HR3200 : Division B : Day Two

There’s a lot of hubbub out there today about the possibility of the “public option” being dropped from the bill. Don’t believe it for a moment. It’s only a ruse to see how people react to that possibility, so they can fine tune their message and try to win support of the bill.

As we have learned in the nearly 300 pages we have covered, the public option is so ingrained into each subtitle and each section, that removing the “public option” would totally re-define the entire bill.

President Obama has made it clear in the past that he supports a single payer system. Then he said he didn’t support it. Is Waffle 101 required before any candidate can run for office?

Anyway, let’s get on with the bill…

Section 1152 “reforms” the payments for post acute care services. This includes skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies.

For purposes of this section, the term “post acute services” means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from a hospital, and such other services determined appropriate by the Secretary.

You see, every payment from the government is being modified. They could have saved 500 pages by stating that everything is changing, it’s not just “reform”.

Payments are not the only thing being modified either. The administration of this section states,

Chapter 35 of title 44, United States Code shall not apply to this section.

Chapter 35 of Title 44 of the U.S. Code makes a few assurances, one of which is to,

ensure that the creation, collection, maintenance, use, dissemination, and disposition of information by or for the Federal Government is consistent with applicable laws, including laws relating to—
(A) privacy and confidentiality, including section 552a of title 5;
(B) security of information, including section 11332 of title 40 [1] ; and
(C) access to information, including section 552 of title 5;

In other words, this bill allows the government to use the data they collect any way they see fit, even if it violates privacy and other laws, because those laws will not apply to this section of the bill. In other words, they can do whatever they want with your data.

In Section 1156 we learn that entities will be required to disclose the entity’s ownership, investments, and compensation arrangements.

Each entity providing covered items or services for which payment may be made under this title shall provide the Secretary with the information concerning the entity’s ownership, investment, and compensation arrangements, including—

“(A) the covered items and services provided by the entity, and

“(B) the names and unique physician identification numbers of all physicians with an ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity.

Does it matter how much of a partnership a physician owns? Only when we factor in socialism. It matters a lot. You see, once this bill becomes law, a physician will not be allowed to increase his/her stake in that entity.

The percentage of the total value of the ownership or investment interests held in the hospital, or in an entity whose assets include the hospital, by physician owners or investors in the aggregate does not exceed such percentage as of the date of enactment of this subsection.

Prohibition of ownership, and the right to invest your money independently is another sign of socialism. Why should we allow the government to tell doctors what they can own and how much they can own?

It doesn’t stop there. Hospitals are going to have to jump through hoops to expand as well.

Except as provided in paragraph (2), the number of operating rooms, procedure rooms, or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms, procedure rooms, or beds, respectively, as of such date.

Let’s see. The government is going to set the price of the service you receive, set the rate that the doctor can be paid for performing that service, and penalize those who produce too many “readmissions”, and on top of all that, hospitals will not be allowed to expand. The result of these actions can be defined in one word. RATIONING.

If you go to the hospital and you’re lucky enough to get in, you’ll have to wait while to government checks your financial ability to pay the bill, then they will treat you. Once you have been treated you will be sent home, and if by chance you get sick again (from the same type of diagnosis) you cannot be re-admitted within 30 days. That is, if the hospital that isn’t allowed to expand has room for you, and the physician that might treat you hasn’t had too many re-admissions already.

If a hospital wants to expand, they must seek community input first.

The process under clause (i) shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application.

I wonder which “community organizations” will be allowed to provide input. (cough)ACORN perhaps?(cough)

At this point I am going to skip ahead to page 331, Subtitle D, Part 1, Section 1161, Medicare Advantage Reforms. It appears that the government will have the authority to remove competing options based on “identified deficiencies”. When this occurs, anyone enrolling in those deficient plans will be enrolled into the government plan.

In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.

Something tells me we’re going to see an awful lot of “deficient” companies out there.

Again, in the interest of time, I am skipping ahead again. If you want to read Part 2, about beneficiary protections and such, feel free, but I am moving forward to Subtitle D, Part 3, Section 1176, Treatment of Special Needs Plans.

Section 1176 restricts when a person of special needs may be enrolled into any of the chronic care specialized MA plans for special needs individuals.

The plan does not enroll an individual on or after January 1, 2011, other than during an annual, coordinated open enrollment period or when at the time of the diagnosis of the disease or condition that qualifies the individual as an individual described in subsection (b)(6)(B)(iii).”.

There will be no modifying coverage, changing plans, or other enrollment actions except once per year or at the time of initial diagnosis. What happens to the special needs individual who has several health issues that alter their diagnosis several times each year?

While Section 1176 limits when a person may be enrolled in a special needs plan, Section 1177 allows the Secretary of Health and Human Services to further restrict enrollment under the special needs plans. (Why does that word “rationing” keep repeating itself in my mind?)

I’ve already learned that thanks to the “readmission” penalties, someone like my sister-in-law April could very well die if this bill is passed.

She suffers from chronic seizures and has had her share of medical situations in the past. In the past she has been admitted when her meds were not working properly, given a high does of some other medication, and then released, only to be brought back soon after because of the fluctuation of the medications.

With the “readmission” penalty doctors would face, it’s unlikely she would be re-admitted in a timely manner and receive the care she needs just to survive. This doesn’t even take into account the fact that her “special needs plan” would be locked in for a whole year whether or not she was having some other issues which required modifying said plan.

Anyone with a family member with special needs should pay attention to these sections. They are going to change (or end) lives.

Tomorrow we’ll pick up with Division B, Subtitle E, Improvements to Medicare Part D on page 355. Yes, tomorrow we’re talking drugs and the fact it’s actually going to be harder to obtain them.

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