HR3200 : Division B : Day Three : Part Two

Now that we have established that cancer treatment will likely be rationed, special needs patients will be left waiting, doctors will be penalized for readmissions, and “death panels” really were in the original text of the bill, let’s more on.

Before we do, however, let me pass something on to you. I received a few messages from someone who read my earlier post today (part one), and told me that the entire “end of life” section I covered was eerily similar to existing VA policy.

It seems her grandfather, who was 78 years old at the time, was diagnosed with prostate cancer. The Veteran’s Administration told him that he was too close to the end of his life to validate the cost of treatment. He lived another eight years as cancer spread through his body before he passed away. But here’s the kicker.

He did not die from the cancer. He died choking on a tuna fish sandwich because the VA also considered the performance of the Heimlich Maneuver to be a violation of his DNR. I kid you not. If you think the government can handle health care on a nationwide scale, all you have to do is look at the VA to learn otherwise.

Let’s see what other gems H.R. 3200 has in store for us.

Division B, Title II, Subtitle C, Section 1234 begins with the waiver of limited enrollment penalty for TriCare beneficiaries. If you are not familiar with it, TriCare is the health care program which serves active duty service members, National Guard and Reserve members, retirees, their families, survivors, and certain former spouses.

Section 1234 will mandate that qualifying individuals will automatically be enrolled in TriCare.

The Secretary of Defense shall establish a method for identifying individuals described in paragraph (1) and providing notice to them of their eligibility for enrollment during the special enrollment period described in paragraph (2).”.

Now we have the Secretary of Defense deciding who gets medical care, along with the Secretary of Health and Human Services, and the Health Choices Administration “Commissioner”, all of whom are not required to be doctors. Section 1234 also states that rates for TriCare will rise.

Section 1236 will establish “patient decision aids”.

The Secretary of Health and Human Services shall establish a shared decision making demonstration program (in this subsection referred to as the “program”) under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options, as compared to comparable Medicare beneficiaries who do not participate in a shared decision making process using patient decision aids.

It seems your doctor will not be allowed to discuss your treatment options with you unless he/she uses one of these “shared decision making demonstration programs” to help you learn the best treatment option for you at the time. Shouldn’t the best treatment option be the one that saves your life? I wonder what that flowchart would look like?

Do you have a serious illness? If yes, continue. If no, get out of here before we penalize your doctor for allowing you back in the door so soon.

Is your serious illness life threatening? If yes, continue. If no, then get the hell out of here before we penalize you for wasting our time.

Are you older than 65? If yes, continue. If no, receive the best treatment possible adjusted by the number of productive years you have remaining in your life. Have a nice day.

Hello senior. You have reached the end of the flowchart. Congratulations! Unfortunately, by reaching the end of the flowchart you have also reached the end of your usefulness to society, therefore we cannot justify spending a dime in additional care for your “serious illness”. Please return home where you will receive a nice visit from one of our “advanced care planning consultants”. Oh, and don’t forget to make your appointment to complete your health care proxy.

It may sound far fetched to you, but that’s basically how it’s going to work if this bill passes.

Title III, Section 1301 creates a new “accountable care organization pilot program”. Say that three time fast.

The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—

“(1) promote accountability for a patient population and coordinate items and services under parts A and B;

“(2) encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery; and

“(3) reward physician practices and other physician organizational models for the provision of high quality and efficient health care services.

Physicians will be rewarded for high quality and efficient health care services, but only if they have not already been penalized for readmitting the patient or not following the government guidelines with the “decision aid” for that patients care.

Remember, everything the government is implementing in this bill will be on the reward/penalty system. If you comply, you will be duly rewarded, if you fail to comply you will be penalized in the form of lower payments and therefore forced to comply if you want to eat.

Section 1302 establishes the “medical home pilot program”. Yes, Medicare covered treatments delivered directly to your front door in the form of medical home services, if you live in a “medical home” anyway.

Subject to subsection (g), the pilot program shall include urban, rural, and underserved areas.

Don’t be surprised, however, if you don’t see a doctor when you answer the door.

Nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as—

“(i) all the requirements of this section are met; and

“(ii) the nurse practitioner is acting consistently with State law.

I can tell you how well this is going to work.

Our oldest son got sick a while ago. He had a fever, was nauseous, and was feeling just awful. Our pediatrician was out of town, but an “office assistant” (who we didn’t even know was not a nurse), told us how to treat his symptoms because a “bug was going around”. After he did not respond to those treatments and seemed to be getting worse we took him to the emergency room. We made it just in time. He had appendicitis and he would have died had we not arrived when we did. He was in the hospital for a week.

We almost lost our son because we had faith in our doctor’s office. We believed we were getting the proper advice from a properly trained individual. It turns out we were wrong, and our son almost died. The doctor was not penalized, the “office assistant” kept her job, and we found another pediatrician immediately.

I can just imagine how well this “medical home pilot program” is going to work. Puh-leaze! Oh, in case you were wondering,

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

That’s right. Those obtaining services under the “medical home pilot program” will not be afforded the right to privacy. Remember, Chapter 35 of Title 44 of the U.S. Code makes a few assurances, one of which is to,

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

Section 1308 amends the Social Security Act to allow for marriage and family therapist services.

Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 1235 and 1305, is amended by adding at the end the following new subsection:

“Marriage and Family Therapist Services

“(jjj) (1) The term ‘marriage and family therapist services’ means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

Because universal health care is all about diagnosing the problems within your marriage. Notice they pooled marriage and mental health into the same section? Is this so your health care practitioners who decide you are too close to the end of life can also claim your spouse is mentally impaired when they try to protest their decision? Just thinking out loud.

Section 1308 goes on to define mental health counselor services, by defining the services that will be covered, creating those services, setting the prices of those services, and then, ultimately, rationing those services.

Section 1310 will expand access to vaccines, which if I am not mistaken are available now at most health department locations for a low, nominal price, or even free in some cases.

Moving on to Division B, Title IV, Subtitle A, Section 1401 brings us to comparative effectiveness research.

The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

Privately funded medical research has been at the forefront of most major discoveries, yet now, in the age of Obama, the government is going to create their own research facility to see if the “effectiveness, and appropriateness of health care services and procedures” are up to par and identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

The government controlled post office can’t even deliver my mail reliably but I am supposed to think the same government can perform valid research on a topic they know nothing about? Unless this “Comparative Effectiveness Research Center” is comprised of the best clinical minds our country had to offer, it won’t be worth the paper it was created on.

The “Center” will have the authority to collect data from any government agency or department.

The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Center, the head of that department or agency shall furnish that information to the Center on an agreed upon schedule.

They will also be authorized to utilize all existing information, both published and unpublished.

In order to carry out its functions, the Center shall—

“(i) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section,

“(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and

“(iii) adopt procedures allowing any interested party to submit information for the use by the Center and Commission under subsection (b) in making reports and recommendations.

So far, I have covered 524 pages of the original 1,018 page House bill. Have you noticed the repeating patterns and the total disregard for the freedoms we enjoy in this country?

This bill will allow the government to keep creating new entities, in the form of administrations, committees, and other administrative (bureaucratic) positions. This bill will allow the government to slowly dissolve our rights as citizens. This bill will allow the government to violate our right to privacy and even one of the amendments to the Constitution.

This bill will allow the government to ration health care where they see fit. This bill will allow the government to ignore current laws regarding paperwork and record keeping. This bill will allow the government to schedule the time frame in which you will die.

But most of all this bill will allow the government to destroy the very fabric of our country by destroying the republic for which we stand and replacing it with a socialist agenda that has proven to fail time and time again.

I’ll pick up tomorrow on page 525, Division B, Title IV, Subtitle B, Nursing Home Transparency.

HR3200 : Division B : Day Three : Part One

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

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

David writes,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and the “automatic enrollment” section, to state,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HR3200 : Division B : Day Two

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

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

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

Anyway, let’s get on with the bill…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HR3200 : Division B : Day One : Part Two

Okay, now that we have digest that whole “rebasing” idea, let’s move forward.

Section 1131 brings us back to those productivity improvements we heard so much about in the previous post, only this time it relates to outpatient hospitals, ambulance services, ambulatory surgical center services, laboratory services, and certain durable medical equipment.

Section 1141 redefines power-driven wheelchairs with “complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher” which means that Medicare and/or Medicaid will not be paying for just any power-driven wheelchair. I bet those Hover Round mobility scooter people are sweating over this one.

The next two sections relate to brachytheraphy and home infusion therapy, while Section 1144 requires ambulatory surgical centers to submit all of their cost and other data. This is a given since we’ve already discovered that everything, every piece of information about you, will be stored in a central government database.

Section 1145 defines the treatment of certain cancer hospitals.

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:

“(18) Authorization of adjustment for cancer hospitals.—

“(A) Study.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).

“(B) Authorization of adjustment.—Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.”.

Yes, you read that correctly. If the Secretary of Health and Human Services (who is probably not a doctor of any kind) decides certain hospitals are furnishing services that exceed the costs at other hospitals, the Secretary will be authorized to adjust the payments received by those “certain” hospitals.

In other words, also known as plain English, if certain hospitals provide services for too many people, the Secretary will require them to stop or slow down to lower costs, and in effect, begin the rationing of health care in those hospitals.

Section 1148 states that once a company supplies equipment to an individual they must do so for the remainder of the life of that equipment no matter where the individual may be located.

In the case of a supplier furnishing such equipment to an individual under this subsection as of the 27th month of the 36 months described in clause (i), the supplier furnishing such equipment as of such month shall continue to furnish such equipment to such individual (either directly or though arrangements with other suppliers of such equipment) during any subsequent period of medical need for the remainder of the reasonable useful lifetime of the equipment, as determined by the Secretary, regardless of the location of the individual, unless another supplier has accepted responsibility for continuing to furnish such equipment during the remainder of such period.

So, for instance, if you require a nebulizer for your breathing problems and ACME Nebulizers provides the equipment for you, they must continue to do so for the life of the equipment, whether you live in Oshkosh, Wisconsin, Nowhere, Arizona, or Prudoe Bay, Alaska.

The next few sections deal with oxygen rental and bone mass measurement.

Subtitle C, Section 1151 aims to reduce potentially preventable hospital readmissions. If a hospital has too many readmissions, their payments will be decreased.

With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of—

“(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and

“(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.

Not only will they penalize the hospital for too many readmissions, but they are also going to set the “readmission rate” at which people can be readmitted in the first place.

The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge. Insofar as the discharge relates to an applicable condition for which there is an endorsed measure described in subparagraph (A)(ii)(I), such time period (such as 30 days) shall be consistent with the time period specified for such measure.

Once the government starts telling you when you are allowed to return to the hospital, it’s called rationing. Plain and simple. There is no other way to describe it, unless of course you bury your head in the sound and pretend you can’t hear the warning alarms.

There will be no right to sue the government for setting the payment amounts, for penalizing hospitals for excess readmissions, how the government measures readmissions, or their determination that your hospital is subject to an increased payment amount because of those readmissions.

There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—

“(A) the determination of base operating DRG payment amounts;

“(B) the methodology for determining the adjustment factor under paragraph (3), including excess readmissions ratio under paragraph (4)(C), aggregate payments for excess readmissions under paragraph (4)(A), and aggregate payments for all discharges under paragraph (4)(B), and applicable periods and applicable conditions under paragraph (5);

“(C) the measures of readmissions as described in paragraph (5)(A)(ii); and

“(D) the determination of a targeted hospital under paragraph (8)(B)(i), the increase in payment under paragraph (8)(B)(ii), the aggregate cap under paragraph (8)(C)(i), the hospital-specific limit under paragraph (8)(C)(ii), and the form of payment made by the Secretary under paragraph (8)(D).

Oh, and don’t forget, it won’t just be the hospitals who pay when they ignore Big Brother’s guidelines for readmission.

In conducting the study, the Secretary shall consider approaches such as—

(A) creating a new code (or codes) and payment amount (or amounts) under the fee schedule in section 1848 of the Social Security Act (in a budget neutral manner) for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital or critical access hospital;

(B) developing measures of rates of readmission for individuals treated by physicians;

(C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission; and

(D) methods for attributing payments or payment reductions to the appropriate physician or physicians.

If a physician sees a patient and readmits them they will be penalized. Forget the fact you may need additional care, forget the fact the physician may be acting in your best interest. If they readmit you before the required “ration” time, their payments will be reduced.

So what have we learned so far?

In order to obtain the “nirvana of health care” in America, the government plans to create a new Health Choices Administration with at least three levels of bureaucracy (aka Commissioners, Ombudsman, etc).

They plan to replace our entire existing health care system, violate the privacy of all Americans and take away freedoms granted by the Constitution.

They plan to violate the 10th Amendment to the Constitution, place an unfair additional tax burden on specific groups of citizens (aka those who make more money than the government thinks they should), fix prices, set rates, and penalize those who don’t comply with the arbitrary rules that the Secretary decides to put in place.

They plan to limit the amount of health care you as an individual may receive (re-read the cancer treatment and readmission sections if you still don’t think they plan on rationing health care services), and it sounds like physicians who thought Medicare and Medicaid were a handful before haven’t even begun to experience the nightmare known as Medicare/Medicaid 2.0.

With any luck we’ll get through this thing before the Obama Administration tries to convince us that they’re willing to drop all the “public options”. The bill (as it is written now) has no chance of passing in either the House or the Senate, so you know they’re not going to actually drop it. They may try to hide it later in the bill, or re-introduce it as an amendment, but believe me, it’s not gone. If it’s gone, the bill is dead, and none of the bill supporters are going to allow that to happen easily.

Tomorrow we pick up with Division B, Subtitle C, Section 1152, on page 299.

HR3200 : Division B : Day One : Part One

Today, we begin with Division B, Medicare and Medicaid Improvements. I know we skipped a little bit, but feel free to read pages 204 – 215 which include Sections 442, 451, 452, and 453.

The table of contents for Division B is eight pages long. Yes, eight pages to tell you where everything is for this section alone. It figures that the Medicare/Medicaid section of this bill would take up so much space. Let’s dig in…

Title I, Subtitle A, Part 1, Section 1101 redefines the payments for skilled nursing facilities. Wow, they didn’t waste any time changing the payment structures in Division B. Section 1102 redefines the payments for inpatient rehabilition facilities, and Section 1103 incorporates “productivity improvements into market basket updates that do not already incorporate such improvements” in such places as skilled nursing facilities, long term care facilities, inpatient rehabilitation facilities, and psychiatric hospitals. Reading ruther it looks like they talk an awful lot about productivity improvements throughout a big part of the Medicare/Medicaid industry.

Section 1112 covers payment adjustments in response to coverage expansion. Not only will everyone be insured, but even more people will qualify for Medicare and/or Medicaid.

Not later than January 1, 2016, the Secretary of Health and Human Services shall submit to Congress a report on Medicare DSH taking into account the impact of the health care reforms carried out under division A in reducing the number of uninsured individuals

What do they want? A complete overhaul of health care. When do they want it? Now! When does the Secretary of Health and Human Services have to report on the impact of their “reform”? Not for 7 years. Whoah!

Universal Health Care. What does that mean? To most people, I think it means everyone will have insurance, everyone will be covered. Maybe not.

There is a “significant decrease in the national rate of uninsurance as a result of this Act” if there is a decrease in the national rate of uninsurance (as defined in subparagraph (B)) from 2012 to 2014 that exceeds 8 percentage points

If, after 3 to 5 years from the time this bill passes that there is a decrease of at least 8 percentage points in the national rate of uninsurance, the government will use the word “significant” when they refer to the decrease. The only thing significant about this section is the fact that national health care won’t provide a decrease of 100% of those who are uninsured. What do this have to do with Medicare and Medicaid anyway? Does this mean only poor people and old people won’t have universal health care?

Apparently it doesn’t apply to Medicare at all.

The term “national rate of uninsurance” means, for a year, such rate for the under-65 population for the year as determined and published by the Bureau of the Census in its Current Population Survey in or about September of the succeeding year.

So that whole section about the “significant decrease” only applies to people who are less fortunate / out of work / on the streets / needing assistance / doing without. Yes, it applies only to those people who need coverage in the first place.

Why exactly is the Secretary of Health and Human Services waiting seven years to report on the impact to Congress? Are they phasing it in, or giving it time while they phase out our existing health insurance plans?

Subtitle B, Part 1, Section 1121 amends the Social Security Act in regard to the sustainable growth rate reform, “rebasing” using 2009 for future adjustments, and limiting the rate computation for physician services. Yes, this means they are reformulating the amounts that can be charged and limiting how much physicians can charge for their services.

What happened to the free market? Setting the rates and limiting earnings are all part of the socialist agenda. It would be bad enough if they set rates for different specialties, but they don’t. Every physician, whether they are podiatrists or oncologists will earn the same amount of money.

Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.

Is “rebasing” a lot like “freebasing”? Because whoever wrote this section must have been on something at the time.

I can’t take anymore right now. One thing for sure, antacids better be covered under this plan because we’re all going to need it if this thing passes.

I’ll be back with more later, beginning with Division B, Subtitle B, Part 2, Section 1132 on page 265.

HR3200 : Division A : Day Four

I was going to do a quick review at this point, but I realized that today is August 15th and if I keep looking back to review, I’ll never move forward quick enough to cover the entire bill before Labor Day.

Division A, Title IV, Subtitle A, Part 2, Section 411 sets the employer responsibility regarding election to satisfy health coverage participation requirements. The section defines how the employer makes an election for coverage, the separate types of elections, and the termination of those elections if the Secretary of Health and Human Services determines that such employer is in noncompliance with participation requirements.

The non-complying employer will then be subject to an additional excise tax of $100 per employee, per day, until the failure is corrected.

In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee to whom such election applies, there is hereby imposed on each such failure with respect to each such employee a tax of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.

Imagine what happens if a small company with just 5 employees is found to be in non-compliance for just 31 days. That small business will be subjected to an additional $15,500 for those 31 days.

Subtitle B, Section 421 allows for the Small Business Employee Health Coverage Credit where a qualified small business employer will receive a credit initially set at 50%, but there’s a catch.

In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the percentage specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000.

That’s right. An employer whose average annual employee compensation is over $20,000, the “credit” is phased out. Wait, there’s more.

In the case of an employer who employs more than 10 qualified employees during the taxable year, the credit determined under subsection (a) shall be reduced by an amount which bears the same ratio to the amount of such credit (determined without regard to this paragraph and after the application of the other provisions of this section) as—

“(A) the excess of—

“(i) the number of qualified employees employed by the employer during the taxable year, over

“(ii) 10, bears to

“(B) 15.

Any employer with more than 15 employees won’t receive the credit. Again, there’s more.

No credit shall be allowed under subsection (a) with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid by the employer to such employee during such taxable year exceeds $80,000.

Section 421 sets the credit at 50% for small business owners, but then takes that credit away from any employer for compensation over $20,000, more than 15 employees, and those who make more than $80,000 per year. This does nothing but penalize those who do well. Yet another example of socialism.

The remainder of Section 421 deals with qualified employee health coverage expenses, average annual employee compensation, special rules for partnerships and self-employed, denial of double benefit, and inflation adjustments (yes, they will be raising amounts based on cost of living adjustments).

Subtitle C, Section 431 gives any Health Choices Administration officer or employee the right to access all of the information being stored in the main database. You remember the database we talked about two days ago don’t you? This section also restricts the use of disclosed information, but we all know how well government “restrictions” are enforced don’t we?

I have a serious problem with Subtitle D, Section 441. This section should be titled the “Socialist Redistribution Plan”.

In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—

“(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,

“(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and

“(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

If you are an individual making more than $350,000 per year, you are going to pay a higher percentage (via a “surcharge”). The more you make, the more you pay. The higher your income the higher percentage you are forced to pay. Let’s forget the fact that people who make more money pay a higher amount (dollar wise) already. Forcing them to pay more (percentage wise) is socialism, plain and simple. If health care is for everyone, then everyone should pay the same amount. Read this section carefully. Corporations that make more money, will not be paying more into the system. Only their employees will be responsible based on their income level.

The remainder of this section sets the definition for health reform savings, as well as adjustments and determinations.

When the government issues it’s reports on savings they will not be required to report all costs when determining those savings.

For purposes of paragraphs (3) and (4), reductions in Federal expenditures shall be determined without regard to section 1121 of the America’s Affordable Health Choices Act of 2009 and other program investments under division B thereof.

We’ll end this evening with this little tidbit at the end of Section 441.

The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.

That’s right. The taxes imposed under this section will not be treated as a tax. Remember, in socialism it’s your duty to contribute to the common good, and it wouldn’t be good for the common person if they used the word “tax” when they took your money from you.