HR3200 : Division B : Day Three : Part One

I hate to say I told you so, but I told you so.

It seems people are finally waking up and reading the health care bill. Some of those people include journalists like David S. Hilzenrath at the Washington Post. David has been reading the bill. He’s paying attention like everyone should be and the best part? He’s reporting what he reads. It’s about time.

David writes,

President Obama promises that, if health-care reform is enacted, people will be able to keep their current coverage.

“I keep on saying this but somehow folks aren’t listening: If you like your health-care plan, you keep your health-care plan. Nobody is going to force you to leave your health-care plan,” he said Saturday in a town hall meeting in Grand Junction, Colo., much as he said Friday in Belgrade, Mont., and earlier in the week in Portsmouth, N.H.

However, under legislation drafted by House and Senate Democrats, that would not necessarily be true.

Under the House legislation, many companies eventually would have to comply with new requirements for minimum benefits, meaning that if they did not already meet the standard they would have to upgrade their insurance.

Nonetheless, in his effort to allay fears about health reform, Obama has continued to make his promise.

Obama’s promise is not just at odds with legislative proposals — it is also at odds with reality. Under the current system, employers can drop coverage, alter benefit packages and switch insurers. In addition, as the president has noted, people who lose or leave their jobs can lose their health plans; that is one of the fundamental problems the legislative proposals address and one of the main arguments for reform.

But in the campaign to overhaul health care, Obama’s promise may serve to reassure people anxious about change. As he said at a news conference on July 22, people may favor the devil they know over the devil they don’t.

Now that people are waking up, and writers like David S. Hilzenrath are telling people what is really happening, maybe President Obama will get a “reality check” from the citizens of this great nation. (Hat tip to Vinny for the heads up on this article).

Section 1181 of Division B eliminates the coverage gap in Medicare Part D. It doesn’t close the gap completely, right away, but slowly closes the gap over a period of years. Section 1181 offers discounts for certain Part D drugs. The funding for closing these gaps will be provided with a “drug rebate agreement” from the drug companies. These rebates are basically taxes that will be imposed on the drug companies.

A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period. Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D–12(b)(7), including as such section is applied under section 1857(f)(3).

The next several pages discuss the varying amount of these rebates, exemptions, qualifications, and all that mess.

Subtitle F, Section 1191 creates yet another government entity. This time, it’s in the form of the “Telehealth Advisory Committee”.

The Secretary shall appoint a Telehealth Advisory Committee (in this subsection referred to as the ‘Advisory Committee’) to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services as established under section 1834(m), including the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such section and for authorized payment under paragraph (1) of such section.

What exaclty does “telehealth” work anyway? What kind of services do you offer through “telehealth”? Will some people be diagnosed over the phone in an attempt to keep them from showing up at the emergency room or doctor’s offices?

Title II, Subtitle A, Section 1201 resets the “assets test” for the low-income subsidy program.

“(III) for 2012, $17,000 (or $34,000 in the case of the combined value of the individual’s assets or resources and the assets or resources of the individual’s spouse); and

“(IV) for a subsequent year, the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.”

If your assets are valued more than the amounts shown above, then you will not be considered low-income even if you are not making any income. Interesting huh? You cannot be considered low-income if you own anything of value. Of course, once you sell it all to pay for your care, or you turn over your assets to Big Brother, then you’ll be considered low-income and qualified for additional help.

I thought this bill was all about picking people up and helping them? This bill may make people think they won’t lose everything, but the truth is, it looks like it’s just going to be spread over a longer amount of time. Don’t fret for grandma though, because the government is also going to put measures in place to guarantee that every Medicare eligible person has the same opportunity to be included in this wonderful program with “intelligent assignment in enrollment” written into Section 1205.

or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary.

Section 1206 modifies Section 1860D of the Social Security Act for the “special enrollment period”, by adding,

In the case of an individual (as determined by the Secretary) who is determined under subparagraph (B) of section 1860D–14(a)(3) to be a subsidy eligible individual.

and the “automatic enrollment” section, to state,

The process established under subparagraph (A) shall include, in the case of an individual described in section 1860D–1(b)(3)(D) who fails to enroll in a prescription drug plan or an MA–PD plan during the special enrollment established under such section applicable to such individual, the application of the assignment process described in subparagraph (C) to such individual in the same manner as such assignment process applies to a part D eligible individual described in such subparagraph (C). Nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate by the Secretary (or in the program under this part) or from changing such enrollment.

Not only will the Secretary of Health and Human Services be allowed to automatically enroll people under Medicare Part D, but he/she will also have the authority to prevent you from changing that enrollment. Re-read that section again if you don’t believe me. Government forced health care at its finest.

In an effort to ensure effective communication in Medicare, Title II, Subtitle B, Section 1221 exempts the government from the Paperwork Reduction Act.

Chapter 35 of title 44, United States Code (commonly known as the “Paperwork Reduction Act”), shall not apply for purposes of carrying out this subsection.

Keep reading this section as well as the next several pages, because the government is also going to require language translation (at our expense) and those companies with “limited English proficiency” will not have to pay cost-sharing or co-pays for language services.

Limited English proficient Medicare beneficiaries shall not have to pay cost-sharing or co-pays for language services provided through this demonstration program.

That’s right. The only companies that will be required to “subsidize” (pay taxes to support) the “language services” will be those who do not need to utilize them. It wouldn’t be the first time that the government taxes one group of people to pay for the services provided to another group of people.

Now I come to the section that many politicians are claiming never existed in the bill. Under Title II, Subtitle C, Miscellaneous Improvements, Section 1233 provides for “advanced care planning consultations”. These consultations will include (please take the time to read this),

“(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

“(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

“(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

“(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

“(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

“(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

“(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

“(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

“(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

“(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—

“(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

“(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

“(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

“(I) ensures such orders are standardized and uniquely identifiable throughout the State;

“(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

“(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

“(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

It sure sounds like an awful lot of “end of life” talk to me. If you are elderly, or close enough to death’s door that the government sees fit, you will be subject to one of these advanced care planning consultations and you will be subject to these “consultations” at the discretion of your health care practitioner (aka doctor, nurse, or physician’s assistant).

An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

In other words, your health care practitioner will be allowed to hound you and hound you to make the decision they want you to choose. How many people have time to focus on a fight over end of life care when they are literally fighting for their lives? Yeah, it’s a bit of an oxymoron isn’t it?

The level of treatment provided (covered) by the health care bill may vary slightly based on your condition.

The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions.

You may receive full treatment, or, if it looks like your days or numbered (aka it’s going to be a waste of money to treat you) you may receive none of the specified interventions. Remember, your family will not be making this decision for you. You will be “consulted” by your health care practitioner while you are fighting to stay alive, and that health care practitioner will be allowed to “sign off” on your decision, whether anyone knows if you were truly capable of making it.

The media has attacked Sarah Palin for her “death panel” statement, which you can read on her Facebook account.

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

She was right. The bill did address this issue, and it did state exactly what she said it did.

Take a few hours to digest this part of the bill which many politicians claim was never included in the bill. I don’t know how you remove something that was never there, but they claim it has now been removed. There is no guarantee, however, that it will not be added back into the bill by amendment or other last minute maneuvering by the House and/or Senate.

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