HR3200 : Division C : Day Two

In addition to the National Health Services Corp (NHS), the government will also establish a new “Public Health Workforce Corps” to ensure they have people to fill the positions they will be “providing” under this section of the bill.

There is established, within the Service, the Public Health Workforce Corps (in this subpart referred to as the ‘Corps’), for the purpose of ensuring an adequate supply of public health professionals throughout the Nation. The Corps shall consist of—

“(1) such officers of the Regular and Reserve Corps of the Service as the Secretary may designate; and

“(2) such civilian employees of the United States as the Secretary may appoint.

This section gives even more unbridled power to the Secretary of Health and Human Services. To appoint such civilian employees as he/she sees fit. Wow. Is that insane or what? Apparently he/she will be doing it under yet another “administration.

Except as provided in subsection (c), the Secretary shall carry out this subpart acting through the Administrator of the Health Resources and Services Administration.

Exactly how many administrations, commissioners, ombudsman, and other positions will it require to manage health care in our country? Does anyone know if the Tootsie-Roll Owl is available to figure this one out for us?

The Director of the Centers for Disease Control and Prevention will help develop the methodology for placing and assigning Corps participants as public health professionals.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a methodology for placing and assigning Corps participants as public health professionals. Such methodology may allow for placing and assigning such participants in State, local, and tribal health departments and Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act).

I feel kind of silly now. I thought “Public Health Care” meant, you know, providing health care for the people of the country, little did I know it mean employing everyone in the country in health care. I wonder though, what exactly will the responsibilities for the Reserve Proctologist be?

So, are you thinking of becoming a doctor, but this new bill seems like a lot of bull, so you have decided to treat bulls instead? Don’t worry, President Obama and Congress aren’t going to leave you out of the loop.

To be eligible to participate in the Program, an individual shall—

“(1)(A) be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at an accredited graduate school or program of public health; or

“(B) have demonstrated expertise in public health and be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at—

“(i) an accredited graduate school or program of nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine; or

“(ii) another accredited graduate school or program, as deemed appropriate by Secretary;

They were not kidding when they said this bill was going to cover health care “for all”. I wonder if it includes jackasses too?

As part of the National Health Service Corps, the Public Health Workforce Corps will help build and run the Public Health Training Centers. Let’s take a peak at what those training centers may look like.

When deciding whether or not you may like to participate in this training program you will be required to sign a contract.

Contract.—The written contract between the Secretary and an individual under subsection (b)(3) shall contain—

“(1) an agreement on the part of the Secretary that the Secretary will—

“(A) provide the individual with a scholarship for a period of years (not to exceed 4 academic years) during which the individual shall pursue an approved course of study or program to prepare the individual to serve in the public health workforce; and

“(B) accept (subject to the availability of appropriated funds) the individual into the Corps;

“(2) an agreement on the part of the individual that the individual will—

“(A) accept provision of such scholarship to the individual;

“(B) maintain full-time or part-time enrollment in the approved course of study or program described in subsection (b)(1) until the individual completes that course of study or program;

“(C) while enrolled in the approved course of study or program, maintain an acceptable level of academic standing (as determined by the educational institution offering such course of study or program);

“(D) if applicable, complete a residency or internship; and

“(E) serve full-time as a public health professional for a period of time equal to the greater of—

“(i) 1 year for each academic year for which the individual was provided a scholarship under the Program; or

“(ii) 2 years; and

“(3) an agreement by both parties as to the nature and extent of the scholarship assistance, which may include—

“(A) payment of reasonable educational expenses of the individual, including tuition, fees, books, equipment, and laboratory expenses; and

“(B) payment of a stipend of not more than $1,269 (plus, beginning with fiscal year 2011, an amount determined by the Secretary on an annual basis to reflect inflation) per month for each month of the academic year involved, with the dollar amount of such a stipend determined by the Secretary taking into consideration whether the individual is enrolled full-time or part-time.

“(d) Application of certain provisions.—The provisions of subpart III shall, except as inconsistent with this subpart, apply to the scholarship program under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Scholarship Program established under section 338A.

As far as I can tell, you are not forced to sign this contract with blood, but that could change once it hits the House floor for debate.

The funding for the Public Health Workforce will be allocated as follows.

For the purpose of carrying out subpart XII of part D of title III and sections 765, 766, and 768, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $51,000,000 for fiscal year 2010.

“(2) $54,000,000 for fiscal year 2011.

“(3) $57,000,000 for fiscal year 2012.

“(4) $59,000,000 for fiscal year 2013.

“(5) $62,000,000 for fiscal year 2014.

“(6) $65,000,000 for fiscal year 2015.

“(7) $68,000,000 for fiscal year 2016.

“(8) $72,000,000 for fiscal year 2017.

“(9) $75,000,000 for fiscal year 2018.

“(10) $79,000,000 for fiscal year 2019.”.

A total of $642 million. The government is going to allocate more that double the money for the training of nurses than it will for training and placement of doctors, dentists, and veterinarians under the Public Health Workforce initiative. This tells us who will be doing most of the work doesn’t it? Stop fussing. It costs a lot to supply you with that bedpan and wake you up in the middle of the night to take your meds. (Don’t be offended nurses, I know you do a heck of a lot more than any doctor will ever admit).

Section 2241 will provide scholarships for health professions training for diversity for “disadvantaged students”. Yes folks, it’s affirmative action in health care education. Al Sharpton will be very pleased with Section 2241.

The funds for “health professions training for diversity” will be allocated as follows.

For the purpose of carrying out sections 736, 737, 738, 739, and 739A, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $90,000,000 for fiscal year 2010.

“(2) $97,000,000 for fiscal year 2011.

“(3) $100,000,000 for fiscal year 2012.

“(4) $104,000,000 for fiscal year 2013.

“(5) $110,000,000 for fiscal year 2014.

“(6) $116,000,000 for fiscal year 2015.

“(7) $121,000,000 for fiscal year 2016.

“(8) $127,000,000 for fiscal year 2017.

“(9) $133,000,000 for fiscal year 2018.

“(10) $140,000,000 for fiscal year 2019.

Diversity will cost an additional $1,138,000,000, or $1.138 billion. Along with the Workforce funding of $642 million, and “interdisciplinary training programs” which will cost $1,149,000,000 or $1.149 billion, that brings our total to $49.373 billion of the $88.7 billion allocated from the general funds of the Treasury for this “division” of the Health Care bill

Title XXXI, “Prevention and Wellness” establishes a “Prevention and Wellness Trust” which will be allocated from, you guessed it, the “Public Health Investment Fund”. The money will be allocated as follows.

There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust—

“(1) amounts described in section 2002(b)(2)(ii) of the America’s Affordable Health Choices Act of 2009 for each fiscal year; and

“(2) in addition, out of any monies in the Public Health Investment Fund—

“(A) for fiscal year 2010, $2,400,000,000;

“(B) for fiscal year 2011, $2,800,000,000;

“(C) for fiscal year 2012, $3,100,000,000;

“(D) for fiscal year 2013, $3,400,000,000;

“(E) for fiscal year 2014, $3,500,000,000;

“(F) for fiscal year 2015, $3,600,000,000;

“(G) for fiscal year 2016, $3,700,000,000;

“(H) for fiscal year 2017, $3,900,000,000;

“(I) for fiscal year 2018, $4,300,000,000; and

“(J) for fiscal year 2019, $4,600,000,000.

For a total of $35,300,000,000 or $35.3 billion, bringing our total money spent from the $88.7 billion Public Health Investment Fund to $84.673 billion (95.5%).

The strategy of the Prevention and Wellness Trust will be to identify the specific goals and objectives in prevention and wellness activities for “Healthy People and National Public Health Performance Standards”.

Identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures and standards, including departmental measures and standards (including Healthy People and National Public Health Performance Standards).

Subtitle D, “Prevention and Wellness Research” and Subtitle E, “Delivery of Community Prevention and Wellness Services” set the stage for all of the “big government” infrastructures you might expect in government forced health care that we have not already covered.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a program for the delivery of community preventive and wellness services consisting of awarding grants to eligible entities—

“(1) to provide evidence-based, community preventive and wellness services in priority areas identified by the Secretary in the national strategy under section 3121; or

“(2) to plan such services.

The Secretary, once again, will give preference to some entities over others.

In awarding grants under this section, the Secretary shall give preference to entities that—

“(1) will address one or more goals or objectives identified by the Secretary in the national strategy under section 3121;

“(2) will address significant health disparities, including those identified by the Secretary in the national strategy under section 3121;

“(3) will address unmet community prevention needs and avoids duplication of effort;

“(4) have been demonstrated to be effective in communities comparable to the proposed target community;

“(5) will contribute to the evidence base for community preventive and wellness services;

“(6) demonstrate that the community preventive services to be funded will be sustainable; and

“(7) demonstrate coordination or collaboration across governmental and nongovernmental partners.

Title V, Subtitle B, mandates the creation of a school-based health clinic program which basically nationalizes the school nurse programs. As we know most schools eliminated those positions years ago because of the lack of government funding, but now we’re bringing them back with a vengeance.

Not only will the school nurse be taking your temperature and calling your parents when you are sick but now they will be full-fledged clinics meeting requirements established in this bill and otherwise integrating every aspect of your child’s school records into the same database as your financial information, medical information, and criminal history.

Title V, Subtitle C provides for a new “National Medical Device Registry” because they apparently forgot (at least until page 1001) that they wanted to track that information in the database as well.

In developing the registry, the Secretary shall, in consultation with the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, the head of the Office of the National Coordinator for Health Information Technology, and the Secretary of Veterans Affairs, determine the best methods for—

“(A) including in the registry, in a manner consistent with subsection (f), appropriate information to identify each device described in paragraph (1) by type, model, and serial number or other unique identifier;

“(B) validating methods for analyzing patient safety and outcomes data from multiple sources and for linking such data with the information included in the registry as described in subparagraph (A), including, to the extent feasible, use of—

“(i) data provided to the Secretary under other provisions of this chapter; and

“(ii) information from public and private sources identified under paragraph (3);

“(C) integrating the activities described in this subsection with—

“(i) activities under paragraph (3) of section 505(k) (relating to active postmarket risk identification);

“(ii) activities under paragraph (4) of section 505(k) (relating to advanced analysis of drug safety data); and

“(iii) other postmarket device surveillance activities of the Secretary authorized by this chapter; and

“(D) providing public access to the data and analysis collected or developed through the registry in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.

That Secretary sure is going to be holding a lot of cards, isn’t he/she?

And finally, we come to the last page of the bill. 1017 pages down, one to go, and we learn that States will only receive funding under this provision (Division C) if they agree to fulfill each obligation under Division A and any amendments made by such division application to persons in their capacity as an employer and if they assure that all political subdivisions in the State will do the same.

States are only eligible for money to cover everything I discussed yesterday and today (Division C) if they, and every county and city government within them, agree to every condition in the first four days of posts (Division A).

In other words, the only way a State will qualify is if every city, town, parish, community, county within that State, along with the State itself, agrees to surrender some of the sovereign rights guaranteed to each State under the U.S. Constitution.

America’s Affordable Health Choices Act of 2009 starts by violating our rights as individuals as well as the Tenth Amendment to the U.S. Constitution, and it ends by demanding the voluntary surrender of States rights in order to “participate” in the soon to be required plan.

I don’t know about you, but this entire bill doesn’t sound to “affordable” nor does it seem to offer any choices.

So how many of you actually read the entire bill with me? It only took 12 days. If you read it, like I did, you can ask your Representative, “What did you do on your summer vacation?

I bet only a handful have read the bill, even now.

Make sure you tell your friends about the bill. Make sure they read the bill. Tell them not to listen to the hype and propaganda from either side of the aisle. Tell them to read the bill. The only way to dispel any “myths” in the bill is to read the bill yourself.

You cannot argue a position on the bill if you don’t even know what it says.

HR3200 : Division C : Day One

Tonight we cover Division C, the last “division” of the monstrosity known as “America’s Affordable Health Choices Act of 2009“.

Division C concentrates on Public Health and Workforce Development. The first thing we learn in this division is that each “amendment” mentioned in this division, unless otherwise specified makes reference to the Public Health Service Act.

Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.)

Section 2002 establishes a fund to be called the “Public Health Investment Fund”. The funding for this “fund” will be set by the following schedule.

There shall be deposited into the Fund—

(i) for fiscal year 2010, $4,600,000,000;

(ii) for fiscal year 2011, $5,600,000,000;

(iii) for fiscal year 2012, $6,900,000,000;

(iv) for fiscal year 2013, $7,800,000,000;

(v) for fiscal year 2014, $9,000,000,000;

(vi) for fiscal year 2015, $9,400,000,000;

(vii) for fiscal year 2016, $10,100,000,000;

(viii) for fiscal year 2017, $10,800,000,000;

(ix) for fiscal year 2018, $11,800,000,000; and

(x) for fiscal year 2019, $12,700,000,000.

That’s a total of $88,700,000,000. That’s $88.7 billion dollars over the next 10 years. Which amounts to just $16 billion more than the cost of covering 0.9% of the population (those treated for HIV, Cancer, and Parkinson’s Disease).

Where do you think the government is going to get an additional $88.7 billion over the course of the next 10 years?

Amounts deposited into the Fund shall be derived from general revenues of the Treasury.

Where do you think general revenues come from? That’s right. Taxes. There ain’t no mincing words about that.

The funds allocated for the “Public Health Investment Fund” will not be subject to the Balanced Budget and Emergency Deficit Control Act. That means the costs for operating this fund may rise and rise with no limit on appropriations at all. Yes, that means your taxes will rise and rise with no limit (until they hit 100%) on your income.

Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.

Title I, section 2101 increases funding for community health centers. This actually makes sense since most of the bill up to this point deals with the Public Option, Medicare, and Medicaid. Everyone will be covered by the time the fund is funded to the levels they claim, so community health centers are going to need the money, aren’t they?

Community health centers will be appropriated money out of the Public Health Investment Fund, in the following amounts.

For the purpose of carrying out this section, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) For fiscal year 2010, $1,000,000,000.

“(2) For fiscal year 2011, $1,500,000,000.

“(3) For fiscal year 2012, $2,500,000,000.

“(4) For fiscal year 2013, $3,000,000,000.

“(5) For fiscal year 2014, $4,000,000,000.

“(6) For fiscal year 2015, $4,400,000,000.

“(7) For fiscal year 2016, $4,800,000,000.

“(8) For fiscal year 2017, $5,300,000,000.

“(9) For fiscal year 2018, $5,900,000,000.

“(10) For fiscal year 2019, $6,400,000,000.”.

The total for Community Health Center funding comes to $38,800,000,000, or $38.8 billion. That’s 43.7% of the money allocated for the Public Health Investment Fund.

Title II covers the “Workforce”. Section 2201 mandates the creation of a “National Health Service Corps.

Individuals who receive educational funding through a federal Scholarship Program or the Loan Repayment Program will be required to provide “half-time” clinical practice. No this does mean that the new up and coming doctors will be treating all their patients during the break in the local football game. It means they will be required to offer half-time service (yes, devoting half of their employment time) for two years to fulfill their obligation for the funding services they received from the government.

I wonder what the “government service” interns will be required to wear? With their coats be red in color?

Section 2202 sets the authorization of appropriations and provides for additional funding for the scholarship and loan repayment programs in the following amounts:

“For the purpose of carrying out this subpart, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $254,000,000 for fiscal year 2010.

“(2) $266,000,000 for fiscal year 2011.

“(3) $278,000,000 for fiscal year 2012.

“(4) $292,000,000 for fiscal year 2013.

“(5) $306,000,000 for fiscal year 2014.

“(6) $321,000,000 for fiscal year 2015.

“(7) $337,000,000 for fiscal year 2016.

“(8) $354,000,000 for fiscal year 2017.

“(9) $372,000,000 for fiscal year 2018.

“(10) $391,000,000 for fiscal year 2019.”.

A total of $3,171,000,000. Thats $3.171 billion or 3.6% of the Public Health Investment Fund. So far, we’ve spent $41.971 billion of the $88.7 billion dollar fund.

Section 2212 sets the loan provisions, rate of interest for those loans, and requires the student to practice in such care for 10 years or through the date on which the load is repaid in full, whichever occurs first.

If you take a government loan to become a doctor, you will be required to work “half-time” in clinical practice, as well as practice for at least 10 years or at least as long as you are repaying the loans you received.

to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.”

The powerful and mighty Secretary of Health and Human Services will be pulling more strings behind that giant green curtain too. In addition to all of the other new responsibilities he/she will hold once this bill becomes law, the Secretary will also be responsible for something else.

The Secretary shall make grants to, or enter into contracts with, eligible entities—

“(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians;

“(B) to provide financial assistance in the form of traineeships and fellowships to medical students, interns, residents, or practicing physicians, who are participants in any such program, and who plan to specialize or work in family medicine, general internal medicine, general pediatrics, or geriatrics;

“(C) to plan, develop, operate, or participate in an accredited program for the training of physicians who plan to teach in family medicine, general internal medicine, general pediatrics, or geriatrics training programs including in community-based settings;

“(D) to provide financial assistance in the form of traineeships and fellowships to practicing physicians who are participants in any such programs and who plan to teach in a family medicine, general internal medicine, general pediatrics, or geriatrics training program; and

“(E) to plan, develop, operate, or participate in an accredited program for physician assistant education, and for the training of individuals who plan to teach in programs to provide such training.

That’s right. The Secretary will be responsible for creating training programs for new doctors. The Secretary will decide (by entering into a contract with services or corporations of his/her choosing) what doctors will learn, how they will serve their communities, and how the inductees students, will repay their debt for the awesome opportunity to serve their country.

The Secretary will decide which hospitals qualify for these contracts, which programs will serve the best community good, and which students will be allowed to participate in these programs.

This bill isn’t just about the common good where health care is concerned, it’s not about lowering costs or making the system more efficient. It’s about the outright full control of health care, and ultimately our lives, in this country.

The allocation for funding for primary care and dentistry will amount to the following values.

For the purpose of carrying out subpart XI of part D of title III and sections 723, 747, 748, and 749, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $240,000,000 for fiscal year 2010.

“(2) $253,000,000 for fiscal year 2011.

“(3) $265,000,000 for fiscal year 2012.

“(4) $278,000,000 for fiscal year 2013.

“(5) $292,000,000 for fiscal year 2014.

“(6) $307,000,000 for fiscal year 2015.

“(7) $322,000,000 for fiscal year 2016.

“(8) $338,000,000 for fiscal year 2017.

“(9) $355,000,000 for fiscal year 2018.

“(10) $373,000,000 for fiscal year 2019.”.

This amounts to another $3,023,000,000 or $3.023 billion. This brings our total “spent” to $44.994 billion.

In case you were wondering, Section 2221 adds nurses into the same “plan” as doctors where they will be allowed to serve their government as a “repayment” for two years. The funding for this additional program is allocated (like the rest) over the next ten years.

For the purpose of carrying out this title, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $115,000,000 for fiscal year 2010.

“(2) $122,000,000 for fiscal year 2011.

“(3) $127,000,000 for fiscal year 2012.

“(4) $134,000,000 for fiscal year 2013.

“(5) $140,000,000 for fiscal year 2014.

“(6) $147,000,000 for fiscal year 2015.

“(7) $154,000,000 for fiscal year 2016.

“(8) $162,000,000 for fiscal year 2017.

“(9) $170,000,000 for fiscal year 2018.

“(10) $179,000,000 for fiscal year 2019.”

A total of $1,450,000,000 or $1.45 billion. Our total is now $46.444 billion of the $88.7 billion total set in the fund. Yes, the government actually wants you to believe that they can fund the opening of community health centers (nationwide) and define plus fund the education of doctors as well as nurses for just $46.444 billion. Remember, it’s going to cost $72 billion to treat just 0.9% of the people in our country. When do we talk about covering the remaining 99.1 percent of the people? Is that included in the remaining 47.6% of the Public Health Investment Fund or are we talking about allocating money somewhere else?

Tomorrow we’ll begin with Subtitle C, “Public Health Workforce” on page 898.

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.

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.

HR3200 : Division B : Day Five : Part One

Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections” begins with a new requirement for public reporting by hospitals on health care associated infections. While the whole “reporting infections” thing is awesome, the intentions of the section may actually be a little deceptive.

The Secretary shall provide that a hospital (as defined in subsection (g)) or ambulatory surgical center meeting the requirements of titles XVIII or XIX may participate in the programs established under such titles (pursuant to the applicable provisions of law, including sections 1866(a)(1) and 1832(a)(1)(F)(i)) only if, in accordance with this section, the hospital or center reports such information on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

Hospitals and ambulatory surgical centers can only be part of the overall health plan if they agree to report “on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

While seemingly innocuous to most readers, I question the additional information that will be required simply on the Secretary of Health and Human Services’ decision. I understand that infections should be reported, and I agree that the information about which types of infections are important, but what other information would the Secretary require? Will they be collecting data on the race of patients? Maybe the age and overall health of patients? Some of that data may be legitimate and needed when analyzing infection data, but the section doesn’t stop there. It gives the Secretary the discretion to include any data he/she sees fit, which could be anything.

Section 1461 goes on to state that the CDC will be the collector of the above mentioned data, so it seems my brother-in-law may have some long term job security if the bill passes.

Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.

Another problem I have with this section is the fact that all of the information will be posted publicly. Remember, the Secretary will have the discretion to collect any information he/she sees fit, and we already know that privacy laws do not affect the government throughout most of this piece of legislation. Exactly what information will be collected and posted on the Internet?

The Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the information reported under subsection (a). Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infections—

“(1) among hospitals and ambulatory surgical centers; and

“(2) by demographic information.

Think about it. If they collect data on staph infections and post that information, will they be including names of patients, age of patients, underlying medical conditions of patients, and prognosis following the infection? What about a patient’s right to privacy? Oh yeah, that’s right it doesn’t apply here. So, if you are someone with an illness that you would rather not be known to your friends, family, co-workers, priests, pastors, and everyone else, you better pray to God that you don’t pick up a health care associated infection while you are in the hospital.

Am I fearmongering? Some might say so, but this section (like many others in the bill) leaves the gate open for a lot of possibilities. Everyone knows that dog is going to run once you leave the gate open.

Starting with Title V, Section 1501 we learn that the government will now “redistribute unused residency positions” at hospitals.

If a hospital’s reference resident level (specified in clause (ii)) is less than the otherwise applicable resident limit (as defined in subparagraph (C)(ii)), effective for portions of cost reporting periods occurring on or after July 1, 2011, the otherwise applicable resident limit shall be reduced by 90 percent of the difference between such otherwise applicable resident limit and such reference resident level.

Does this mean there will be the same number of doctors at each hospital, no matter which hospital you choose? What happens if all the residency programs are filled up in your home state? Does this mean young doctors will be forced to move out of state to pursue their chosen profession? Who will decide which hospitals will be allowed more residency positions? Oh yes, the great and powerful Secretary, apparently.

In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:

“(I) The Secretary shall give preference to hospitals that had a reduction in resident training positions under subparagraph (A).

“(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.

“(III) The Secretary shall give preference to hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings, and to hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department.

“(IV) The Secretary shall give preference to hospitals with a number of positions (as of July 1, 2009) in excess of the otherwise applicable resident limit for such period.

“(V) The Secretary shall give preference to hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act).

“(VI) The Secretary shall give preference to hospitals in States that have low resident-to-population ratios (including a greater preference for those States with lower resident-to-population ratios).

Read that last one again. Residents will no longer have the option to choose which location they will practice medicine. In fact, someone from Georgia, who is educated at Emory, could end up doing their residency in some small town in northern Idaho, simply because the Secretary of Health and Human Services decided that the hospital there had a low resident-to-population ratio and they were a Federally qualified health center.

The government makes all the rules. The government enforces all the rules. The people have no say. The government decides it all. If it’s not good for the collective, it is not allowed. If it serves the collective, then it is required.

Socialism — a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole.

Once again, we are left with no doubt as to the direction this bill will take our country.

The remainder of Title V covers all of the different aspects of the resident programs. Feel free to read it if you wish.

Title VI, Subtitle A is an oxymoron as far as government is concerned. “Increased Funding to Fight Waste, Fraud, and Abuse” and Subtitle B describes the “Enhanced Penalties for Fraud & Abuse”. Subtitle C provides for “Enhanced Program and Provider Protections”.

All three of these Subtitles give the Secretary of Health and Human Services the authority to impose penalties and ultimately to decide if a provider is a “serious risk of fraud, waste, or abuse”. If so, the Secretary has the discretion to deny their application as a Medicare/Medicaid provider.

Section 1632 requires a face-to-face encounter with the patient in order to certify eligibility for home health services or durable medical equipment under Medicare. Section 1632 will modify Section 1814(a)(2)(C) of the Social Security Act.

by inserting after “care of a physician” the following: “, and, in the case of a certification or recertification made by a physician after January 1, 2010, prior to making such certification the physician must document that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual during the 6-month period preceding such certification, or other reasonable timeframe as determined by the Secretary”.

On the surface this does not seem so bad, does it? The doctor must meet with the patient before they are eligible for home health services or medical equipment under Medicare. The key is that they have to have had a face to face encounter with the patient in the six month period leading up to that certification. How long will certification last? Will patients be required to see the physician every six months to continue certification?

In the case of my sister-in-law, who is mentally handicapped, the government sends her notices every year insisting that she can “work” to offset some of the costs of her care. She has the mentality of a three-year old and cannot talk. She suffers from seizures and has injured herself numerous times during those seizures. Where exactly would she be qualified to work, and what job would she perform? Yet, the government insists on her seeing a physician every year to “guarantee” that she has not recovered from her 50 plus year diagnosis of brain damage. Yes, they’ve been requiring this every year for the past twenty years or so.

Can you imagine what will happen if seniors and disabled people all across the country are required to meet with their physician every six months simply to prove that they still require the treatment or equipment to keep them healthy (and/or alive)? How does this ensure lower cost health care? Won’t more frequent visits drive up the costs?

If you’re not disabled, requiring home health care or durable medical equipment, don’t worry about feeling like you have been left out.

The Secretary may apply the face-to-face encounter requirement described in the amendments made by subsections (a) and (b) to other items and services for which payment is provided under title XVIII of the Social Security Act based upon a finding that such an decision would reduce the risk of waste, fraud, or abuse.

Every person on Medicare/Medicaid could be required to visit their physician every six months whether or not they have a reason to be doing so, simply to help reduce the risk of waste, fraud, and abuse in the system. If this isn’t an abuse of the system, I don’t know what is.

Subtitle D, Section 1651 takes health care into the realm of criminal justice by allowing access to information by the Attorney General.

For purposes of law enforcement activity, and to the extent consistent with applicable disclosure, privacy, and security laws, including the Health Insurance Portability and Accountability Act of 1996 and the Privacy Act of 1974, and subject to any information systems security requirements enacted by law or otherwise required by the Secretary, the Attorney General shall have access, facilitation by the Inspector General of the Department of Health and Human Services, to claims and payment data relating to titles XVIII and XIX, in consultation with the Centers for Medicare & Medicaid Services or the owner of such data.”.

Once again, on the surface this sounds like something that should already be done. If someone is committing a crime that information should be turned over to law enforcement. The thing is, it already is. I served on the Grand Jury just a couple months ago and one of the cases before us was someone trying to defraud the Medicaid system. Why would the government need to add this to the books?

Of course this just ties up all of our information into one central database.

Financial information, medical information, and now criminal history. All of our information provided to anyone in the government who needs it, all in one nice nifty central database.

Once central place where all of your information is located. One central place where your existence is recorded. Once central place where that mere existence could be wiped from the record books, forever.

“People simply disappeared, always during the night. Your name was removed from the registers, every record of everything you had ever done was wiped out, your one-time existence was denied and then forgotten. You were abolished, annihilated: vaporized was the usual word.”

– George Orwell, 1984, Book 1, Chapter 1

Could this happen? Sure it could. Will this happen? Let’s not find out.

HR3200 : Division B : Day Four

I’ve heard from several people since publishing yesterday’s second post who all had stories about Veteran’s Administration related health care. I am not going to go into each and every story, as there are enough of them to provide content for several weeks.

I get the feeling we’re all going to be in a lot of trouble if the new health care system is going to be as reliable as the VA and the Post Office.

“UPS and Fedex are doing just fine, it’s the Post Office that’s always having problems.”

I don’t know about you, but if it comes down to a choice of UPS or the USPS when it comes to delivering a new kidney or making sure my medical supplies arrive on time, I’ll take ol’ Brown everyday over the Post Office.

President Obama said it himself. So think about it. If the Post Office is having problems compared to UPS and Fedex, why on Earth would we want a government health care plan that is clearly going to be insufficient when compared to our current health system? I thought this bill was supposed to be about improving health care in America, not degrading it?

Anyway, I digress. Let’s move forward, shall we? Today we pick up with Division B, Title IV, Subtitle B, Nursing Home Transparency.

Upon passage of the bill, nursing facilities will be required to disclose all ownership and disclosable parties information. They will be required to retain such information on the effective date of the final regulations, and of course, they will be required to keep them forever.

Nothing in subparagraph (A) shall be construed as authorizing a facility to dispose of or delete information described in such subparagraph after the effective date of the final regulations promulgated under paragraph (4)(A).

Whether or not the facility is a publicly traded company, they will be required to make all of that information available to the public.

During the period described in paragraph (1)(A), a facility shall—

“(A) make the information described in paragraph (3) available to the public upon request and update such information as may be necessary to reflect changes in such information; and

“(B) post a notice of the availability of such information in the lobby of the facility in a prominent manner.

There is a lot more to this section, including more about the required components of the program, design of regulations, and evaluations. I am sure you get the gist though. Nursing facilities will be required to follow all of the new regulations and report all information and activity to Big Brother. Seriously, is this any different than any other section thus far?

Section 1421 shows us if a skilled nursing facility is found to be in noncompliance, the Secretary of Health and Human Services will once again have the authority to impose an arbitrary fine.

The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).

Some of these penalties are defined in the bill.

In this clause, the term ‘applicable per instance amount’ means—

“(aa) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000;

“(bb) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and

“(cc) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.

Wow. $100,000. That’s what your life is worth (in fines) to the government. If you’re wondering how the government will fund some of the items in this bill, look no further than the arbitrary fines and penalties that will be imposed by the Secretary of Health and Human Services.

Section 1422 will regulate the “large intrastate chains of skilled nursing facilities” and provide a pilot program to monitor them.

The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

How much you want to bet they will add chains to their list, even if they don’t send in an application requesting it. Think about it. Who is going to request that the government monitor every move they make? Yeah, they’ll be beating down the doors, won’t they?

When has the government ever had a quality program that is efficient, disciplined, and well-run? Yeah. Well, it seems they are going to be defining exactly what quality is when it comes to health care. Section 1441 defines a quality measure.

The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.

If they plan on enforcing the same quality measures imposed by the Veteran’s Administration, you may as well plan on hearing a lot of stories about people who died choking on sandwiches, falling out of their wheelchairs, being placed in a room and forgotten about, and maybe even released out the front door with no memory of anyplace else to go.

Sure, it sounds extreme. Sure, it sounds frightening. It’s happening now, with people under the care of the Veteran’s Administration. Don’t believe me? Just ask some of our elderly veterans about the care they receive. Just ask them what it’s like waiting months for a procedure that usually takes 10 minutes. Just ask them if they support a national health care plan modeled after the quality of care they currently receive. Don’t take my word for it.

The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.

Oh Lord, here it comes.

Quality measures developed under agreements under subsection (a) shall be designed—

“(A) to assess outcomes and functional status of patients;

“(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;

“(C) to assess patient experience and patient engagement;

“(D) to assess the safety, effectiveness, and timeliness of care;

“(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language;

“(F) to assess the efficiency and resource use in the provision of care;

“(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services;

“(H) to be available free of charge to users for the use of such measures; and

“(I) to assess delivery of health care services to individuals regardless of age.

Wow. To assess the functional status of patients. Are you still able to perform as a productive member of society? If so, we’ll coordinate your care, assess the timeliness of that care, assess the efficiency of that care, and make sure your health care services are delivered no matter how old you are. Well, until you meet with the advanced care planning consultant anyway.

Section 1443 will allow multi-stakeholder input into the selection of quality measures. What does this mean? This means any multi-stakeholder in a facility will be allowed to help define what constitutes quality care at that facility.

A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs.

Let’s reflect on that section for a moment. Any multi-stakeholder will be invited to participate. Who might these multi-stakeholders be? Private investors, unions, community organizations, you get the idea. Remember though, physicians will not be allowed to increase their ownership in such facilities after the passage of this bill. (From Section 1156 of the Division B):

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.

This means the “quality measures” decided upon will not be determined by anyone trained to know what quality health care is in the first place. That sure makes me feel confident about the level of care I would receive. (cough)

Never fear though. If the entity has not defined quality measures for a given procedure or area, the Secretary of Health and Human Services will determine what is appropriate. Section 1444 actually takes it a step further.

In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.

If a measure has not been endorsed by the entity or if one has been decided and the Secretary has given consideration to those measures, the Secretary has the authority to decide on the quality measures therefore overriding the entity endorsements. I honestly don’t think Josef Stalin had the kind of authority that the Secretary of Health and Human Services will have if this bill passes.

Division B, Title IV, Subtitle D, Section 1451 exposes the financial relationships between manufacturers and physicians, but does nothing to expose the relationships between those same manufacturers and representatives of our government.

The section covers approximately 18 pages and covers everything from reporting such relationships, making that information public, the accuracy of that reporting, and the penalties for not reporting or knowingly failing to report. The section also defines the term payment when pertaining to these financial relationships.

The term ‘payment or other transfer of value’ means a transfer of anything of value for or of any of the following:

“(i) Gift, food, or entertainment.

“(ii) Travel or trip.

“(iii) Honoraria.

“(iv) Research funding or grant.

“(v) Education or conference funding.

“(vi) Consulting fees.

“(vii) Ownership or investment interest and royalties or license fee.

Check out the terms I highlighted. Don’t those sound like items a Senator or Representative may receive from specific corporations for their support on certain legislation?

Why is there no “sunshine” clause for our elected officials and representatives of our government? Why are they exempt from the ethical standards being imposed on everyone else? What exactly do they have to hide?

That’s it for tonight. Tomorrow we will pick up on page 654, Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections”. That should be fun.