HR3200 : Division A : Day Three : Part Two

We have a lot more to cover, so let’s continue.

Section 221 establishes the “public health insurance option” even though pretty much 99% of what we’ve read so far can be interpreted as “public option”.

For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the “public health insurance option”) that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary’s primary responsibility is to create a low-cost plan without compromising quality or access to care.

Not only will the Secretary of Health and Human Services create another health benefits plan, but they will also work to make sure that choice, competition and stability of affordable, high quality coverage is provided. I’m a little leery of this section. How do you ensure that prices stay affordable if you don’t set fixed prices for everyone across the board? Am I missing something?

The Secretary of Health and Human Services will create yet another position, the office of the “Ombudsman for the Public Health Insurance Option. Great, now we have two ombudsman and 95% of the people have no idea what an Ombudsman is, let alone what he/she will actually be doing to help reduce costs. Am I wrong to presume that costs will go down with this plan? It is called “America’s Affordable Health Choices Act of 2009” after all.

At this point we have an interesting item for you to take note of.

The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner—

(A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and

(B) at a level sufficient to fully finance the costs of—

(i) health benefits provided by the public health insurance option; and

(ii) administrative costs related to operating the public health insurance option.

The Secretary of Health and Human Services will be setting different premium rates for the “public option” based on your geographic location. Does it matter if you live in New York, Mississippi, Oklahoma, South Dakota, Utah, or Alaska? Shouldn’t health care cost the same across the board for everyone under the public plan? Do they plan on paying doctors in New York more than the doctors in Oklahoma? Sure, some places have a higher cost of living, but amputating a leg should cost the same amount no matter where you live.

Speaking of legs being amputated, did you see this statement from the American College of Surgeons?

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.

Of course, President Obama could have made an honest mistake and mispoke, like his predecessor, but he really should check his facts before opening his mouth at these events. He wouldn’t want to mislead people about the facts about health care in our country.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

Now, back to the health care “reform” bill.

Section 223 sets the payment rates for items and services. Ah Hah! I knew it. I knew they were going to be setting rates and fixing prices. They have to. There is no other way they can guarantee “affordable coverage” if they don’t fix prices. How do you think the private companies will feel about price fixing? You remember the private companies don’t you? They’re the entities that you’ll allegedly be able to keep your plans with, although the wording of this bill proves otherwise.

At least the companies involved have a way out if the government begins to set prices too low where it starts to interfere with their bottom line.

There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

Oops, my bad. It looks like the companies participating in the plan will not have the option of suing the government for price fixing. No judicial review means no court proceedings. Sorry guys, I guess you’ll have to take what the government gives you.

Not only can they fix the price where they want it, but Section 224 says they can do so without sufficient reason or explanation also.

Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas.

Section 225 doesn’t get any better, as they set the rate at which physicians can be paid.

Physicians.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes:

(A) Preferred physicians.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.

(B) Participating, non-preferred physicians.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.

Let’s review… The Secretary of Health and Human Services will create yet another Ombudsman position, set the rates for the public option, fix the prices for services under the public option, and set the rate for which physicians are paid under that option. Wow. So enticing. I bet you want to be a doctor now just so you can discover the joy of a colorectal exam. Receiving one, silly. The way things are going, physicians will experience pretty much the same thing when they participate in the public health plan option.

Subtitle C, Section 241 begins by re-assuring us that the public health plan option will be subsidized by the government (just like Medicaid), which of course can be directly translated to mean “subsidized by your tax dollars” in the form of “affordability credits”. The money has to come from somewhere people, and it isn’t like it’s going to start raining money all of a sudden. Unless of course, President Obama gets his giant weather generator working behind that big old curtain of his.

Sections 242, 243, 244, and 245 all define the affordability credits, premium credits, cost-sharing credits, and income determinations. Make sure you go back and read section 243, it sets the premium percentage based on your income above the Federal Poverty Level. If you make more, you pay more. No wonder liberals love this bill. It’s beginning to look like this “reform” bill will simply charge more money (percentage wise) to those who make more money, and in return, re-distribute the wealth, so to speak. Wait, isn’t that one of the key pieces of socialism?

Section 246 states,

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

Well, of course the government won’t give illegal immigrants any affordability credits, if you remember correctly, Section 152 said that services shall be provided “without regard to personal characteristics extraneous to the provision of high quality health care or related services. If they aren’t denied service, and they are not paying, there would be no reason to give them an affordability credit, would there?

Title III, Subtitle A, Section 301 defines individual responsibility. Here is the entire section of individual responsibility:

For an individual’s responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 401 of this Act).

It seems your only responsibility as an individual will be paying taxes. All Hail Socialism! Now shut up and pay your taxes you dolt.

Title III, Subtitle B, Sections 311, 312, 313, and 314 define employer responsibility.

These sections span eight and a half pages and require the employer to offer coverage to all employees. In addition to full-time employees, employers will also be required to contribute for part-time employees as well.

Minimum employer contribution for employees other than full-time employees.—In the case of coverage for an employee who is not a full-time employee, the amount of the minimum employer contribution under this subsection shall be a proportion (as determined in accordance with rules of the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable) of the minimum employer contribution under this subsection with respect to a full-time employee that reflects the proportion of—

(A) the average weekly hours of employment of the employee by the employer, to

(B) the minimum weekly hours specified by the Commissioner for an employee to be a full-time employee.

I wonder how fast the food will be at places like McDonald’s when they refuse to hire so many part timers because of the insurance costs. What’s the quality of service going to be like in any business, when companies are forced to make contributions for all of their part-timers. Something tells me that part-time jobs will become harder and harder to find.

Employers will not be allowed to “share” the cost of the health care plan contribution with the employee by taking his/her share out of their paycheck.

For purposes of this section, any contribution on behalf of an employee with respect to which there is a corresponding reduction in the compensation of the employee shall not be treated as an amount paid by the employer.

Any employer who chooses not to provide coverage through the public option will pay an additional tax on all payroll. Section 313 sets that rate to be 8% if the company payroll is over $400,000, 6% if it’s between $350,000 and $400,000, 4% if it’s between $300,000 and $350,000, and 2% if it is between $250,000 and $300,000. There will be no additional payroll tax for companies paying less than $250,000 per year in payroll. Something tells me a lot of smaller companies are going to be cutting salaries if this bill passes.

The next several pages and sections describe the satisfaction of health coverage participation requirements, as well as the rules for applying requirements. If you feel like reading about 14 pages of blah blah blah, feel free to go back and read it. For the sake of making it through the bill before Congress comes back from recess, I am going to move forward.

Title IV, Subtitle A, Section 401 imposes an additional tax on all individuals without “acceptable” coverage. This section amends the Internal Revenue Code of 1986, and does not define who will decide, nor how they will decide what is “acceptable” coverage. We should presume the requirements are the same as we have read in the prior 166 pages of the bill.

The additional tax to be imposed on the individual without acceptable coverage will be 2.5%.

In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—

“(1) the taxpayer’s modified adjusted gross income for the taxable year, over

“(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

Section 401 also states that

The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.

Basically, if you have unacceptable coverage, the government is going to tax you the amount of coverage up to the national average premium (remember the rates are set geographically so you could end up paying more than your neighbors). This means whether or not you want health care, whether or not you have coverage, you are going to pay for “acceptable” health care up to and including the national average premium, unless of course you’re Non-Resident alien.

Section 401 exempts nonresident aliens from the additional tax.

Subsection (a) shall not apply to any individual who is a nonresident alien.

Nonresident aliens can live here, work here, earn money here, and get medical treatment here. We are not allowed, however, to charge them an additional tax if they do not carry acceptable health care coverage. That sounds fair, right?

By the way, if you read Section 401, you’ll find that those who have religious conscience objections are also exempt from the additional “unacceptable coverage” tax. Again, that’s fair, right?

Acceptable coverage will be defined as,

Acceptable coverage.—For purposes of this section, the term ?acceptable coverage’ means any of the following:

“(A) Qualified health benefits plan coverage.—Coverage under a qualified health benefits plan (as defined in section 100(c) of the America’s Affordable Health Choices Act of 2009).

“(B) Grandfathered health insurance coverage; coverage under grandfathered employment-based health plan.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America’s Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).

“(C) Medicare.—Coverage under part A of title XVIII of the Social Security Act.

“(D) Medicaid.—Coverage for medical assistance under title XIX of the Social Security Act.

“(E) Members of the Armed Forces and dependents (including TRICARE).—Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

“(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran’s Affairs and the Health Choices Commissioner, based on the individual’s priority for services as provided under section 1705(a) of such title.

“(G) Other coverage.—Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.

I almost made it to page 200, but I realized this post was getting quite long, and I didn’t intend for it to be so long. I’ll leave it here for this evening and we’ll pick up tomorrow at the top of page 179, Section 411.