Obamacare Trumpcare

2017’s Best Medical Billing Company

We’re the best medical billing company of 2017 you can talk to for two reason.  But before we get to that here’s a little about ourselves.  On our home page we can tell you about the processes we have in place to make sure you practice get the most and quickest revenues from your receivables.  Many billing companies do many of the same things but here are the unique benefits of working with Preferred Health Resoures (PHR). Learn about the reason why you should outsource your billing with PHR.

The best medical billing company of 2017 … that’s it for the initial pitch, back to the two reasons why you should talk to PHR.  We want to help you because we hope we get your business but also we’re in turbulent times.

The Affordable Healthcare Act – ObamaCare/TrumpCare

The Affordable Care Act has made it more complicated effort to deal with the insurance carriers with all the continuous changes in rules, upgrades and conformity regulations.  Add to this most practices added a new EMR system in the last 5 years and frankly they didn’t necessarily make billing any easier. Add to this the ICD-10 switch over, more billing complications.

Whatever the Trump administration decides you can be sure your office is going to be hard pressed to adjust to all the changes.  We know this and work with many small practices to make sure your reimbursements continue to flow.

Further, no matter what changes are made we know that the insurance companies will continue to play the game of NOT paying on the initial submission.  That’s why PHR allocates over 50% of its charge prices to the successful group of the last 20-30% of fees that usually don’t get paid on first entry. Reach and resolution of the claims can require 10 times more attempts to successfully get a payment. Most practices have limited resources that virtually never possess enough time to reach those problem claims. By regularly using timely and aggressive follow-up much more consistent revenue can be achieved for our practices.

OK that’s ONE Big Problem, You Said Two

Yes, its two big problem, simply stated:

  1. How do we collect revenues under the present system, AHA.
  2. How will the Trump Administration change this.

So the idea behind this page will try to act as a running journal as the healthcare political winds change.  Much of this will be in the form of blog posts but collected in this same spot.

We hope you find this useful and you’re welcome to call use at 877-877-6900.

Obamacare vs Trumpcare – The Republicans Subdivide
History seems to be repeating itself.  Just because you control the White House and both Houses of Congress doesn’t mean you can make legislative progress as Republicans Subdivide.   In the case of the Obamacare, the Affordable Care Act, the bill was signed by the President in March 23, 2010 the and upheld by the Supreme Court on June 28, 2012.   But it took a secondary role to dealing with the Great Recession and it took almost the whole first term of the administration to get it launched.
CMS logo - Republicans Subdivide
History seems to be repeating itself.  Just because you control the White House and both Houses of Congress doesn’t mean you can make legislative progress.  In the case of the Obamacare, the Affordable Care Act, the bill was signed by the President in March 23, 2010 the and upheld by the Supreme Court on June 28, 2012.   But it took a secondary role to dealing with the Great Recession and it took almost the whole first term of the administration to get it launched.

We now have somewhat of a parallel situation with the attempted change to Trumpcare.  First, there has been major backlash on the part of the public to the repealing of Obamacare. Many people have attended local meeting with their Representatives and have been very vocal about keeping the plan in place.  Some Congressmen have even skipped out of their planned meeting altogether.   Representative Jason Chaffetz of Utah met with an angry crowd of around 1,000 people to voice their concerns.

So where is the parallel to the earlier stages of the Obama administration.  I thinks is fair to say that at present the Trump administration has bigger fish to fry.  Two examples are the courts suspending the Executive Order regarding immigration and the resignation of General Mike Flynn as National Security Advisor.

Republicans Subdivide on Obamacare Direction

In the meantime Congress itself is also delaying its efforts to replace Obamacare. Despite efforts by Speaker Ryan to come up with a replacement no amount of whipping have come up with a voting consensus.  The most Freedom Caucus members aren’t willing to wait and insist on eliminating Obamacare whether or not there’s an replacement in place or not. Further, there is no real guidance from from the White House or Secretary Price.

There are other factors in play but it looks like Trump administration has had its hand tied in its immigration efforts.  It will have to be seen if the Judaical Branch weights in on Obamacare issues.

For example, the recent ruling on ACA Insurance Risk Corridors would confirm that those insurers that didn’t do well and have gone out of business or written off the costs will get some of their expenses returned.  But it is not sure if this specific ruling will be overturned.  Or even if Congress just changes the law the disallow the use of The Judgement Fund by enacting HHS Slush Fund Elimination Act.

Meanwhile I am listening to a webinar on the MACRA Merit-based Incentive Payment System Annual Call.  Point being, that in the belly of the HHS/CMS beast life is goes on.  There’s an actual Radiologist on the cal, the poor man, that is trying to figure out how to participate in the merit/performance standards.  The people from CMS are trying their best and they did direct the doctor to a good contact point at CMS, good stuff.

Obamacare vs Trumpcare – Who are the Players to Perform this Surgery?

Who are the players that will take on the change from Obamacare to Trumpcare?  Before is an outline of all the players that come to mind.  In some cases there is a short description.

When there are other players that need to be added this blog will be revised.  If new people enter the picture we’ll try to add those individuals.

The Governments

Federal Government

The Executive Branch

The President – Donald J Trump    President Trump

Yes, we start off with Trump, he’s had other matter on his plate for the first couple of weeks but its still a major item on his plate.

HHS – Secretary Tom Price   Secretary Tom Price

Before he was a Congressman he was a successful orthopedic surgeon for many years.  As a Congressional Representative from Georgia he was Pro-Life, Pro Gun, classic Southern Conservative.

We’ll do a separate blog post on the Secretary Price and he past legislative efforts involving healthcare, like Empowering Patients First Act.

If Dr. Ben Carson become Secretary of HUD we’ll have two Doctors in the Trump cabinet, that’s interesting.

Centers of Medicare and Medicaid Services (CMS)     question head of CMS

This is the agency that gets doctors paid for Medicare and Medicaid.  The present administrator is the acting head.

Elected vs Not Elected Officials

Really, Elected Appointees come and go but the bureaucrats are there until they retire. Who is in charge of CMS on a day-to-day basis will have a lot to do with when and how doctors are going to get paid.  This is especially true of the next year of two.

The Legislative Branch

The Senate

Majority Leader McConnell   

So the Senator worked the Senate parliamentary procedure to cut off the filibuster by the Democrats so Obamacare can be repealed.  That’s only the procedure, not the actual act of taking the funds away.  But again that was almost a month ago.

Chairman Lamar    Lamar Adexander

We’ve already mentioned that Senator Lamar Alexander has his toe in the water when it comes to Obamacare.  He wants to adjust it, not throw it away.

The House

Speaker Ryan    Speaker Paul Ryan
Speaker Ryan’s plan is called The Patients’ Choice Act, which is designed to ensures universal, affordable health care for all Americans. “Under The Patients’ Choice Act, patients and doctors would control their health care decisions – not insurance companies and federal government bureaucrats”, so says the Speaker.  But this is from 2009,
Chairman ???

The are a number of committees that have their hand in the Obamacare pie on the House.  Plus the committees are larger and/or more specialized.

But there’s a lot more concern at the House level about a radical repeat of the law.  Here’s another Congressman’s quote:

“I’m much more concerned about the content than the timing,” said Rep. Tom MacArthur (R-N.J.), a former insurance executive who voted no

State Governments

Important to realize that the States have as much to do with the major health programs.  Sometimes these programs have serious cross-talk with the carriers.  For example Blue Cross/Blue Shield is the prime contractor in New York State for Medicare/Medicaid.

Of course there’s the fact that many of Governors opted out of the ACA and how that reduced the pool of people that could have added critical mass to the number of the insured

K Street – The Lobbyists

There are lobbyists for the Insurance Carriers, Pharmaceuticals, Device Manufacturers just waiting in the wing to craft the actual legislation that is created.

It these special interest groups that tend to write the initial draft of most bills, not Congressional staff. 

The Public

Seniors/AARP         AARP logo

Look the subject line from the email I JUST GOT:

Jxxxxx, Join the Fight: Tell Congress to Protect Medicare

Need we say more; Seniors are going to be looking over any changes that are made to the healthcare system.  Seniors did vote for President Trump but they are very suspicious of both Democrats and Republicans

The Doctors

Can the new administration make things any easier for physicians, in particular small practices.  Is it even possible for the small practice to continue to thrive?


There are 100’s of associations for physicians to work with but the AMA is the biggest by far.  They will be working with and sometime working against the insurance companies.


As long as the healthcare system is centered on Employers it will favor large companies and make it difficult for people to switch job.  Taking your healthcare insurance with you is becoming more and more of an issue as freelancing becomes the norm in the economy.

Is the best that we can do in this economy is COBRA insurance?

Do most people remember that we ended up with an employer based healthcare system by mistake?  It is a remnant of 1930’s depression based marketing and then workforce shortages sealing the deal during  WWII.

But if its a bad habit its one that’s going to be hard to break.

The Media

Is the media capable of covering healthcare?  Will we end up with with another round of Death Panels or/and misstatements like You can keep your doctor.  Or on the other end that Medicare will cause the US to become a socialist dictatorship? 

Can the healthcare’s own trade press add to the discussion or the confusion.

Who are the Players – The Ones that Really Count

It’s the Insurance and Pharmaceutical Companies that are the gatekeepers when you objectively look at the chess board.


This post will be revised as more player fall in place.  Unlike a game of chess new players often come into the picture, and old players fall away.


Obamacare will Stay in Place Till 2018 – Trump on Fox News

Just before the Superbowl President Trump was interviewed on Fox News with Bill O’Reilly POTUS said that the change to Trumpcare was going to take some time, unlike the message telegraphed at the start of January.  Bottom line, Obamacare will stay in place, that there are members of both the Senate and the House of Representatives that know its unrealistic to change things any quicker that that. Here is the quote from the interview on Sunday January 5, 2017:

O’Reilly: “Can Americans in 2017 expect a new health care plan rolled out by the Trump administration this year?”

POTUS: “Yes, in the process and maybe it’ll take till sometime into next year but we’re certainly going to be in the process,” Trump said.

POTUS: “(It’s) very complicated — Obamacare is a disaster. You have to remember, Obamacare doesn’t work so we are putting in a wonderful plan,” he said. “It statutorily takes a while to get. We’re going to be putting it in fairly soon, I think that — yes, I would like to say by the end of the year at least the rudiments but we should have something within the year and the following year.”

First, I didn’t know that statutorily was a real word.  Thank you Mr. President for the new vocabulary word.

Obamacare vs Trumpcare

Obamacare in 2017 – Trumpcare in 2018 – Or Later?

Why don’t well look at the where the nomination for HHS Secretary stands, the full vote for Representative Tom Price for his confirmation at best will happen later this month (2/17). Plus I count at least 10 Assistance Secretaries in the Congressional Research Service Presidential Appointee Booklet.

The Insurers Say 2018

According to Bloomberg’ s Insurance Journal the insurance companies are asking for guidelines for 2018. They need to have plans in place for the public to be able purchase these plans.

Aetna said, in a conference call, it won’t start selling Obamacare plans again in the states where it has pulled out. “Further, there’s not enough time to develop plans and prices for new markets before next year … There is no possible way we’ll be prepared to do that, given the unclear nature of where regulation’s headed,” Chief Executive Officer Mark Bertolini said.

“The amount of uncertainty right now is quite problematic,” said Karen Ignagni, CEO of  EmblemHealth, a nonprofit insurer in New York. “There’s a lot of chatter, but there’s not a lot we know.”

All the Players

I will continue to react to the blow-by-blows but in the next couple of posts I hope to layout an understanding of all the players in this wonderful space: Executive, Legislative, Judaical , Private, Physicians, Associations … just to name a few … stay tune.

Look Out Obamacare, Here Comes Lamarcare, The Chairman Steps In

Seem that a certain senior Senator from Tennessee Republican,  Lamar Alexander, has a different take on getting rid of Obamacare. According to the NY Times the Senator wants to modify the Obamacare instead of wiping it of the face of the earth, like most of the members of the Freedom Caucus  want to do. The Senator has his own version planned, Lamarcare instead of Trumpcare.

Lamar Adexander

Seems the Senator want to take the go slow approach to the issue.  Here’s a great quote right from his website:

“If your local bridge were ‘very near collapse,’ the first thing you would do is send in a rescue crew to repair it temporarily so no one else is hurt. Then you would build a better bridge, or more accurately, many bridges… and as they are finished, you would close the old bridge.”

The most important thing about the Senator is that he the chairmen of the Senate Health Committee.  Being the chairmen of a Senate committee reminds me of the joke about the different parts of the body arguing about who is in charge.  If you don’t know the joke go ask someone.  But what it means is that he’s the gatekeeper of anything that the Trump Administration wants to do about healthcare.

On the side of movement The Senate Finance Committee approved Representative Tom Price as HHS secretary without and votes from the Democrats.

Now that  Rep. Price as advanced from the Committee a vote by the full Senate is next.  BUT, at that point we will have upper management for HHS is place.  I think the next big question in terms of getting your bills paid by Medicare and Medicaid will be who will be the head of the Centers for Medicare & Medicaid Services (CMS).

I also believe that Speaker Ryan said at his press conference on Feb. 2 that he expected to have a bill in place to replace Obamacare but not till next month.

Here’s an update this to post with quoting The Speaker who leaves the question of when much more open ended:

“The question there is: How long will it take for markets to be put in place, for markets to adjust?” Mr. Ryan told reporters on Jan. 5. “That question we don’t know the answer to.”

The general feeling by many on the Hill is that the President’s first two weeks didn’t go all that well and this has put Healthcare further back in the queue.


Trump Declares Obamacare DOA – Not So Fast Say the GOP

The Republican House has spend the last 6 years trying to repeal Obamacare, the Affordable Care Act.  They tried between 30 to 60 times depending on who’s counting.  Guess what the Grand Old Party was able to move that rubber tree plant in the last election.  The Republican got control of the White House, the Senate and the House of Representatives.

So we have Trump issuing an executive order to cease and desist all matter having to do with Obamacare.  Sorry, for all the initial analysis its a nothing burger.

Whatever is pronounced by this administration give it at least a week to let it settle in. See more about the Republican retreat described below.

Here are Some Obamacare to Trumpcare Factoids

  • OK Obamacare to Trumpcare is like getting a super tanker to do 180 degree turn.  It will take time, more like a year or two, lord willing and creek don’t rise.  I think the Washington Post has a good Q&A for consumers.  More difficult for docs.
  • Let’s talk about the 2nd biggest factor with the move from Obamacare to Trumpcare, litigation.  Just moments ago a judge overturned one of the executive orders related to immigration, the administration isn’t two weeks into its term.  Don’t like how high your malpractices insurance is costing?  Washington is a town of
  • 18 million individuals would lose their insurance according to the Congressional Budget Office. It’s potential that insurance companies get skittish and will examine the language of the order, next year, setting off a marketplace fall.
  • That number could go as high as 52 million if preexisting conditions aren’t dealt with.  But that’s 1 in 4 of every American. Yes, Trump said that was going to be kept in Trumpcare.  But that’s an offly large spread
  • The individual mandate might have important effects for the individual insurance markets. If fewer healthy individuals purchase insurance many leading insurance companies may get out of the marketplace.
  • Will the Trump administration be will to extent Medicaid.  Does he really want to provide healthcare for the 10 million people that didn’t get covered by Obamacare.  Will this be relegated to the States, including coverage if you’re doing some kind of work or training?
  • Personnel at HHS/CMS they are still heading down that road to more regulation.  They can’t help themselves, making policy for HHS is like a drug addiction.  Never underestimate the power of a non-appointed government employee to do their own thing.

This isn’t a complete list by any means, will most likely revise over time.

Republican Retreat – No Kidding

Someone turned mole during the Republican Retreat in Philadelphia this week.  During the meeting they secretly recorded the whole session and feed to the Washington Post, nice scoop.

I am just to start with quotes from Representative and Senators:

“Our goal, in my opinion, should be not a quick fix. We can do it rapidly — but not a quick fix … We want a long-term solution that lowers costs.” Sen. Lamar Alexander (R-Tenn.)

Talking about need 1/2 trillion dollar over ten year to transition to Trumpcare

“This is going to be what we’ll need to be able to move to that transition,” Sen. Rob Portman (R-Ohio)

Middle class family can’t afford to prepay plans that call for a tax refund

De-funding Planned Parenthood when you’re revising the AHA

“We are just walking into a gigantic political trap if we go down this path of sticking Planned Parenthood in the health insurance bill … If you want to do it somewhere else, I have no problem, but I think we are creating a political minefield for ourselves — House and Senate.” Rep. John Faso (R-N.Y.)

So, not bad for less than two weeks work.

On the positive side you can see that a number of Republicans are being a lot more realistic about changing Obamacare.  Let’s hope the Congressional leadership takes this all into account as they do move forward.