HR3200 : Division A : Day Two, Part Two

So far, in my previous three posts, we have learned that President Obama and Congress are planning to create government based health care plans and at least two new “high profile” jobs, including a new health care “Commissioner” and a Qualified Health Benefits Plan Ombudsman.

We’ve also learned that someone is lying to us when it comes to keeping our existing health plans, and the cost of covering the main illness of 0.9% of the population will cost approximately $72 billion per year.

Subtitle F refers to numerous additional requirements, like coverage not offered through the health care “exchange”, coverage that is offered through the exchange, and the prohibition of discrimination in health care. Section 152 states,

Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

Coverage offered by HR 3200 shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services?

If I read this correctly then am I to believe that health care coverage and related services will be provided to anyone no matter what other facts we may know about that person as long as those facts have nothing to do with the health care or the services being offered?

Exactly who would this cover? If this health plan is for all Americans, what other people would there be to consider, other than illegal immigrants? Does this mean we, as citizens, will be paying for the health care of illegal immigrants? Wait, don’t we already do that?

After this carefully crafted paragraph that increases our debt load by providing free health care to approximately 20 million more people, the bill goes on to protect whistle-blowers, collective bargaining, and severability. In Subtitle G, Section 161 amends Title XXVII of the Public Health Service Act to establish the enforcement of rebates to enrollees (which we have already discussed),

Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.

Section 163 pertains to administrative simplification. Has anything in government ever been simple? Pay attention to this section though, it provides authorization for the government to obtain real-time access to your financial information as well as the creation of a national health care ID card.

Goals for financial and administrative transactions.—The goals for standards under paragraph (1) are that such standards shall—

“(A) be unique with no conflicting or redundant standards;

“(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;

“(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;

“(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

“(E) enable, where feasible, near real-time adjudication of claims;

“(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;

“(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and

“(H) harmonize all common data elements across administrative and clinical transaction standards.

So, up to this point (page 58) we have also learned that the government will have the right to audit the books of any company that self-insures their employees, and the government will have real-time access to all of our financial as well as medical information, to be reviewed, before you are provided service.

There is good news, however. While they are reviewing your finances before providing service, they will be authorized to debit your account on the spot to pay for that service.

Requirements for specific standards.—The standards under this section shall be developed, adopted and enforced so as to—

“(A) clarify, refine, complete, and expand, as needed, the standards required under section 1173;

“(B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version;

“(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;

“(D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing;

“(E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; and

“(F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.

Not only will they be performing surgery that could save your life, but it looks like they’ll be surgically removing money from your bank account at the same time.

Why would they need to determine your financial responsibility before they saved your life? Are they insinuating that, based on your finances, your life might not be worth saving? Wow. That’s a bit archaic isn’t it?

You really need to re-read this section, the entire section. It gives the government far too much power, for a level of service you already receive right now. The only difference is that right now, if something happened and you were rushed to the emergency room, they would save your life first, without looking at your bank account.

Don’t forget, the whole idea of a nationalized health care program wouldn’t be complete if the government didn’t store all the data it collects from doctors, hospitals, banks, and other health and financial institutions.

The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are—

“(1) used and disclosed in a manner that meets the HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), including any privacy or security standard adopted under section 3004 of such Act; and

“(2) protected from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.”.

We all know how safe government controlled data is, right? We have no reason to suspect that anyone would ever attempt to access that data through “inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses

Imagine the data they will be keeping. How much money are you making? How much money do you have left after you pay your bills? How much money do you spend on items that might have an adverse affect on your health (cigarettes, alcohol, fatty foods, soft drinks)? What kind of lifestyle do you lead? Do you have guns in the house? Are you active in your community? Do you go to church each Sunday? Do you live an alternative lifestyle?

All of this information will be kept by the government for use at their disposal. Just imagine the possible ramifications. How long will it be until they start denying claims for lung cancer because people smoked and knew better? Do you honestly think they will cover HIV medication for gay people that never spent a dime on protection? I’m serious. What do they plan to do with the information they collect and just how much information are they planning to collect?

They’ve already made it clear how far they plan to intrude into our lives, why should a silly little thing like privacy matter when America’s Affordable Health Choices Act of 2009 could mean so much to so many people?

You pay the government a huge increase in taxes, you give the government access to your medical records, you give the government access to your bank account, and you give the government the right to store all of your personal data in an easily accessed (real-time) database. For all that, you receive health care that is decided by a “Commissioner”, overseen by an Ombudsman, and paid for by your freedom. It’s worth the trade isn’t it?

If you’re planning on retiring anytime soon, you may want to read Section 164. Tomorrow we will pick up again at page 72, which is the beginning of Division A, Title II, the Health Insurance Exchange and Related Provisions.

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