Rico as volunteers, coordinating efforts with HHS. About 80 nurses and doctors from New York-area hospitals flew to Puerto Rico Thursday.

Demand for volunteers is strong, said Jenna Mandel-Ricci, an executive with the Greater New York Hospital Association, which helped organize the trip with HHS and New York state officials. The federal agency “is saying they are taxed,” and volunteers left without knowing where they would be working during a two-week stay, she said. “That’s how fluid things are on the ground.”

Write to Melanie Evans at


Doctor Shortage? — Overwork taking a toll on Malaysian doctors — Public healthcare — Rising cost of living drives patients to seek cheaper treatment

August 20, 2017

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Klinik Kesihatan Kuala Lumpur, one of KL’s largest government clinics, which can treat up to 1,000 patients a day.PHOTO: BERNAMA

Public hospitals stretched as rising cost of living drives patients to seek cheaper treatment

As a paediatrician in training, Dr Nurul Huda Ahmad dreamed of making healthcare fun for children.

But her dream will never come true. The 33-year-old from Kuala Terengganu was driving home after working for 33 hours straight, with little rest, when she died in an accident on May 9.

In July last year, another young doctor, anaesthesiologist Afifah Mohd Ghazi, also died in similar tragic circumstances.

Worn out after a long shift, Dr Afifah lost control of her car and crashed into a tree, resulting in fatal injuries to her chest and brain. She was only 27.

Post-call fatigue is nothing new in the medical world, especially for doctors in the public health sector.

But the situation is worsening as more Malaysians switch to public hospitals to cope with the rising cost of living in recent years, especially since the 6 per cent goods and services tax (GST) was introduced on April 1, 2015.

The influx has added to doctors’ workloads and, in many instances, led to deadly consequences, according to anecdotal accounts from physicians and surveys by medical associations.

Dr Nurul Huda Ahmad also died in a crash after completing a 33-hour shift.
  • 55% Percentage of accidents that occurred after respondents had worked for 25 to 36 hours, according to a 2015 survey of 440 healthcare professionals.65% Percentage of respondents who admitted they suffered from post-accident psychological trauma.


We (doctors) are happy to be of service but I believe it is slowly taking a toll on us. A doctor at a public hospital sometimes has to take care of up to 500 patients. Imagine the exhaustion.

DR KUAN, on how the workloads of public hospital doctors have become heavier in recent years


Cost is definitely a factor because the prices of goods and services are steadily increasing. But another reason is that the waiting time (at public hospitals) is almost the same as at private hospitals.

MR MUHAMMAD NAJMI ABDULLAH, 36, an engineer, on how public hospitals are just as efficient as private ones.


When you have more people seeking treatment at public hospitals… it will also affect the doctors attending to them – they get overworked.

DR AZLAN HELMY ABD SAMAT, from the Islamic Medical Association of Malaysia, on how the rising cost of living has resulted in a higher number of patients going to public

Dr Rozaimi (not his real name), a 35-year-old doctor at a public hospital in Selangor, told The Straits Times that he and his peers suffer from chronic fatigue and high levels of stress. “There is no job without stress and fatigue, but I’ve lost count of how many times I’ve accidentally fallen asleep behind the wheel post-call,” said Dr Rozaimi.

“One incident will always stand out – I had just completed a 35-hour shift and was driving to my home in Shah Alam. I accidentally swerved into the fast lane when a car was already speeding along it. The loud honks (from the driver) saved me, I managed to swerve back into my lane.”

Dr Kuan (not his real name), 32, has also had his share of near-miss post-call experiences.

He said: “Although most of us (doctors) have adjusted to our hectic schedules, I can never forget an incident several years ago when I almost lost my life. I crashed into a divider and my car ended up in a drain. My injuries were minor but I could have drowned.

“After transferring to a research department two years ago, I no longer work more than 24 hours at a stretch. My quality of life has improved tremendously and I have not fallen asleep behind the wheel any more.

“We have all been guilty of falling asleep post-call while driving.”

Both Dr Rozaimi and Dr Kuan say their workloads have become heavier in recent years due to more patients going to public hospitals.

Dr Kuan said: “The number of patients has definitely doubled compared with several years ago. Most of the patients I have attended to have cited the higher cost of living as the reason they’re seeking treatment at public hospitals.

“We (doctors) are happy to be of service but I believe it is slowly taking a toll on us. A doctor at a public hospital sometimes has to take care of up to 500 patients. Imagine the exhaustion.”

In 2015, a survey of 440 healthcare professionals on the topic of post-call motor vehicle accidents was published by the Islamic Medical Association of Malaysia (Imam) and Pertubuhan Amal Perubatan Ibnu Sina Malaysia, a non-profit organisation.

Some 55 per cent of the accidents the respondents had been involved in occurred after they had worked for 25 to 36 hours.

Nearly 65 per cent of respondents also admitted they suffered from post-accident psychological trauma.

Imam’s Dr Munawwar Salim said that at the time, the survey highlighted the need for further investigations into the correlation between motor vehicle accidents and the preceding hours of duty.

After serving the standard 24 hours, most doctors have to work for a further four to 10 hours just to clear the backlog of work.

Sleep deprivation is one of the recognised factors contributing to motor vehicle accidents.

Research has shown that drivers who are suffering from fatigue are as cognitively impaired as drivers who are intoxicated.

The high cost of living has been cited as the top reason that more Malaysians are seeking treatment at public hospitals.

Last year, public hospitals saw 20 per cent more patients compared with the year before, according to the Health Ministry’s deputy director-general, Dr Jeyaindran Sinnadurai. He noted that even before 2016, the number had been increasing.

Restaurateur Rita Liyana Rahmat, 41, said she started going to government-funded hospitals and clinics after the GST kicked in.

“It’s already hard to cope with daily expenses these days. Forking out money for medical treatments at private medical institutions just doesn’t make sense to me,” she told The Straits Times.

Engineer Muhammad Najmi Abdullah, 36, said he prefers going to public hospitals, which he said are just as efficient as private ones.

“Cost is definitely a factor because the prices of goods and services are steadily increasing. But another reason is that the waiting time (at public hospitals) is almost the same as at private hospitals,” said Mr Najmi.

“Instead of using up my deposit – which always happens at private hospitals after I get discharged – I would rather get treated at or admitted to government hospitals.”

Dr Azlan Helmy Abd Samat from the medical association Imam said there is a definite link between the rising cost of living and the rising number of patients opting for public hospitals.

“When you have more people seeking treatment at public hospitals… it will also affect the doctors attending to them – they get overworked,” he said.

This shift also means that private outfits have seen a drop – of almost 30 per cent – in patient numbers, according to Association of Private Hospitals of Malaysia president Jacob Thomas.

He told The Malaysian Insight news site last month that patients are turning to public hospitals asthese hospitals are exempt from GST and treatment is almost fully subsidised by the government.

Dr Jacob urged the Health Ministry to collaborate with the private sector to reduce long waiting times for procedures such as magnetic resonance imaging, computerised tomography and positron emission tomography scans.

At some private hospitals, patients who have been referred by public hospitals are offered these services at reduced prices, he noted.

“We understand that 25 per cent of patients at public hospitals have access to private healthcare insurance. We can manage them in our private hospitals,” Dr Jacob was quoted as saying.

In May, government representatives from the Road Safety Department and the Health Ministry’s Occupational Health and Safety Unit, as well as medical associations, held a meeting to discuss ways to prevent doctors from getting into road accidents after exhausting shifts.

The meeting was held in response to concerns aired by a group of medical non-governmental organisations (NGOs) on May 13 about the number of medical professionals who were involved in road accidents after working long hours.

“Until today, we do not have data on this subject. This is the reason why we need to have our own research on this,” Dr Munawwar from Imam told The Straits Times.

For now, the NGOs are working to raise awareness of the problem through campaigns and engagements, he added.

They will also launch a discounted ride-hailing service for post-call doctors in collaboration with GrabMalaysia on Sept 16.




U.S. Faces Looming Shortage Of Primary Care Physicians — A Growing Problem ObamaCare Never Tried to Address — Its now a global problem

August 3, 2017

NEW YORK (CBSNewYork) – America will soon face a shortage of as many as 90,000 doctors.

CBS2’s Dr. Max Gomez reports a combination of retiring doctors and increasing demand will lead to a significant need for primary care physicians. But some medical schools are working to ease the problem.

Dr. Katelyn Norman just started her internal medicine residency at Waterbury Hospital in Connecticut. It’s one of the final steps to achieving her lifelong dream of becoming a doctor.

“The work you do has such consequences for people and their lives and their health,” she said.

The U.S. is in need of more primary care doctors, partly because many older physicians are retiring, citing increased paperwork and decreased time with patients.

Norman is part of the first graduating class at Quinnipiac University’s new medical school that is tackling the shortage in internal medicine, OBGYN, pediatrics and psychiatry.

The school’s dean, Dr. Bruce Koeppen, says primary care applicants are put at the top of the admissions list.

“Your primary care physician is your navigator through the healthcare system,” he said. “They see you for every particular problem you have, they can refer you to specialists if that’s the case, but they’re the ones who know you the best.”

Image result for emergency room, photos

By 2025 there could be a shortage of up to 35,000 primary care physicians. Koeppen says money plays a role.

“If you’re graduating from medical school with several hundred thousand dollars in debt, you may choose a sub-specialty where your earning potential is greater,” he said.

Still, Norman said she made the right choice about the kind of doctor she wants to be.

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“If you’re able to control their pain, if you’re able to explain their risk factors when they’re afraid of inheriting something from family… It’s equally beautiful and rewarding,” she said.

Another reason for the looming doctor shortage is that as our population grows older, we are all going to need more health care. And most of that can and should be handled by primary care physicians, Dr. Max reported.

Other medical schools like the Touro College of Osteopathic Medicine are also prioritizing primary care applicants.

Includes video:

U.S. Faces Looming Shortage Of Primary Care Physicians


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Hong Kong faces medical manpower crisis, government study warns

June 15, 2017

Food and Health Bureau estimates the city will need more than 1,000 extra doctors by 2030, but critics say study fails to make accurate predictions

By Emily Tsang
South China Morning Post

Wednesday, June 14, 2017, 11:22pm

Hong Kong may be forced to recruit hundreds of medics from overseas as the health sector will face a critical manpower shortage in just 10 years’ time, the government has warned.

In the city’s first comprehensive staffing review of more than 13 professions by the Food and Health Bureau, it projected a manpower crisis in nine of them, including dentists, general nurses, occupational therapists and physiotherapists, as a result of the city’s ageing population.

The report stated that the most seriously affected would be doctors, as the shortage of 285 practitioners last year is expected to increase to 500 by 2020 and 1,007 by 2030, if the city is to maintain its current level of service.

There will also be a shortfall of 1,669 general nurses in 13 years, accounting for 3.3 per cent of the profession, rising from 1,485 last year.

The figures were based on population projections by the Census and Statistics Department.

Ten recommendations were made to address the shortfall, including a further increase in public and privately funded training places at tertiary institutions, retaining existing manpower by asking the retired to take on part-time work and recruiting non-local professionals.

A bureau source admitted that none of these measures could immediately ease the shortage.

“At least it may lay the foundation for health care manpower planning and set out directions for professional development,” the source said.

 Nurses at Queen Mary Hospital, Pok Fu Lam. Photo: Nora Tam

But the suggestion to import medics from overseas is a controversial topic among local doctors.

Medical Association president Dr Gabriel Choi Kin said the report exaggerated the problem as it failed to accurately estimate the capacity provided by private doctors, who were less responsive to the government’s study than their public counterparts.

Medical sector lawmaker Dr Pierre Chan said the report failed to address the uneven distribution of manpower among public hospitals. He also expressed fears that there may actually be a surplus of doctors in coming years, as the government almost doubled the number of medicine graduates to 470 a year last year, from 250 a few years ago.

But the Hong Kong Academy of Nursing said in a joint statement with other nursing schools that the government had underestimated the demand for nurses, and the figures were “too crude to truly reflect the manpower needs”.

They said the average ratio of nurses to in-patients at the city’s public hospitals was one to about 10, but the international standard was one nurse for every four to six patients.

The bureau source said he was “rather confident” that the shortage of professionals such as doctors and dentists could be solved as it could increase the number of publicly funded training places for students.

But he admitted the government would have less control over other professions, such as nurses and occupational therapists, who are usually trained in privately funded programmes.

On a brighter note, the report estimated the city would have enough psychiatric nurses, pharmacists, traditional Chinese medicine practitioners and chiropractors over the same time frame.

“For some professions, having sufficient manpower means there will be people losing their jobs. It means there will be room for these professions to enhance the health service. They can take up more duties to help those with shortages,” the source added.


Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

March 20, 2017

Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

Taxpayers spend P2.5 million over four years to produce a graduate of the Philippine Military Academy. Why not make the same investment in producing surgeons and other physicians?

The proposal was made by Senate President Pro Tempore Ralph Recto, who noted that the Department of Health already has an existing scholarship program for aspiring doctors. All that’s needed is to expand the program while at the same time making compensation and benefits more attractive for physicians working for the DOH.

Unless remuneration is improved, the nation may see its shortage of doctors worsen, especially in rural areas. Recto noted that of the 946 available slots in the government’s Doctor to the Barrios program from 2015 to 2016, only 320 were filled. The program is meant to provide at least one doctor in each low-income municipality, but there were few takers. Those 626 unfilled slots meant that millions were deprived of the services of a doctor in their communities.

The medical profession can pay handsomely – but only after many years of grueling studies and substantial financial investment in schooling and specialized training. The cost of medical textbooks alone can be beyond the reach of a low-income household.

Parents who have invested their life savings to send their child to medical school would naturally be reluctant to let the new doctor volunteer for a rural assignment that pays P56,000 a month, especially in conflict zones. The medical community is still waiting for justice for a Doctor to the Barrio volunteer, Dreyfuss Perlas, who was shot dead by still unknown assailants last March 1 while serving in Lanao del Norte.

If the government shoulders the schooling expenses of deserving medical scholars, the nation may be assured of a steady supply of physicians, even if the beneficiaries leave the DOH after a mandatory four-year service. The government may then have at least one doctor for every municipality, with the scholars encouraged to serve in their hometowns.

Health experts estimate that the country currently faces a shortage of 60,000 doctors. This means six out of every 10 Filipinos die without seeing a doctor. This need not be the case. The government is recruiting more police and military personnel. Why not boost resources to produce and recruit more doctors?

Physician Shortage: Hospital postponing elective surgeries for March break — Rural areas of the U.S. brace for doctor shortage — Foreign Medical Graduates Essential to U.S. Health Care

March 19, 2017
Maureen Coulter
Charlottetown, Prince Edward Island, Canada
Published on March 17, 2017
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Queen Elizabeth Hospital in Charlottetown.

©Guardian file photo

CHARLOTTETOWN, P.E.I. – The Queen Elizabeth Hospital is postponing all of its elective operative procedures over the March break.

An internal memo was sent out this past week notifying all medical staff and department managers that there is a planned service slowdown.

Twenty-two beds are closing in surgical, rehab and critical care units until March 27, including two beds in ICU, eight beds in Unit 1, eight beds in Unit 2 and four beds in Unit 7.

The memo states “any urgent emergency cases will proceed as usual” but that “no elective operative procedures” will be booked during this time.

A statement from Health P.E.I. says it does plan scheduled slowdowns at two main hospitals during specific times of the year, including March break, summer and Christmas, when the public demand for non-urgent elective services is lower and more people are on vacation.

“A planned slowdown during this time of year is a fairly standard practice across most health-care jurisdictions,” said the statement. “It also ensures that our hard-working staff and physicians have the opportunity to take some well-deserved time off with their families.”

Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.

James Aylward, MLA for Stratford – Kinlock

However, James Aylward, MLA for Stratford – Kinlock, told The Guardian Friday evening that he heard otherwise from an “extremely” reliable source.

“They confirmed to me that the reason for these bed closures had nothing to do with shortage of staff and vacations, but it had more to do with Health P.E.I. trying to reduce costs here coming towards the end of the fiscal year.”

Aylward, who is opposition critic for health and wellness, said he found this news about service slowdown alarming.

“This is the very first time that anyone can remember bed closures during March break.”

Aylward feels this decision did not consider the pain and suffering of Islanders as they could have been having these elective operative procedures over the course of this planned service slowdown.

The other issue he has with this is that this continues the “constant backlog of patients” in the emergency room waiting for acute care beds.

“Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.”

The statement from Health P.E.I. noted that during the March break slowdown, emergency services, including emergency surgical services, will remain fully operational.

“Slowdowns at Island hospitals are planned well in advance and we work with our health-care providers to ensure patient safety and patient care standards are never compromised. We always have a contingency plan in place to ensure that we continue to provide high quality care.”

Aylward feels at the very least the public should have been informed of this service disruption.

He adds this planned service slowdown is one of many things he plans on bringing forward during the spring session of the legislature.

Health PEI is responsible for the operation and delivery of publicly funded health services in Prince Edward Island. … Health PEI is governed by a Board of Directors, which ensures that approved programs are delivered in accordance with the direction from the Minister of Health and Wellness.


Rural areas of the U.S. brace for doctor shortage

Posted: Saturday, March 18, 2017 11:00 pm

In Coudersport, Pa., a town in a mountainous region an hour’s drive from the nearest WalMart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.

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Charles Cole Memorial Hospital, Coudersport, Pa.

In Fargo, N.D., a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.

In Great Falls, Mont., 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.


Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.


While the Trump administration is fighting for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.


In Montana where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.


“Our health system already has nine months invested in her, and now we have no idea when she can start,” said Erica Martin, who recruits doctors for the company.

The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo.

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“I won’t have an income, I don’t know if I will afford rent, I don’t know where I will be,” she said. “It’s insane.”


The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced that it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee.


A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to “work down the existing backlogs due to the high volume of incoming petitions.”


The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.


H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.


About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.


There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.


Sens. Amy Klobuchar, D-Minn.; Susan M. Collins, R-Maine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.


“Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America,” Heitkamp wrote in an email.


The delay also could affect the roughly 400 foreign medical graduates who come each year to participate in residency programs at teaching hospitals. The doctors were matched Friday for residencies starting July 1 across the country.


“Everyone around the country will be in a mad scramble to figure out this visa situation,” said Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, which usually takes 10 or 12 residents on H-1Bs each year at its Anschutz Medical Campus.


The immigration agency said in a statement that applicants could still request an H-1B approval on an “expedited basis,” if they could prove there was an emergency or humanitarian justification.


Immigration lawyers said that it was extremely difficult to meet that standard, and that they doubted whether the agency could handle a flood of such requests.


“If they don’t have the manpower to do premium processing, I don’t see how they are going to do special requests,” said Andrea Szew, a lawyer in Los Angeles.


Foreign Doctors Assist With Physician Shortage

The challenge in Iowa, where the shortage of physicians is more pronounced, is finding qualified doctors that will stay in the area.

| March 18, 2017, at 1:02 a.m.

By DEVAN PATEL, Quad-City Times


DAVENPORT, Iowa (AP) — Dr. Nazir Kayali settled into his chair, deep in thought.

His hand stroked his chin and a smile grew into a laugh as he considered his circuitous path to the Quad-Cities.


The Syrian-born pediatrician’s first trip outside his native country was to Ohio in 1990, where his cousins were practicing medicine.

Wishing to follow in his cousins’ paths, Kayali asked what he might expect from America.

They halfheartedly told him a joke that went along with the generalization that Americans are egotistical and care only about money.

“A stranger comes to America and finds a booth that says ‘Two questions for $100,'” Kayali began, barely able to get the words past his own laughter. “He asks a woman, ‘Is that a lot of money for two questions?’ She replies ‘Yes. What’s your second question?'”


But the international medical graduate found the opposite to be true in middle America. Here, he said, he found warmth, compassion and acceptance.


Dr. Nazir Kayali has his plate dished up by daughter, Sarah, 17, as they sit down for dinner at their home in Bettendorf. Having lived in Des Moines for his residency and in the Quad-Cities previously, Kayali, a Syrian-born pediatrician, has called Bettendorf home for the past five years.


Having lived in Bettendorf for the past five years, Kayali boasts that the Quad-Cities is his third stint in Iowa, having secured his H-1B visa to complete his residency from 1993-1996 at Iowa Methodist Medical Center in Des Moines. Out of all the hospitals in the nation, his first choice was in Iowa’s capital city.


He then came to the Quad-Cities from 1999 to 2007, returning to Syria so his children could get to know their family in Aleppo.

But his Iowa memories and experiences stayed with Kayali.


When war made Syria too dangerous, the pediatrician with a soft spot for Iowa was relieved to learn of an opportunity in the safe place he had come to know more than 6,200 miles away. And it called his family back.


“I’ve had a very positive experience,” Kayali said. “The acceptance and the people, from residents, staff, colleagues and patients; it was all so incredible.”


The sentiment is the same for many of the international medical graduates who have immersed themselves in the community, including Dr. Sarojini Ratnakar, who joked that she took the easy path to practicing medicine in the United States.


The Indian-born and -trained hospitalist for Genesis Health System did not have to jump over the same hurdles that other international medical graduates did. Her husband already had a visa, so she was able to come as a spouse.


Dr. Sarojini Ratnakar talks with patient Marcia Johnson of Bettendorf in her room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar’s story, however, is similar in that she, too, came to the U.S. to make a better life and has settled into the void created by the country’s physician shortage.


In America’s heartland, where the shortage is more pronounced, the challenge isn’t so much in finding qualified doctors. The real test is in convincing them to stay.


Iowa ranked seventh in medical students per 100,000 population, but the state has one of the lowest physician-to-population ratios in the country. In other words, medical students are graduating in Iowa; they just aren’t practicing here.


Even more alarming is Iowa’s consistently low ranking in retaining physicians who earned their medical degrees in-state.

Since 2006, the retention percentage for in-state graduates has fluctuated between 34 percent and 36 percent for physicians, according to data from the Association of American Medical Colleges, or AAMC.


Hospitalist Dr. Sarojini Ratnakar, who was born in India, reads a chart before going to the patient’s room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar said she struggled when she first came to practice in Iowa in 2004.


“I moved from Atlanta, because my family was here, but at the beginning, I really wanted to go back,” she said.


As she immersed herself in the Quad-Cities, however, something changed.


“It’s the people here,” she said. “I wanted to go back, but now I won’t leave, because this place is just fantastic. I would not trade it for anything.”


Just like Ratnakar, other international medical graduates are starting to form attachments and a sense of place and are not necessarily waiting for a door to open elsewhere.


Community Health Care CEO Tom Bowman has become familiar with the doctor shortage in his 10 years at the Davenport clinic.


Bowman said Community Health Care, or CHC, tries to fill the gaps in medical treatment in the community and, in order to do so, relies heavily on sponsorship of international medical graduates through J-1 or H-1B visas.


Foreign graduates accounted for more than 50 percent of CHC recruits in the past decade, and they haven’t always been keen on staying in the area.


“Some of it, even though we’re not as rural as some parts of country, is that they tend to gravitate to more diverse and urban areas,” Bowman said. “But we’re getting better on that front.”


In the past 15 years, Community Health Care has sponsored and employed 33 international medical graduates, but only 17 have remained here. However, when narrowing the focus to the past decade the percentage of doctors sticking around increases from 50 percent to about 65 percent, the Quad-City Times ( ) reported.

Hospitalist Dr. Sarojini Ratnakar looks over the patient board for the night at Genesis Medical Center-East Rusholme Street, Davenport.


The same can be said of the percentage of active physicians who are international medical graduates, practicing in Iowa. As of 2014, their numbers increased from 17 percent to 18.6 percent, making foreign doctors second only to Iowa-educated doctors in the recruitment pool.


From 2006-14, foreign doctors accounted for almost one-third of physician growth in Iowa, according to data from AAMC. In fact, foreign graduates have become such a mainstay in American medical care, they now account for about 1 in 4 physicians.


“Foreign graduates are very hard workers, so they really don’t mind going to any place,” Ratnakar said.


The sprawling city of Kingwood, West Virginia, county seat of Preston County, was home to just more than 3,000 people when Kayali practiced there after his three-year residency in Des Moines.


“(It’s) a small town in the mountains where no one else would go,” the Bettendorf pediatrician said.


Except for his family’s social life, Kayali said, the little town produced a positive experience. But it also was the place in which he first experienced the struggles that strike a community that is medically under-served. Some of the most basic conditions were worsened, he said, by the lack of physicians in the area.


“I would see really sick kids, and I wouldn’t imagine seeing such cases in the United States,” Kayali said.

For rural areas in the U.S. like Kingwood, it’s difficult to attract physicians, which is why foreign physicians have become such a vital resource.


A study commissioned by AAMC found that the U.S. will have a shortage of 61,700 to 94,700 physicians by 2025, and rural areas can expect to suffer the most. Those regions of the country typically lack the amenities, diversity and financial incentives available in urban areas, making them less desirable to many incoming physicians.


As an incentive, foreign graduates can prolong their stay in the U.S. by serving in medically under-served areas with modest populations where other health providers are scarce.


With J-1 visas, states can sponsor physicians through the Conrad 30 waiver, which allows 30 international medical graduates to stay in the country as long as they practice their medical specialty in shortage areas for a minimum of three years.


J-1 visas typically require participants to return to their home country for two years to apply the knowledge and training they acquired in the U.S.


Over the past 10 years, more than 10,000 physicians in the U.S. stayed and served in shortage areas under Conrad 30, according to AAMC President Darrell Kirch. In the same decade, the Iowa Department of Public Health sponsored 292 foreign doctors out of the potential maximum of 300, meaning Iowa used 97 percent of its allotment of Conrad 30 doctors. In comparison, the national average is 59 percent.


From 2007 to this year, Scott County ranked eighth in the number of Conrad 30 waivers granted in the state with 18.


But the number of state-sponsored waivers has decreased since 2012, when the Department of Health and Human Services took over applications for Federally Qualified Health Centers such as CHC.

While Scott County did not receive a single Conrad 30 waiver out of the 30 recommended by the state this year, it does not mean the need isn’t there.


Information from: Quad-City Times,




Hospitals in England cancelled record number of urgent operations last year

January 27, 2017

A total of 4,093 urgent procedures were scrapped in England in 2016 as staff shortages and lack of beds took toll

Hospital staff wheel a patient into a lift
The latest figures mean that 17,598 patients have had their urgent operation cancelled over the past five years. Photograph: Christopher Furlong/Getty

Hospitals cancelled a record number of urgent operations last year as bed shortages left them struggling to cope with the growing number of patients needing surgery, NHS figures show.

Hospitals in England cancelled 4,093 urgent procedures during 2016, equivalent to 341 per month. This was 8% more than the 3,777 scrapped in 2015 and up by 27% on the 3,216 such operations cancelled during 2014.

While some cancellations occur because of a patient’s health, the vast majority are due to hospitals having too few beds, especially in intensive care or high-dependency units in which patients can recover afterwards, often because a more urgent case has arrived. A few involve staff shortages or a surgeon unexpectedly being unavailable.

The latest figures mean 17,598 patients have had their urgent operation cancelled over the past five years, often at the last minute, despite their condition requiring surgery without delay.

Opposition parties claimed that the figures, published on Friday by NHS England, showed problems in the health service were deepening and the government was not giving it sufficient money to keep up with rising demand for treatment.

Jonathan Ashworth, the shadow health secretary, said: “Theresa May’s NHS crisis continues, and the problems are worse and more widespread than in previous years. By underfunding and overstretching the NHS, the Tories have pushed health services to the brink.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The government’s stubborn refusal to give the NHS emergency funding means record numbers of operations are being cancelled as hospitals face weeks on end of intolerable pressure. This will inevitably have serious repercussions for patient care and the morale of NHS staff.”

The NHS England data shows that hospitals also cancelled 38,129 non-urgent elective operations between April and October, the largest number yet recorded for those six months.

Of those patients, 2,204 did not have their surgery rescheduled within 28 days, as the NHS constitution stipulates, in another sign of the huge pressures on the service.

However, NHS England’s latest winter situation reports showed that hospitals came under slightly less strain last week than during the crisis that unfolded in the early weeks of January.

Overall, 43 acute hospital trusts were forced to divert A&E patients to another emergency department because they could not cope with the large numbers of people needing care, down from 52 the week before. Similarly, 51 trusts declared some sort of alert during the week, down from 68 a week earlier.

A further eleven people died from flu last week, bringing the total to 53 since the start of December, and 65 needed to be treated in an intensive care or high-dependency unit.

NHS England and Public Health England said the number of flu cases hospitals were treating was worrying and linked to the particularly cold weather affecting much of England recently.




Doctor Shortages Help Drive Up Costs of Obamacare

October 31, 2016

OCT 25, 2016

A new report shows that Florida hospitals have increased their number of residency slots 19 percent since 2013.

The state faces a severe shortage of about 7,000 medical specialists through 2025.

Since Florida policymakers began focusing on graduate medical education in 2013, hospitals have filled 736 more residency slots.  A total of 310 newly filled residency slots were in physician specialties facing the most severe shortages.

The report, “Training Tomorrow’s Doctors: Graduate Medical Education in Florida 2016 Annual Report” was produced by the Safety Net Hospital Alliance of Florida (SNHAF) and the Teaching Hospital Council of Florida to document and evaluate progress toward increasing residency slots.

“This is our first glimpse at both where we are now in terms of medical residency slots and where we need to be,’’ said Carlos Migoya, president and CEO of Jackson Health System and immediate-past chairman of SNHAF, whose hospitals provide more than 70 percent of Florida’s graduate medical education programs.

“This report makes it clear that while we’re not where we want to be yet in solving the physician shortage crisis, the concerted efforts of SNHAF members to increase the training opportunities for Florida’s next generation of doctors are already paying off.’’

Doctors are more likely to practice in the area they complete their residency. With few residency slots, many doctors educated in Florida leave for other states.

David Hart, vice president of the Florida Chamber of Commerce, said it’s important for the state to continue creating residency positions, not just for health care access, but for financial reasons.

“It comes down to really protecting a tax payer investment. After all, taxpayers subsidize a pretty substantial amount of four-year degrees and medical degrees in Florida.”

According to the report, residency shortages span every Medicaid region in the state, and in specialties like psychiatry, family medicine, general surgery, adult and pediatric anesthesia, cardiology, neurology and pulmonology.

In 2013, Gov. Rick Scott and the Florida Legislature appropriated $80 million in recurring state and matching federal funds to create the Medicaid Residency Program (MRP). The MRP initially funded 3,896 residency slots and now funds 4,632. Nineteen of those hospitals that previously had no residency programs now do, raising the number of participating hospitals to 60.

In 2015, the Florida Legislature appropriated an additional $100 million for the Graduate Medical Education Startup Bonus and Retention Programs. These programs provide hospitals a one-time $100,000 bonus for every residency slot created in a shortage specialty and at the end of each fiscal year direct any remaining funding to hospitals that have slots in the shortage areas as retention incentives.

In the first year of the GME Startup Bonus Program, 66 new residency positions in seven shortage specialties qualified for the bonus. Under the GME Retention Program, the number of filled residency slots in shortage specialties grew from 1,869 to 2,179.

“We are confident that state leaders and policymakers will see not only the progress we are making together in securing Florida’s health care future, but the remarkable return on the public’s investment in GME,’’ said Dr. Jonathan Ellen, president and vice dean at Johns Hopkins All Children’s Hospital and chairman of SNHAF. “These are real results that are making a real impact on Floridians’ lives and a heck of a bargain to boot.”

(When Obamacare was first created, one of the biggest problems in the U.S. medical service was a doctor shortage. Obamacare brought millions of new patients into the medical system without working on getting more trained and qualified doctors to handle the entire work load….)


There is a shortage of physicians countrywide, not just in Redding. It isn’t because of lack of interest, but because of lack of money. No agency can feel the pain more than the Department of Veterans Affairs, which I served in for over 32 years.

In working with the VA Medical Center at Reno, we were affiliated with the University of Nevada Medical School. One of the biggest complaints of the medical students, interns and residents was the payment of their student loans. These loans can run from $250,000 to $500,000 for a medical education.

I made a suggestion to President Obama on a way to recruit physicians for the VA, and help students pay off their student loans and benefit the VA System, but it was met with an air of indifference by the White House.

The VA clinic here in Redding and other VA clinics in California are being hit hard by the lack of qualified physicians. Family nurse practitioners have their purpose, but primary medical care as well as specialists are needed in the proper care of our veterans.

I’m a veteran who worked in a VA medical center and received medical care from a private physician. There’s a need for physicians in all medical avenues of medical care. The veterans are in need of more physicians to improve care, reduce waiting lists and provide viable care before they are unable to obtain the needed care.

The public is waking up to the fact that there is a shortage of physicians here in Redding, but there is a nationwide shortage because of the cost of a good medical education. The brains are there; the bucks are not.

We don’t need walls. We need doctors.

If there’s money for political waste, there should be money for good quality medical care. The opportunity to forgive student loans is of the utmost and paramount concern if we are to remain a great nation.

Ernest Kimball lives in Redding.–3e9ace17-0ba6-2aba-e053-0100007f3d21-397115881.html

Vietnam’s Hospitals and Health Care: Patients wait for 10 hours on average after walking in — IT not effectively used

June 27, 2016

Thanh Nien News

HO CHI MINH CITY – Monday, June 27, 2016 09:51

Image may contain: 7 people, people sitting and indoor

Vietnamese patients wait to be examined at Binh Dan Hospital in Ho Chi Minh City. Photo by Khanh An

Ho Chi Minh City’s public hospitals need to make better use of information technology to improve their services since a patient has to wait for 10 hours on average to be examined, experts said at a conference in the city Saturday.

Vu Anh Tuan, general secretary of the HCMC Computer Association, said most hospitals do not use information technology efficiently.

“Vietnam’s medical system needs effective IT use to better manage patients’ records, reduce the waiting time and improve examination and treatment services,” he said.

Tang Chi Thuong, deputy director of the city health department, said, “Cloud is not widely used.”

The city with more than 10 million inhabitants has a total of 113 hospitals with nearly 34,400 beds.

“A medical network that provides healthcare services for millions of people needs an advanced information technology system for better treatment,” Thuong said.

According to a survey by the Vietnam Posts and Telecommunications Group, city hospitals examine and treat 40 million people annually.

On average, a patient has to wait around 10 hours for being examined and a doctor sees around 90 patients a day.

Short-term health insurance fills Obamacare gaps but has risks — Republicans Unveil Replacement Plan — Birth control case is back in the lower courts

May 22, 2016


Short-term health insurance fills Obamacare gaps but has risks

By Victoria Colliver, San Francisco ChronicleSun, May 22, 2016


Sales of health insurance policies with limited benefits — plans that represent the very type of coverage and industry practices that the Affordable Care Act was designed to get rid of — appear to be on the rise.

.These short-term policies, which don’t include such basic benefits as prescription drugs or maternity coverage and can exclude applicants based on their medical history, are experiencing a resurgence among consumers willing to exchange comprehensive care and a potential tax penalty for significantly cheaper premiums than those sold under the rules of the federal health law many refer to as Obamacare.

“While Obamacare is appropriate for some people, for others it is not, and they want other choices,” said Sam Gibbs, executive director of Agile Health Insurance, a Mountain View company that operates what it calls the first website dedicated to selling these policies exclusively.

Gibbs said the year-old business, a division of Health Insurance Innovations, has been growing 100 percent each quarter and has sold 35,000 policies nationwide since last fall.

Most people who purchase these policies do so because they need to fill a gap in health coverage and just need something to protect their assets in case of a medical emergency. They don’t want the cost or hassle that comes with applying for standard health insurance.

“The reason you buy temporary insurance is so you can survive a Muni accident. … Or if you fall off a building and live,” said Kevin Sullivan, 36, of San Francisco, who bought a six-week policy when his wife, whose employers normally provide the couple’s coverage, was between jobs.

He did the math: continuing coverage under his wife’s former employer’s policy would have cost $1,100 a month, and six weeks of a temporary policy cost just over $400. Sullivan, who runs a company that sells commercial insurance, understood the downside.

“You take the risk that you’re diagnosed with cancer in the temporary period. You take the risk you’re not going to get your prescriptions filled,” he said.

Getty Images

Sullivan, who purchased the plan through Agile Health, said he didn’t he even know who the carrier was. He and his wife never used the policy. Her new job-based coverage started May 1.

When the Affordable Care Act’s major provisions went into effect in January 2014, many of the problems that plagued people who had to buy health insurance on their own, rather than getting as part of a group policy from a job, were supposed to go away.

No longer could people be rejected or charged more if they had pre-existing health conditions. No longer would they get hit with bills for basic services that weren’t covered, even if they were informed in the fine print. In exchange for ending those practices, the law requires most Americans to buy health insurance. They have to buy coverage during a specific “open enrollment” period to prevent them from buying it only when they need it, like on the way to the hospital.

Federal numbers released Tuesday show that the Affordable Care Act has pushed the percentage of uninsured Americans to a record low of 9.1 percent, the first time it has dipped into the single digits. But there are growing concerns nationwide that insurers may seek double-digit increases in premiums next year for policies sold through the health law’s insurance marketplaces.

Even the state’s health insurance exchange, Covered California, which has managed to keep rate increases relatively low, is expecting premiums to rise 8 percent on average next year. This follows two years of increases averaging just 4 percent.

Short-term policies, which can last a few months or up to a year, are virtually everything the policies that comply with the Affordable Care Act are not. They require applicants to answer some basic health questions, and those with chronic or past health problems may be rejected. They don’t cover basic benefits mandated by the law, and consumers aren’t guaranteed of getting a policy if they reapply.

While buying health coverage that doesn’t meet the new marketplace requirements is legal, people can get hit with a tax penalty if they don’t have coverage and don’t qualify for various exemptions. (Short gaps in coverage, for example, are accepted.)

Temporary health insurance that doesn’t cover mandated benefits doesn’t count under the law. The penalty started at $95 per adult in 2014, the first year the policies were sold, and will rise to $695 this year.

For Orlando Figueroa of San Leandro, the penalty wasn’t high among his priorities when he opted for a short-term policy.

A father of two, the 44-year-old was laid off from his recruiting job for a major Silicon Valley tech company. While he worked as a contractor, Figueroa’s family coverage could cost him as much as $1,300 a month.

While searching for options online, he learned about temporary health insurance and bought a short-term Aetna policy for about $850 a month. He considered buying a regular policy — his change in job status allowed him to buy outside the open enrollment period — but he didn’t qualify for a subsidy through Covered California.

“This is a lot cheaper. This can help me bridge the gap,” he said. “For a case like mine, it’s going to cover a two- to three-month gap. Then I can weigh what I’m going to do next at the time.”

Figueroa bought his plan through eHealth, a Mountain View company that sells short-term policies as well as those that comply with Affordable Care Act rules.

“The reality is, insurance doesn’t do you any good if you can’t afford it,” said Nate Purpura, vice president of consumer affairs at eHealth.

EHealth sold about 60,000 short-term policies nationwide in 2013, the year before the major Affordable Care Act provisions went into effect, Purpura said. In 2014 and 2015, its annual sales of policies jumped to about 140,000.

“We thought maybe once people understood the enrollment period better, we’d not see quite the same appetite for short-term (policies), but the demand has stayed consistent,” Purpura said.

Numbers like that pose concerns for consumer advocates like Betsy Imholz, who plans to ask state insurance commissioners to ensure that their residents understand the risks of these policies.

“I worry about people not fully understanding what they’re getting,” said Imholz, special projects director at Consumers Union, the policy and advocacy division of Consumer Reports.

Imholz said people should be asking about what the plan covers, what it doesn’t, as well as how much of their money these companies actually spend on medical claims.

Imholz said she also worries that these policies are siphoning younger, healthier consumers out of the pool of people buying coverage.

“We need to keep the larger risk pool healthy to keep rates down for everyone else,” she said.

These young, healthy consumers include people like 29-year-old Brianna Skellie, of Oakland, who lost her health insurance last fall when she finished graduate school.

Skellie said it took a bad reaction to an insect bite to remind her how much she needed coverage.

“It was such a moment of panic,” she said. “It was like anything could happen to me. I ride my bike a lot and just needed to have something more than nothing.”

She may have qualified for a subsidized policy through Covered California, but Skellie planned to quickly get a job and didn’t want to go through proving her income and citizenship and other hassles. So she purchased a short-term plan online for less than $100 a month and dropped it a couple months later when she got a full-time job with benefits.

Officials from the California Department of Insurance said they receive reports from the insurers they regulate about these policies. They said not many of them are sold in California, and they have received few complaints.

But the companies that sell these policies remain bullish on the market.

“Obamacare has left a gap. We’re entrepreneurs and innovators, so we build products to fill those gaps,” Agile Health’s Gibbs said. “Time will tell where this goes, but so far it’s just been fantastic.”


The Obamacare birth control case is back in the lower courts

The Obamacare birth control case is back in the lower courts

Lower courts must now take another look at the case, which consists of making an exception for faith-based groups so they do not have to cover the birth control costs of their female employees.

It presently provides what it describes as an “accommodation” that requires the Little Sisters of the Poor and other religious organizations to sign a form for the government that directs their insurance providers to offer the objectionable coverage through their health plan. The challengers claim this doesn’t go far enough, because their plans are still being used as vehicles for providing access to contraceptives, even if they don’t have to pay for it.

All that stands in the way is governmental stubbornness and bureaucratic convenience – neither of which amounts to a hill of beans compared with respect for religious liberty.

According to the justices, lower court should bring a solution to the issue in such a way that religious organizations’ objection to contraception is met accordingly while the benefits of Obamacare’s coverage protections could still be attained by people.

In the case now before the court, Zubik v. Burwell, the Little Sisters are joined by other plaintiffs including the Archdiocese of Washington, Bishop David Zubik of Pittsburgh, the pro-life group Priests for Life, and several Christian colleges and universities.

“On both sides there is probably ideological pressure to keep this going”, said Kevin Martin, an attorney in the Boston office of Goodwin Proctor.

In an unsigned opinion issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out.

In a unanimous opinion issued Monday, the justices remanded the case to the respective United States Courts of Appeals for the Third, Fifth, Tenth and District of Columbia Circuits. In any event, the very real possibility is that one or more cases could end up before the Supreme Court in a later session. The Zubik case could eventually reach the Supreme Court again, after adjudication in lower courts, but that would nearly certainly occur only after a new justice had been added to the bench, allowing for a definitive ruling. “If the government desires to do so, it must do so on its own, without requiring Catholic organizations to violate their religious beliefs”.

“Nothing in this opinion, or in the opinions or orders of the courts below, is to affect the ability of the Government to ensure that women covered by petitioners” health plans “obtain, without cost, the full range of FDA approved contraceptives‘”.

The failure to arrive with a final ruling is also said to have been caused by the recent passing of Supreme Court Justice Scalia, leaving only 8 seats filled, with 4 conservatives and 4 liberals.


Guess Who Just Sued the Federal Government Over Obamacare

By Sean Williams Published May 21, 2016

The Affordable Care Act, or Obamacare as it’s best known, has had a bumpy ride since Jan. 1, 2014, when it became the official health law of the land.

On the one hand, Obamacare has worked to lower the rate of uninsured adults in this country to the lowest levels on record. According to first quarter data from Gallup, just 11% of respondents were uninsured, compared to 17.1% in the fourth quarter of 2013, the quarter preceding Obamacare’s full implementation. Recently released data from the Centers for Disease Control and Prevention, which also includes Medicare enrollees, shows an uninsured rate of only 9.1%, a new low.

Furthermore, millions of lower-income consumers and families have gained access to medical care through the Affordable Care Act, with 31 states choosing to take federal funds and expand their Medicaid programs. Provisions excluding insurers from rejecting people with pre-existing conditions have also allowed the previously uninsured to get the care and coverage they need.

Conversely, Obamacare has arguably made life miserable for other consumers, kicking millions off their non-Obamacare-compliant health plans and potentially forcing them to seek out new primary care physicians. Consumers are also facing what look to be steep premium increases in 2017 as health insurers large and small attempt to cope with higher medical utilization rates and a generally sicker group of enrollees in the Obamacare exchanges.

But Obamacare was dealt another bump in the road this past week: a lawsuit from a surprising source.

Guess who just sued the federal government over Obamacare

As reported by The Wall Street Journal on Tuesday, Highmark, a health insurance provider under the Blue Cross Blue Shield brand in Delaware, Pennsylvania, and West Virginia, is suing the federal government over Obamacare. “Why?” you ask? Highmark claims that it didn’t receive its promised allocation via the risk corridor.

The risk corridor has been a largely unsuccessful component of the Affordable Care Act that sought to encourage new entrants into the individual marketplace by providing a financial foundation if they were to lose excessive amounts of money. The idea was to have overly profitable insurers contribute their excessive profits to the risk corridor pool, which would then be distributed to insurers losing excessive amounts of money on Obamacare’s exchanges. The program was only designed to be in place for three years (2014-2016), since that was deemed more than enough time for insurers to correct premium pricing mistakes.

What actually happened was few insurers were excessively profitable in 2015 — mainly on account of the aforementioned higher medical utilization rates — leading to the risk corridor program disseminating only $362 million (12.6%) of the $2.87 billion that had been requested by money-losing insurers. The lack of adequate reimbursement is what caused 12 of Obamacare’s 23 approved healthcare cooperatives to shutter their doors.

However, it’s Highmark’s contention that the federal government had pledged to initially cover the difference in the risk corridor program even if excessive insurer profits didn’t cover the amount requested by money-losing insurers. Eventually, the federal government backed off this stance and went with a budget-neutral approach to the risk corridor, essentially meaning only the funds pooled from profitable insurers would be dispersed to struggling insurers.

Highmark is requesting the federal government pay it the $223 million that it was promised via the risk corridor, as well as cover interest on the $223 million and its legal fees for the lawsuit. Highmark has received just $27 million via the program to date. According to Highmark’s CEO, David Holmberg, “All we’re asking is for the federal government to do what they promised.”

If Highmark were to win its case, it could open the floodgates for a class action suit against the federal government for the remainder of unpaid risk corridor funds.

An array of concerns

Unfortunately for Obamacare, this latest lawsuit represents just one in a string of concerns for the program. While the headline enrollment numbers look good, a number of internal components of Obamacare aren’t up to par.

Aside from the risk corridor failing to live up to expectations, young adult enrollment has been subpar, even with year-over-year improvement in 2016. I suspect the biggest deterrent to getting younger and healthier people to enroll in Obamacare is that the shared responsibility payment (SRP) — the penalty paid by consumers for not purchasing health insurance — is simply too low.

I’m sure there are those out there who would argue that this is far from the case, with the average SRP in 2016 expected to be nearly $970 according to the Kaiser Family Foundation. However, an SRP of $970 pales in comparison to the annual costs of purchasing even the cheapest healthcare plan in the bronze category, which can often run $2,500+ for a full year. Even accounting for the potential tax breaks associated with paying healthcare premiums, it’s a night-and-day cost difference that’s keeping healthier young adults out of the program.

The other issue, which works somewhat hand-in-hand with the risk corridor’s shortcomings, is insurers’ ongoing losses. Health-benefit providers need to be able to turn a profit, and in order to make that happen insurers could need to enact some very large premium price hikes in 2017. Though the reports are still coming in, insurers in a number of states have requested double-digit percentage increases in premiums in order to make their Obamacare plans make ends meet. While this probably isn’t too big a problem for the roughly 85% of Americans receiving partial subsidies for the premium, it could be a big concern for the remaining Obamacare enrollees and those who are still uninsured. Obamacare was expected to entice competition and transparency, using both to keep cost inflation under control; however, it looks as if premium inflation may rise faster than it has in a decade in 2017.

There are also no guarantees Obamacare will survive much past the 2016 presidential election. Though Democratic Party front-runner Hillary Clinton wants to build upon Obamacare’s success, presumptive Republican nominee Donald Trump is itching to repeal it and start anew.

Obamacare has some serious questions to answer in the coming months, and both consumers and investors would be wise to pay close attention to what happens next.

The article Guess Who Just Sued the Federal Government Over Obamacare originally appeared on

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GOP lawmakers unveil ObamaCare replacement bill

By Peter Sullivan – 05/19/16 05:08 PM EDT
The Hill

Two Republican lawmakers on Thursday introduced an alternative to ObamaCare as the House develops its own healthcare plan.


The bill from Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.) does not fully repeal ObamaCare, a notable departure from the GOP’s long-stated goal.

But it would eliminate many central aspects of the Affordable Care Act, including the mandates for individuals to have coverage and for employers to provide it, as well as requirements for what an insurance plan must cover.

The core of the plan is a $2,500 tax credit that any citizen would be eligible for and use to purchase health insurance. The lawmakers say this gives flexibility to people, whether they get employer-based insurance or not, to more directly control their healthcare spending, for example by using a health savings account.

Sessions and Cassidy are putting forward their plan as a task force set up by Speaker Paul Ryan (R-Wis.) is nearing the release of its own plan to fully repeal ObamaCare and replace it with an alternative.

Sessions, the chairman of the powerful House Rules Committee, said in an interview that his plan is not meant to compete with that effort.

“Everybody’s submitting their ideas, so it’s very complimentary,” he said.

The Ryan-backed task force, though, will not be releasing a bill; it will instead be a general outline of ideas.

“The thing that makes us different is we made a bill out of it, and that’s the hard part,” Sessions said. “It’s really easy to have ideas. It’s really hard to put it in a bill that works.”

Under the Sessions-Cassidy plan, people currently with insurance through the ObamaCare marketplaces could keep it because they would be grandfathered in.

But new ObamaCare enrollees would no longer be eligible for ObamaCare’s financial assistance. Instead, they would receive the new plan’s $2,500 tax credit, according to John Goodman, a health economist who worked with Sessions and Cassidy on the plan.

The new tax credit is a flat sum, as opposed to ObamaCare’s tax credits, which increase for lower-income people. Therefore, Goodman said, lower-income people would receive less assistance under the Sessions-Cassidy plan, but higher-income people could receive more.

Sessions defended the decision to allow current ObamaCare plans to be grandfathered in if people want to keep them.

“I want to be fair about this,” he said. “If you want that, you ought to have it; I mean, we’re in a world of options.”

The Sessions-Cassidy bill also shakes up the current system of not taxing health insurance plans provided through employers, which can be politically fraught. However, the plan allows employers to opt to stay in the current system if they want, and only opt in to the new tax credit if they choose.




Healthcare has many problems in almost every corner of our world…



The health services in Britain and the U.S. cannot possibly determine future costs because neither nation knows how many new migrants reside within their borders…. The result is that money and trained medical staff are always in a state of shortage and crisis….

Americans are suffering “the awful legacy of the last eight years,” Bill Clinton said in March.