HR3200 : Division B : Day Six

Division B, Title VII, Subtitle C covers payments to primary care practitioners, the medical home pilot program (as it will work under Medicaid), translation and interpretation services, option coverage for freestanding birth center services, and inclusion of public health clinics under the vaccines for children program.

Subtitle D begins by defining optional Medicaid coverage of low-income HIV-Infected individuals, extending transitional Medicaid assistance, and then defines the requirement for 12-month continuous coverage under certain CHIP programs. That’s it. I don’t know how or why those three topics relate to each other, but that’s all that is included in Subtitle D titled “Coverage”.

Subtitle E sets payments to pharmacists (Section 1741),

The Secretary shall calculate the Federal upper reimbursement limit established under paragraph (4) as 130 percent of the weighted average (determined on the basis of manufacturer utilization) of monthly average manufacturer prices.

Requires manufacturers to provide rebates for some drugs (Section 1742),

In the case of a drug that is a line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form, the rebate obligation with respect to such drug under this section shall be the amount computed under this section for such new drug or, if greater, the product of—

“(i) the average manufacturer price of the line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form;

“(ii) the highest additional rebate (calculated as a percentage of average manufacturer price) under this section for any strength of the original single source drug or innovator multiple source drug; and

“(iii) the total number of units of each dosage form and strength of the line extension product paid for under the State plan in the rebate period (as reported by the State).

In this subparagraph, the term ‘line extension’ means, with respect to a drug, an extended release formulation of the drug.”.

Extends the prescription drug discounts to enrollees (Section 1743), and affords payments for graduate medical education (Section 1744),

Subtitle F, another “waste, fraud, and abuse” section, allows the government to decide which “health care acquired conditions” will be be covered. In other words, the government will be allowed to ration what they pay for and what they don’t. Section 1751 states,

Medicaid non-Payment for certain health care-Acquired conditions.—Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—

(1) by striking “or” at the end of paragraph (23);

(2) by striking the period at the end of paragraph (24) and inserting “; or”; and

(3) by inserting after paragraph (24) the following new paragraph:

“(25) with respect to amounts expended for services related to the presence of a condition that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) and for any health care acquired condition determined as a non-covered service under title XVIII.”.

In other words, if you are in the hospital and you contract a health care acquired condition, you will be rolling the dice as far as coverage is concerned. I’m sure that brings a lot of reassurance to those who will be staying in the hospital.

Section 1759 requires any billing agents, clearing houses, or alternative payees be registered under Medicaid. Every private payment system will be required to register with the government. How many regulatory hurdles will the Secretary impose on them before approving their registration?

Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b), 1703, 1753, and 1757, is further amended—

(1) in paragraph (76); by striking at the end “and”;

(2) in paragraph (77), by striking the period at the end and inserting “and”; and

(3) by inserting after paragraph (77) the following new paragraph:

“(78) provide that any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary under section 1866(j)(1)(D).”.

Subtitle H covers technical corrections to the Social Security Act.

And with that, we finally come to the section where they draw the lines. Remember yesterday when I mentioned they had to draw the lines somewhere?

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.

It took a few more pages, but we finally found it. Of course, this line only includes persons on Medicare, but heck, it’s a line. I knew they would be drawing lines. They always do.

Title VIII, Section 1801 defines the disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare Prescription Drug Program to assist the Social Security Administration’s outreach to eligible individuals.

Upon written request from the Commissioner of Social Security, the following return information (including such information disclosed to the Social Security Administration under paragraph (1) or (5)) shall be disclosed to officers and employees of the Social Security Administration, with respect to any taxpayer identified by the Commissioner of Social Security—

“(i) return information for the applicable year from returns with respect to wages (as defined in section 3121(a) or 3401(a)) and payments of retirement income (as described in paragraph (1) of this subsection),

“(ii) unearned income information and income information of the taxpayer from partnerships, trusts, estates, and subchapter S corporations for the applicable year,

“(iii) if the individual filed an income tax return for the applicable year, the filing status, number of dependents, income from farming, and income from self-employment, on such return,

“(iv) if the individual is a married individual filing a separate return for the applicable year, the social security number (if reasonably available) of the spouse on such return,

“(v) if the individual files a joint return for the applicable year, the social security number, unearned income information, and income information from partnerships, trusts, estates, and subchapter S corporations of the individual’s spouse on such return, and

“(vi) such other return information relating to the individual (or the individual’s spouse in the case of a joint return) as is prescribed by the Secretary by regulation as might indicate that the individual is likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act.

In an earlier post, I wondered how the government was going to cover the cost of insuring so many more people under the “public option”. Section 1802 answers the question for funding Medicare.

The government plans to impose a fee on every private health insurance policy (while they last) and every self-insured health plan to fund the

Chapter 34 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subchapter:

“subchapter B—Insured and Self-Insured Health Plans
“Sec. 4375. Health insurance.
“Sec. 4376. Self-insured health plans.
“Sec. 4377. Definitions and special rules.

“SEC. 4375. Health insurance.

“(a) Imposition of Fee.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.

“(b) Liability for Fee.—The fee imposed by subsection (a) shall be paid by the issuer of the policy.

The government already deducts a percentage of your paycheck for Medicare. Now they are going to take a piece from those who provide your health plan. What happens if you choose the public option? You know the government is not going to pay themselves, so I’m sure they will pass that fee on to you as well.

Unlike Section 441 which stated that “tax imposed under this section shall not be treated as tax“, this section states,

the fees imposed by this subchapter shall be treated as if they were taxes.

So remember, taxes are not treated as taxes but fees imposed are treated as taxes. Fees are the new taxes.

Title IX, Miscellaneous Provisions, is one of the most disturbing pieces of this legislation (as if the threat of socialism isn’t bad enough, this takes it a bit further) and the last section of Division B.

The section in question is Section 1904. “Grants to States for quality home visitation programs for families with young children and families expecting children.”

The government establishes the creation of “quality home visitation programs”,

The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.

While the purpose states that these visits are “voluntary”, states will have a monetary incentive to increase the number of visitations, therefore pressuring more and more families in need to accept those services where government officials will be entering their homes, monitoring their children and teaching the parents the “government standard” for raising their children.

In order to qualify for the grants, each state will be required to submit a needs assessment.

The results of a statewide needs assessment that describes—

“(A) the number, quality, and capacity of home visitation programs for families with young children and families expecting children in the State;

“(B) the number and types of families who are receiving services under the programs;

“(C) the sources and amount of funding provided to the programs;

“(D) the gaps in home visitation in the State, including identification of communities that are in high need of the services; and

“(E) training and technical assistance activities designed to achieve or support the goals of the programs.

And the government must received certain assurances from the State.

Assurances from the State that—

“(A) in supporting home visitation programs using funds provided under this section, the State shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment;

“(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds;

“(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance;

“(D) home visitation programs supported using such funds will, when appropriate, provide referrals to other programs serving children and families; and

“(E) the State will comply with subsection (i), and cooperate with any evaluation conducted under subsection (j).

They go on to define exactly what they will be looking for while performing these visitations.

“(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);

“(II) knowledge of realistic expectations of age-appropriate child behaviors;

“(III) knowledge of health and wellness issues for children and parents;

“(IV) modeling, consulting, and coaching on parenting practices;

“(V) skills to interact with their child to enhance age-appropriate development;

“(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and

“(VII) activities designed to help parents become full partners in the education of their children;

These requirements will make it difficult for any family to refuse the visitations as the government could very well imply that families are abusing their children or neglecting them by refusing the home inspections visitations.

This section completely opens your home to inspection by authorities in your state based on their assessment of your parenting skills, or possibility that you are abusing your children.

It gives the government the right to come into your home to check whether or not your kids are eating properly, whether or not they are going to sleep at an appropriate time, and basically, whether or not you are a good parent.

While this section does not directly impact homeschool freedoms, I think you can see the dangers that lurk if this section is allowed to become law. Many states and communities frown on homeschoolers as it is. How long will it take before States start pressuring homeschoolers to “volunteer” for this visitation program?

With that, we have completed Division B of “America’s Affordable Health Choices Act of 2009“. I’ll leave you with one final thought for the day.

“Don’t you see that the whole aim of Newspeak is to narrow the range of thought?… Has it ever occurred to your, Winston, that by the year 2050, at the very latest, not a single human being will be alive who could understand such a conversation as we are having now?… The whole climate of thought will be different. In fact, there will be no thought, as we understand it now. Orthodoxy means not thinking—not needing to think. Orthodoxy is unconsciousness.”

– George Orwell, 1984, Book 1, Chapter 5

Tomorrow we will begin to tackle Division C, “Public Health and Workforce Development” on page 856. That’s right people, there are only 162 pages remaining and we have covered the entire text of H.R. 3200.