Aug

16

HR3200 : Division B : Day One : Part One

Category: HR 3200, Our Nation | Comments Off | 769 words | Print

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.

Aug

15

HR3200 : Division A : Day Four

Category: HR 3200, Our Nation | Comments Off | 1,023 words | Print

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.

Aug

14

HR3200 : Division A : Day Three : Part Two

Category: HR 3200, Our Nation | Comments Off | 2,528 words | Print

We have a lot more to cover, so let’s continue.

Section 221 establishes the “public health insurance option” even though pretty much 99% of what we’ve read so far can be interpreted as “public option”.

For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the “public health insurance option”) that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary’s primary responsibility is to create a low-cost plan without compromising quality or access to care.

Not only will the Secretary of Health and Human Services create another health benefits plan, but they will also work to make sure that choice, competition and stability of affordable, high quality coverage is provided. I’m a little leery of this section. How do you ensure that prices stay affordable if you don’t set fixed prices for everyone across the board? Am I missing something?

The Secretary of Health and Human Services will create yet another position, the office of the “Ombudsman for the Public Health Insurance Option. Great, now we have two ombudsman and 95% of the people have no idea what an Ombudsman is, let alone what he/she will actually be doing to help reduce costs. Am I wrong to presume that costs will go down with this plan? It is called “America’s Affordable Health Choices Act of 2009” after all.

At this point we have an interesting item for you to take note of.

The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner—

(A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and

(B) at a level sufficient to fully finance the costs of—

(i) health benefits provided by the public health insurance option; and

(ii) administrative costs related to operating the public health insurance option.

The Secretary of Health and Human Services will be setting different premium rates for the “public option” based on your geographic location. Does it matter if you live in New York, Mississippi, Oklahoma, South Dakota, Utah, or Alaska? Shouldn’t health care cost the same across the board for everyone under the public plan? Do they plan on paying doctors in New York more than the doctors in Oklahoma? Sure, some places have a higher cost of living, but amputating a leg should cost the same amount no matter where you live.

Speaking of legs being amputated, did you see this statement from the American College of Surgeons?

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.

Of course, President Obama could have made an honest mistake and mispoke, like his predecessor, but he really should check his facts before opening his mouth at these events. He wouldn’t want to mislead people about the facts about health care in our country.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

Now, back to the health care “reform” bill.

Section 223 sets the payment rates for items and services. Ah Hah! I knew it. I knew they were going to be setting rates and fixing prices. They have to. There is no other way they can guarantee “affordable coverage” if they don’t fix prices. How do you think the private companies will feel about price fixing? You remember the private companies don’t you? They’re the entities that you’ll allegedly be able to keep your plans with, although the wording of this bill proves otherwise.

At least the companies involved have a way out if the government begins to set prices too low where it starts to interfere with their bottom line.

There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

Oops, my bad. It looks like the companies participating in the plan will not have the option of suing the government for price fixing. No judicial review means no court proceedings. Sorry guys, I guess you’ll have to take what the government gives you.

Not only can they fix the price where they want it, but Section 224 says they can do so without sufficient reason or explanation also.

Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas.

Section 225 doesn’t get any better, as they set the rate at which physicians can be paid.

Physicians.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes:

(A) Preferred physicians.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.

(B) Participating, non-preferred physicians.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.

Let’s review… The Secretary of Health and Human Services will create yet another Ombudsman position, set the rates for the public option, fix the prices for services under the public option, and set the rate for which physicians are paid under that option. Wow. So enticing. I bet you want to be a doctor now just so you can discover the joy of a colorectal exam. Receiving one, silly. The way things are going, physicians will experience pretty much the same thing when they participate in the public health plan option.

Subtitle C, Section 241 begins by re-assuring us that the public health plan option will be subsidized by the government (just like Medicaid), which of course can be directly translated to mean “subsidized by your tax dollars” in the form of “affordability credits”. The money has to come from somewhere people, and it isn’t like it’s going to start raining money all of a sudden. Unless of course, President Obama gets his giant weather generator working behind that big old curtain of his.

Sections 242, 243, 244, and 245 all define the affordability credits, premium credits, cost-sharing credits, and income determinations. Make sure you go back and read section 243, it sets the premium percentage based on your income above the Federal Poverty Level. If you make more, you pay more. No wonder liberals love this bill. It’s beginning to look like this “reform” bill will simply charge more money (percentage wise) to those who make more money, and in return, re-distribute the wealth, so to speak. Wait, isn’t that one of the key pieces of socialism?

Section 246 states,

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

Well, of course the government won’t give illegal immigrants any affordability credits, if you remember correctly, Section 152 said that services shall be provided “without regard to personal characteristics extraneous to the provision of high quality health care or related services. If they aren’t denied service, and they are not paying, there would be no reason to give them an affordability credit, would there?

Title III, Subtitle A, Section 301 defines individual responsibility. Here is the entire section of individual responsibility:

For an individual’s responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 401 of this Act).

It seems your only responsibility as an individual will be paying taxes. All Hail Socialism! Now shut up and pay your taxes you dolt.

Title III, Subtitle B, Sections 311, 312, 313, and 314 define employer responsibility.

These sections span eight and a half pages and require the employer to offer coverage to all employees. In addition to full-time employees, employers will also be required to contribute for part-time employees as well.

Minimum employer contribution for employees other than full-time employees.—In the case of coverage for an employee who is not a full-time employee, the amount of the minimum employer contribution under this subsection shall be a proportion (as determined in accordance with rules of the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable) of the minimum employer contribution under this subsection with respect to a full-time employee that reflects the proportion of—

(A) the average weekly hours of employment of the employee by the employer, to

(B) the minimum weekly hours specified by the Commissioner for an employee to be a full-time employee.

I wonder how fast the food will be at places like McDonald’s when they refuse to hire so many part timers because of the insurance costs. What’s the quality of service going to be like in any business, when companies are forced to make contributions for all of their part-timers. Something tells me that part-time jobs will become harder and harder to find.

Employers will not be allowed to “share” the cost of the health care plan contribution with the employee by taking his/her share out of their paycheck.

For purposes of this section, any contribution on behalf of an employee with respect to which there is a corresponding reduction in the compensation of the employee shall not be treated as an amount paid by the employer.

Any employer who chooses not to provide coverage through the public option will pay an additional tax on all payroll. Section 313 sets that rate to be 8% if the company payroll is over $400,000, 6% if it’s between $350,000 and $400,000, 4% if it’s between $300,000 and $350,000, and 2% if it is between $250,000 and $300,000. There will be no additional payroll tax for companies paying less than $250,000 per year in payroll. Something tells me a lot of smaller companies are going to be cutting salaries if this bill passes.

The next several pages and sections describe the satisfaction of health coverage participation requirements, as well as the rules for applying requirements. If you feel like reading about 14 pages of blah blah blah, feel free to go back and read it. For the sake of making it through the bill before Congress comes back from recess, I am going to move forward.

Title IV, Subtitle A, Section 401 imposes an additional tax on all individuals without “acceptable” coverage. This section amends the Internal Revenue Code of 1986, and does not define who will decide, nor how they will decide what is “acceptable” coverage. We should presume the requirements are the same as we have read in the prior 166 pages of the bill.

The additional tax to be imposed on the individual without acceptable coverage will be 2.5%.

In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—

“(1) the taxpayer’s modified adjusted gross income for the taxable year, over

“(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

Section 401 also states that

The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.

Basically, if you have unacceptable coverage, the government is going to tax you the amount of coverage up to the national average premium (remember the rates are set geographically so you could end up paying more than your neighbors). This means whether or not you want health care, whether or not you have coverage, you are going to pay for “acceptable” health care up to and including the national average premium, unless of course you’re Non-Resident alien.

Section 401 exempts nonresident aliens from the additional tax.

Subsection (a) shall not apply to any individual who is a nonresident alien.

Nonresident aliens can live here, work here, earn money here, and get medical treatment here. We are not allowed, however, to charge them an additional tax if they do not carry acceptable health care coverage. That sounds fair, right?

By the way, if you read Section 401, you’ll find that those who have religious conscience objections are also exempt from the additional “unacceptable coverage” tax. Again, that’s fair, right?

Acceptable coverage will be defined as,

Acceptable coverage.—For purposes of this section, the term ?acceptable coverage’ means any of the following:

“(A) Qualified health benefits plan coverage.—Coverage under a qualified health benefits plan (as defined in section 100(c) of the America’s Affordable Health Choices Act of 2009).

“(B) Grandfathered health insurance coverage; coverage under grandfathered employment-based health plan.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America’s Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).

“(C) Medicare.—Coverage under part A of title XVIII of the Social Security Act.

“(D) Medicaid.—Coverage for medical assistance under title XIX of the Social Security Act.

“(E) Members of the Armed Forces and dependents (including TRICARE).—Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

“(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran’s Affairs and the Health Choices Commissioner, based on the individual’s priority for services as provided under section 1705(a) of such title.

“(G) Other coverage.—Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.

I almost made it to page 200, but I realized this post was getting quite long, and I didn’t intend for it to be so long. I’ll leave it here for this evening and we’ll pick up tomorrow at the top of page 179, Section 411.

Aug

14

HR3200 : Division A : Day Three : Part One

Category: HR 3200, Our Nation | 1 Comment | 1,794 words | Print

People amaze me. Over the course of the past two days I have received half a dozen emails from people regarding HR 3200. Why do people think I am against health care reform just because I do not support this bill? I know our current system is flawed. I know our current system needs work. I also know that completely overhauling and replacing our current system, as this bill does, is a ludicrous idea.

The whole idea of reform is to improve upon something, or to change what is wrong with something. When you reform something, or someone, you improve it/them by alteration, substitution or abolition. The key word in reform, is improve.

I’ve yet to see one item in “America’s Affordable Health Choices Act of 2009“, the health care reform bill, that improves anything already in place within our current system. I see where it is going to complicate a lot of things and I see where it’s going to place additional burden on all Americans. I see that it is going to require us to give up some of our personal liberties (such as privacy and financial information), and I see that costs are going to skyrocket. All this, and I’ve covered less than a hundred pages with you. There isn’t much reason to be optimistic in the remaining 900 pages either.

In Division A, Title II, Subtitle A, Section 201, we learn that the “Health Choices Administration”, under the direction of our now famous “Commissioner”, will

facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.

At this point we finally learn what the “Commissioner’s” duties will be, and the “Health Insurance Exchange” is defined. The “Exchange” includes any qualified health benefits plan operating under the health care plan. It sounds to me like this puts private and employer-based health care plans under the government control (else they would not be allowed to participate in the “Exchange” would they).

Section 202 defines “exchange eligible” individuals and employers, how and when they can enroll, and how they will be covered.

Section 203 sets the benefits package levels and states,

The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.

I guess I don’t have to remind you that any benefits package you choose, whether it comes from the soon to be “regulated out of existence” private health care plans to the government created plans, will be defined by the “Commissioner”.

Section 203 goes on to define the requirements for offering basic, enhanced and premium plans as well as repeat the fact that the “Commissioner” will also set the individual benefit levels for each benefit plan.

By giving the “Commissioner” the authority to set the benefit levels for each plan, each year, the bill sets the stage to allow for health care rationing.

As I discussed yesterday, the “no annual or lifetime limits” clause of this bill will send costs skyrocketing, and the only way to control those costs will be to ration the amount of care provided, and as a result, the amount of money spent on health care. Of course, the word ‘rationing’ does not appear in the bill, but Section 203 sets the stage so the “Commissioner” can authorize it without approval of the President, Congress, or the citizens of the United States.

Section 204 defines the contracts for offering exchange-participating health benefits plans. Whew, that’s a mouthful. If you think this 1,018 page bill is intimidating you should wait to see some of the “contracts” that will come out of the “Exchange”.

Section 205 covers the outreach and enrollment of individuals and employers in the exchange-participating health benefits plan.

The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.

Which entities will be considered “appropriate”? Which organizations will be utilized to reach the “vulnerable populations”? Exactly which part of the population is considered “vulnerable” under this plan? It sounds to me like community organizations like ACORN could be tapped for something like this. Maybe Obama will use AmeriCorp resources. Would that be appropriate? Section 205 sure leaves a huge loophole for any number of circus acts (organizations favorable to the “Commissioner” or the administration) to jump through.

Section 205 also allows the “Commissioner” to automatically enroll any Medicaid eligible individual unto Medicaid.

The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

I thought President Obama said this health care “reform” was about keeping our freedom to choose our health care benefits? I thought, if we were happy with our current plan we could keep it? I guess that promise doesn’t apply if you are self-employed, insured through an employer, elderly, unemployed, or eligible for Medicaid. President Obama should really put an asterisk after his statements.

“You can keep your current plan, asterisk”. Then they could use that guy that speaks after every automobile commercial (you know, since he’s a government employee now too), to voice the actual disclaimer and everything, so.

Section 206 sets “other functions” such as the coordination of affordibility credits, coordination of risk pooling, and establishment of yet another new government position as well as the duties for that position.

There is hereby established the Office of the Special Inspector General for the Health Insurance Exchange, to be headed by a Special Inspector General for the Health Insurance Exchange (in this subsection referred to as the “Special Inspector General”) to be appointed by the President, by and with the advice and consent of the Senate.

So, in review, we have created a new “Health Choices Administration” with a “Commissioner” who heads that administration and sets the definitions and requirements for all of our health care plans, as well as the benefit levels of those plans. We have created a new “Qualified Health Benefits Plan Ombudsman” who will receive complaints and grievances, and submit annual reports to Congress and the “Commissioner”. We have created a new office, the Office of the Special Inspector General for the Health Insurance Exchange which will be headed by the “Special Inspector General for the Health Insurance Exchange”.

The “Special Inspector General” will conduct, supervise, and coordinate audits while reporting to both the “Commissioner” and Congress.

Section 207 establishes the Health Insurance Exchange Trust Fund (think Social Security Trust Fund and you’ll pretty much understand this whole section). Haven’t politicians been talking about fixing Social Security for years now? Isn’t Social Security going broke? What makes them think an additional trust fund set up the same way will work this time around?

Section 207 also sets the stage for additional taxes. What? You thought this was going to be free? The only way to fund the health insurance trust fund will be raising taxes. Of course the text of the bill won’t specify it, but how do you think these government trust funds are funded?

In addition to the normal additional taxes you’ll already be paying to cover the cost of this health care bill, if you do not obtain acceptable coverage, or as an employer you do not provide acceptable coverage, you will pay additional taxes.

There is hereby appropriated to the Trust Fund amounts equivalent to the following:

(A) Taxes on individuals not obtaining acceptable coverage.—The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).

(B) Employment taxes on employers not providing acceptable coverage.—The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).

(C) Excise tax on failures to meet certain health coverage requirements.—The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).

As a small business owner, I won’t have a choice. I won’t be able to afford the government’s new definition of “acceptable coverage” for my smallest of companies, so I am sure I will be paying an additional tax. My wife owns her own small business as well, she won’t be able to afford the government’s new definition of “acceptable coverage” either, so in addition to the additional tax on her as an employer, she’ll also be paying an additional excise tax.

Section 208 removes a States right to offer their own State-based health insurance.

If—

(1) a State (or group of States, subject to the approval of the Commissioner) applies to the Commissioner for approval of a State-based Health Insurance Exchange to operate in the State (or group of States); and

(2) the Commissioner approves such State-based Health Insurance Exchange,

then, subject to subsections (c) and (d), the State-based Health Insurance Exchange shall operate, instead of the Health Insurance Exchange, with respect to such State (or group of States). The Commissioner shall approve a State-based Health Insurance Exchange if it meets the requirements for approval under subsection (b).

The “Commissioner” must approve any State-based “Exchange”, therefore denying States rights granted under the U.S Constitution.

The 10th Amendment to the U.S. Constitution states,

The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.

The U.S. Constitution does not give the United States (the feds) the authority to regulate health care within the borders of the States, and it also doesn’t prohibit the States from doing so, therefore, the United States (the feds) can not legally decide what the States can and cannot do in regard to health care. There is no right side or left side of this argument, it’s written in the Tenth Amendment to the U.S. Constitution.

Who knew reform included completely replacing our current system, creating additional bureacracy, violating the privacy of all Americans, taking away freedoms from all Americans, placing an unfair additional tax burden on a specific group of citizens and violating the U.S. Constitution?

When Barack Obama said he was going to bring fundamental change to America, he wasn’t kidding, was he?

I’ll pick up with Division A, Title II, Subtitle B later today.

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Aug

13

HR3200 : Division A : Day Two, Part Two

Category: HR 3200, Our Nation | Comments Off | 1,565 words | Print

So far, in my previous three posts, we have learned that President Obama and Congress are planning to create government based health care plans and at least two new “high profile” jobs, including a new health care “Commissioner” and a Qualified Health Benefits Plan Ombudsman.

We’ve also learned that someone is lying to us when it comes to keeping our existing health plans, and the cost of covering the main illness of 0.9% of the population will cost approximately $72 billion per year.

Subtitle F refers to numerous additional requirements, like coverage not offered through the health care “exchange”, coverage that is offered through the exchange, and the prohibition of discrimination in health care. Section 152 states,

Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

Coverage offered by HR 3200 shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services?

If I read this correctly then am I to believe that health care coverage and related services will be provided to anyone no matter what other facts we may know about that person as long as those facts have nothing to do with the health care or the services being offered?

Exactly who would this cover? If this health plan is for all Americans, what other people would there be to consider, other than illegal immigrants? Does this mean we, as citizens, will be paying for the health care of illegal immigrants? Wait, don’t we already do that?

After this carefully crafted paragraph that increases our debt load by providing free health care to approximately 20 million more people, the bill goes on to protect whistle-blowers, collective bargaining, and severability. In Subtitle G, Section 161 amends Title XXVII of the Public Health Service Act to establish the enforcement of rebates to enrollees (which we have already discussed),

Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.

Section 163 pertains to administrative simplification. Has anything in government ever been simple? Pay attention to this section though, it provides authorization for the government to obtain real-time access to your financial information as well as the creation of a national health care ID card.

Goals for financial and administrative transactions.—The goals for standards under paragraph (1) are that such standards shall—

“(A) be unique with no conflicting or redundant standards;

“(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;

“(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;

“(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

“(E) enable, where feasible, near real-time adjudication of claims;

“(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;

“(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and

“(H) harmonize all common data elements across administrative and clinical transaction standards.

So, up to this point (page 58) we have also learned that the government will have the right to audit the books of any company that self-insures their employees, and the government will have real-time access to all of our financial as well as medical information, to be reviewed, before you are provided service.

There is good news, however. While they are reviewing your finances before providing service, they will be authorized to debit your account on the spot to pay for that service.

Requirements for specific standards.—The standards under this section shall be developed, adopted and enforced so as to—

“(A) clarify, refine, complete, and expand, as needed, the standards required under section 1173;

“(B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version;

“(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;

“(D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing;

“(E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; and

“(F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.

Not only will they be performing surgery that could save your life, but it looks like they’ll be surgically removing money from your bank account at the same time.

Why would they need to determine your financial responsibility before they saved your life? Are they insinuating that, based on your finances, your life might not be worth saving? Wow. That’s a bit archaic isn’t it?

You really need to re-read this section, the entire section. It gives the government far too much power, for a level of service you already receive right now. The only difference is that right now, if something happened and you were rushed to the emergency room, they would save your life first, without looking at your bank account.

Don’t forget, the whole idea of a nationalized health care program wouldn’t be complete if the government didn’t store all the data it collects from doctors, hospitals, banks, and other health and financial institutions.

The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are—

“(1) used and disclosed in a manner that meets the HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), including any privacy or security standard adopted under section 3004 of such Act; and

“(2) protected from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.”.

We all know how safe government controlled data is, right? We have no reason to suspect that anyone would ever attempt to access that data through “inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses”

Imagine the data they will be keeping. How much money are you making? How much money do you have left after you pay your bills? How much money do you spend on items that might have an adverse affect on your health (cigarettes, alcohol, fatty foods, soft drinks)? What kind of lifestyle do you lead? Do you have guns in the house? Are you active in your community? Do you go to church each Sunday? Do you live an alternative lifestyle?

All of this information will be kept by the government for use at their disposal. Just imagine the possible ramifications. How long will it be until they start denying claims for lung cancer because people smoked and knew better? Do you honestly think they will cover HIV medication for gay people that never spent a dime on protection? I’m serious. What do they plan to do with the information they collect and just how much information are they planning to collect?

They’ve already made it clear how far they plan to intrude into our lives, why should a silly little thing like privacy matter when America’s Affordable Health Choices Act of 2009 could mean so much to so many people?

You pay the government a huge increase in taxes, you give the government access to your medical records, you give the government access to your bank account, and you give the government the right to store all of your personal data in an easily accessed (real-time) database. For all that, you receive health care that is decided by a “Commissioner”, overseen by an Ombudsman, and paid for by your freedom. It’s worth the trade isn’t it?

If you’re planning on retiring anytime soon, you may want to read Section 164. Tomorrow we will pick up again at page 72, which is the beginning of Division A, Title II, the Health Insurance Exchange and Related Provisions.

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Aug

13

HR3200 : Division A : Day Two, Part One

Category: HR 3200, Our Nation | Comments Off | 1,025 words | Print

As I sat down this morning to start this post, I received an email with a link to a post at The Foundry over at The Heritage Foundation.

They add more insight to answering the question, “Does the House Plan Outlaw Private Insurance?”. They provide two different takes on the wording of Section 102 (which we covered yesterday), but they come to one simple conclusion.

Furthermore, all these new regs would not apply just to individual insurance plans, but to all insurance plans. So the House bill will also drive up the cost of your existing employer coverage. Until, of course, it becomes too expensive and they just dump you into the government plan.

So IBD is wrong: individual health insurance will not be outlawed. But it will be effectively regulated out of existence… which is effectively the same thing.

We begin today with Division A, Subtitle C, Section 121 which lays the groundwork for essential benefits packages, and defines the choices of coverage. Section 122 defines the essential benefits package.

In this division, the term “essential benefits package” means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that—

(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

(4) complies with section 115(a) (relating to network adequacy); and

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.

The basic definition of the essential services sounds nice on first read, but after reading it a second time I have a couple questions.

No annual or lifetime limits sound awesome, but how many private or employer-based insurance companies will survive if they cannot impose any annual or lifetime limits on coverage?

How will the government control the costs of the government controlled plans if there are no limits? Think about it for a moment.

More than 1.4 million people in the United States were diagnosed with cancer in 2008. According to U.S. News and World Report, the cost of treating people with cancer varies greatly depending on the cancer, with annual costs ranging from $39,891 for someone with lung cancer down to $18,261 for someone with prostate cancer. These estimates do not take into account newer, more expensive medications so for the sake of argument I will use an average of $29,076 for this example. With each type of cancer there are numerous possibilities for life expectancy, which depends not only on the type of cancer, but how soon it was diagnosed, the success of treatment, and whether or not the cancer returns. The average annual cost of treating everyone newly diagnosed with cancer (remember this is only for the 1.4 million that were diagnosed in one year) is $40,706,400,000. $40.7 billion.

Parkinson’s disease affects more than 500,000 people in the United States with an average of 50,000 new cases each year. There is no cure for Parkinson’s. According to medicinenet.com, the annual cost to the nation for treating Parkison’s is $6 billion.

According to AVERT, there are more than a million people living with HIV in the United States. The average lifetime cost of treatment (in 2006) for someone living with HIV was $618,900. So, to cover just one million people for their expected lifetime, the cost of that care will be close to $618,900,000,000. That’s $618.9 billion. According to the same reports, the average person lives 24 years after being diagnosed with HIV, which brings the average yearly cost of treating everyone in the United States living with HIV to $25,574,380,165. Yes, $25.5 billion.

The current population of the United States is just over 304 million. The annual cost of treating just the 2.9 million of us who are diagnosed with cancer, Parkinson’s, or HIV is $72.2 billion.

Remember, that’s an annual cost, not the lifetime cost. $72.2 billion to treat 0.9% of the population. I wonder how high the annual costs will be when we include the other 99.1% of the population and heart disease, stroke, and the other leading causes of death in the United States?

Section 122 continues by defining the essential services to be offered, the minimum services to be covered, and the requirements relating to cost-sharing and minimum actuarial value.

Section 123 defines the Health Benefits Advisory Committee which will consist of the Surgeon General, 9 non-Federal employee members appointed by the President, and 9 non-Federal employee members who are appointed by the Comptroller General of the United States, similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission.

The Health Benefits Advisory Committee will decide what benefits and treatment options are included in each plan. If Medicare is broken and we’re trying to fix it, why are we allowing the same crony to appoint people the same way as the system that is known to be broken? That just doesn’t make any sense does it?

As we read even further, into Section 131, we find that not only will the advisory committee set the benefits and treatment options, but the “Commissioner” will decide which review process to use while considering appeals. Nice independent review there huh?

The next several sections cover everything from benefit plans not covered through the “exchange”, timely payment of claims, the governance of the program by the Commissioner, his/her duties, and the creation of the Qualified Health Benefits Plan “Ombudsman”. The Ombudsman will receive complaints, grievances, and requests submitted by individuals, provide assistance to those items, and submit annual reports to Congress and the Commissioner. It sounds like just another layer of bureaucracy to me.

Later tonight we will will continue with SubTitle F of Division A. Make sure you’re ready…

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Aug

12

HR3200 : Division A : Day One

Category: HR 3200, Our Nation | 1 Comment | 1,657 words | Print

Now that we’ve all read “Division A” of House Resolution 3200, America’s Affordable Health Choices Act of 2009, let’s look at the bill a little more closely.

Following the purpose of the bill, in section 101, we see the requirements for qualified health benefits plans. These plans will not be considered qualified health benefits plans unless they meet the same requirements that the government created plans. That means they have to meet all of the same standards, make coverage affordable, provide essential benefits, and offer additional consumer protections.

On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:

(1) Subtitle B (relating to affordable coverage).

(2) Subtitle C (relating to essential benefits).

(3) Subtitle D (relating to consumer protection).

Sadly, it does not end there. In the beginning, you will be allowed to keep your current employer-based coverage. Existing plans can be grandfathered in.

Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met

If we stop reading at this point, it doesn’t sound so bad. But what are those “following conditions”? Are there limitations? Why, yes, there are.

(1) Limitation on new enrollment.

(A) In general.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) Dependent coverage permitted. — Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) Limitation on changes in terms or conditions.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) Restrictions on premium increases.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

That doesn’t sound so bad does it? Read section (A) again. Existing plans cannot “enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1 (year one). Existing plans cannot change any terms or conditions including benefits after the first day of year one, and they cannot raise rates unless they raise them for everyone in the plan. Yes, the bill states you can keep your existing plan, but with the added “standards”, regulations, prohibition of adding new enrollees, and inability to modify their plans. How many of those current plans will still exists when the “grace period” ends in year five?

Can we be sure that existing plans will still be an option once this bill is signed into law?

President Obama assures us that we can keep our existing coverage. Pay attention at the 3:33 minute mark. In his own words…

Click here To Watch Video

“Under our proposal, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period. End of story.”

Apparently, the story doesn’t end there. As the legendary Paul Harvey would say, here’s the rest of the story.

Click here To Watch Video

Again, wait for the 1:11 mark, and you’ll hear the President, in his own words, guarantee us that we will be able to keep our existing insurance.

Linda Douglass wants us to think that people are cherry picking President Obama’s words and piecing them together, then she played two videos where he admits once again that we will be able to keep our existing insurance plans if we like them. Thanks Linda! (Special thanks to Vinny for supplying the Douglass video).

If President Obama is telling the truth about existing health care plans, why did the Energy & Commerce Committee vote on an amendment from Rep. Cliff Stearns (R-FL) on July 28th that stated, “Nothing in this division shall prevent or limit individuals from keeping their current health benefit plan”?

If President Obama was telling the truth, that text should already be included in the bill, and an amendment stating such would not be introduced in committee. As you probably know, “Amendments are proposals to alter or rewrite legislation being considered by Congress. The amending process provides a way to shape bills into a form acceptable to a majority in both the Senate and House of Representatives.” Did you catch that? A proposal to alter or rewrite legislation, not repeat the text within it.

According to this fact sheet at the Congressional Quarterly,

“Amendments have many objectives. Members may introduce amendments to dramatize their stands on issues, even if there is little chance that their proposals will be adopted. Some amendments are introduced at the request of the executive branch, a member’s constituents, or special interests. Some become tools for gauging sentiment for or against a bill. Some may be used as “sweeteners” to broaden support for the underlying measure. Others are used to stall action on or to defeat legislation. In the House, where debate is strictly limited, amendments may be used to buy time; a member may offer a pro forma amendment, later withdrawn, solely to gain a few additional minutes to speak on an issue.”

The amendment introduced by Rep. Stearns was not a “pro forma” amendment. It was discussed and voted on. For your information, the amendment FAILED in a vote of 32-26. You can see how committee members voted by clicking the image to the left.

So who’s misleading us? Is President Obama lying when he says we will be allowed to keep our existing health benefit plan? If the guarantee that we could keep our existing health benefit plan was written in the bill, the Energy and Commerce Committee would not be wasting their time voting on an amendment that proposed the same guarantee.

Sixteen pages into the bill and we’ve already established that someone is lying to us. You don’t have to have an R or a D after your name to see that.

Let’s move on…

Section 112 informs us of the guaranteed availability and renewability of health insurance coverage, whether it’s government provided or employer-based. It really irks me that on page 20 they keep referring to employer-based plans even though we’ve already learned that those plans are only temporary.

In Section 113, we learn,

The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets.

This study will include types of employers, similarity and difference of health plans offered, the financial solvency and capital reserve levels of employers that self-insure by employer size, the risk of self-insured employers becoming financially insolvent, and the extent to which rules likely to cause and adverse selection.

Stop for a moment. Re-read the previous paragraph. Tax returns report the income an individual or company makes for the year. It does not report the financial solvency of the company or their capital reserve levels. Exactly how is the government “study” going to report this information? It’s an honest question that is not answered within the confines of HR 3200. It sounds to me like the government plans on having the authority to examine the books of any company that self-insures. Is that authority written into the bill? We need to keep reading don’t we?

Section 115 sets another standard for qualified health benefits plans.

A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

Apparently, this “Commissioner” will have the sole authority to decide which provider networks are qualified and which ones are not. Who will be the Commissioner and why are we giving him/her the sole authority to make such decisions? Did you know that Section 116 also gives him/her the authority to set the prices for all qualified plans?

A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

That’s right. All qualified health benefits plans will be required to meet the same “medical loss ratio”, which means any profit above the ratio set by the “Commissioner” will be returned to enrollees in the form of rebates. How many private employer-based health plans would still participate after the first year if they had to return most of their profits at the end of the year (provided we were allowed to keep our current providers in the first place)?

We sure as hell know we won’t get rebates from the government controlled plans, and what private company in their right mind would do business this way? Section 116 sure does a good job of subtly setting the stage for “socialized medicine” doesn’t it?

To Be Continued…
(We’ll start with page 25 next. If you still haven’t finished reading “Division A”, you still have time).

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