HR3200 : Division B : Day Five : Part Two

This evening we begin with Division B, Title VII (Medicaid and CHIP), Subtitle A (Medicaid and Health Reform), Section 1701, “Eligibility for individuals with income below 133 1/3 percent of the federal poverty level”.

Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i) is amended—

(A) by striking “or” at the end of subclause (VI);

(B) by adding “or” at the end of subclause (VII); and

(C) by adding at the end the following new subclause:

“(VIII) who are under 65 years of age, who are not described in a previous subclause of this clause, and who are in families whose income (determined using methodologies and procedures specified by the Secretary in consultation with the Health Choices Commissioner) does not exceed 1331/3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;”.

According to the Department of Health and Human Services, the poverty rate for a family of five (like mine) is $25,790. Using the brilliant calculation above we know that I could make as much as (but not more than) $34,385.80 and still qualify for Medicaid. We all know what happens to those people who make $34,385.81 or more, don’t we? Yes, they fall through the cracks just like they do now!

Remember, this plan is about health care for everyone. Everyone who can be covered by existing plans (which will be phased out), everyone who can choose to be covered through the public plan through their employer, and everyone who can pay an additional 2.5% tax on their income to pay for the public plan on their own. But not everyone, really. Get real people.

If they are mandating a minimum income to “qualify” for low-income Medicare, someone has to draw the line somewhere and I can guarantee you that the “we cover everyone” line is nowhere near the low-income line when they are drawn.

Let’s read on to see what happens to those people who fall into the “gap”.

The first thing we learn is that States may not add someone to the managed care entity unless the entity has the capacity to meet all of the needs of that person being added.

A State may not require under paragraph (1) the enrollment in a managed care entity of an individual described in section 1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the satisfaction of the Secretary, that the entity, through its provider network and other arrangements, has the capacity to meet the health, mental health, and substance abuse needs of such individuals.”

How many health care plans do you know of, right now, that have the capacity to meet the health, mental health, and substance abuse needs of every person enrolled under that plan?

Sure. Uh-huh. What if everyone on that plan goes loopy tomorrow, do they still have that capacity? This provision simply provides a loophole for not covering people that cannot pay their fair share.

Section 1703 addresses CHIP and Medicaid maintenance. Where they allow states to impose limitations on coverage in order to limit expenditures under their child health plan.

Paragraph (1) shall not be construed as preventing a State from imposing a limitation described in section 2110(b)(5)(C)(i)(II) for a fiscal year in order to limit expenditures under its State child health plan under title XXI to those for which Federal financial participation is available under section 2105 for the fiscal year.

Subtitle B, Section 1711 defines the “Required Coverage of Preventive Services” where vaccines will now be required.

The preventive services described in this subsection are services not otherwise described in subsection (a) or (r) that the Secretary determines are—

“(1)(A) recommended with a grade of A or B by the Task Force for Clinical Preventive Services; or

“(B) vaccines recommended for use as appropriate by the Director of the Centers for Disease Control and Prevention; and

“(2) appropriate for individuals entitled to medical assistance under this title.”.

Nothing in this section indicates there will be a “religious exemptions” where administration of these vaccines is concerned. Will people no longer have the right to refuse vaccinating their children for religious reasons?

Section 1712 tells us that Medicaid will not cover tobacco cessation. I actually laughed when I read this section.

Section 1927(d)(2) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amended—

(1) by striking subparagraph (E);

(2) in subparagraph (G), by inserting before the period at the end the following: “, except agents approved by the Food and Drug Administration for purposes of promoting, and when used to promote, tobacco cessation”; and

(3) by redesignating subparagraphs (F) through (K) as subparagraphs (E) through (J), respectively.

(b) Effective date.—The amendments made by this section shall apply to drugs and services furnished on or after January 1, 2010.

It’s a given that the government is not going to pay for this. Of course they won’t. The government is not going to pay for something that helps you quit smoking. The taxes you pay for those cigarettes are going to help fund this program you moron.

The way they see it, every time someone lights up a cigarette another Medicaid recipient gets treatment (think bells and angel wings here people). They forget that a lot of those low-income people smoke too, defeating the purpose.

While the word “abortion” never appears in this version of the bill, Section 1713 does make reference to something you might find interesting.

The term ‘nurse home visitation services’ means home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age), who is eligible for medical assistance under this title, but only, to the extent determined by the Secretary based upon evidence, that such services are effective in one or more of the following:

“(1) Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.

“(2) Reducing the incidence of child abuse, neglect, and injury, improving family stability (including reduction in the incidence of intimate partner violence), or reducing maternal and child involvement in the criminal justice system.

“(3) Increasing economic self-sufficiency, employment advancement, school-readiness, and educational achievement, or reducing dependence on public assistance.”.

Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies?

Notice they don’t say they will work to help “prevent pregnancies”, but they will work to “increase birth intervals”. How do you increase “birth” intervals, without preventing the pregnancies in the first place. Yeah. Enough said. The word “abortion” never appears in the bill, but it’s implied much more strongly (and subtly) than even I thought it would be.

If that wasn’t enough, Section 1714 covers the state eligibility option for family planning services. We all know what kind of services are offered and what advice is given at family planning clinics. They don’t have to use the word abortion if they don’t want too. We can all read, can’t we? Abortion will be covered by this bill. These last two sections leave no doubt about that.

I can’t take anymore of this tonight. I need sleep. Tomorrow we will begin with Division B, Title VII, Subtitle C, on page 778.

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