Two Thousand Seventy Four Pages

Scary Harry Reid released the brand new Senate health care reform bill. I’ve added it to the source document list to the left, and I will begin reading it sometime tomorrow. According to early reports, the bill will cost $849 billion over 10 years, and will reduce the deficit by $127 billion over that same 10 years.

$127 billion dollars sounds like an awful lot, except it’s not. Not really. The federal deficit for October 2009 alone, was $176 billion. Think about it. The Senate version of health care reform will reduce the deficit by $1.058 billion per month for 10 years. If we have more months like October 2009, the deficit will still rise by more than $174 billion every month.

The next time you hear someone brag about this bill “reducing the deficit” just slap them in the face with the facts and watch the blood drain from their face.

The Senate health care bill is being introduced as an amendment, in the form of a substitution, for House Resolution 3590. HR 3590 had absolutely nothing to do with health care before this substitution.

Early reports indicate that this substitute HR3590 contains a 40% excise tax on health care plans which are in excess of $8,500, an additional 0.5% Medicare tax on wages in excess of $106,800, and additional fees for manufacturers of certain drugs and medical devices. The bill also raises taxes by $370 billion over 10 years, and it doesn’t stop there. The Senate health care reform bill allows for taxpayer-funded abortions through the public health insurance plan and the health insurance “exchange”.

In short, the Senate bill will raise premiums, raise taxes, and cut benefits. You can read the Congressional Budget Office score of the bill (PDF), for more information on the costs of this version of health care reform but remember one thing. The bill they scored for this report (HR 3590) will not be the same bill (therefore their score of the bill will no longer be valid) once it passes. It is sure to “evolve” before any final vote comes to the Senate floor.

Like I said at the beginning of this post, I will begin my review of the substitute to HR3590 tomorrow evening. Until then, get reading. Don’t make me do it alone.

HR3962 : Division D

So far, the contents of HR3962 have been absolutely insane. From the transition to the single payer system and federally funded abortions to the tight regulation of neighborhood obesity, restaurant menus, and vending machines, it’s been quite a ride.

This final section, Division D, pertains to Indian Health Care Improvement, but just wait until you see some of the items Nancy Pelosi and the gang feel will improve Indian health.

Section 3101 of HR3962 amends the Indian Health Care Improvement Act. In addition to numerous other sections, it also amends section 301, by stating,

Congress finds the following:

(1) The provision of sanitation facilities is primarily a health consideration and function.

(2) Indian people suffer an inordinately high incidence of disease, injury, and illness directly at attributable to the absence or inadequacy of sanitation facilities.

The bill states “sanitation facilities” several times in this section, and Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services, yet they never really state which sanitation systems will be further regulated, and there is no mention about the authority of the local tribes that will be affected by this legislation. What if they have existing standards, infrastructure and systems? Shouldn’t they have some say about how these facilities will be serviced and monitored? Is clean drinking water part of the plan for these “sanitation facilities”?

In the previous post we saw the return of involuntary servitude and discrimination so it only makes sense that “Indian Health Care Improvement” would involve the taking of Indian land… again… right?

Notwithstanding any other provision of law, the Bureau of Indian Affairs and all other agencies and departments of the United States are authorized to transfer, at no cost, land and improvements to the Service for the provision of health care services. The Secretary is authorized to accept such land and improvements for such purposes.

Something tells me this isn’t going to go over well either. Health care services or not, they may take offense to the fact that the Secretary of Health and Human Services now has the right to take any land he/she wants as long as she justifies it in the name of improved health care.

This section continues to erode tribal sovereignty by assigning control of any and all grants and/or contracts between Tries and any health care, education, disease prevention, wild life preservation, land preservation, land purchases, and anything else covered by the Snyder Act.

Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), the Secretary, acting through the Service, shall enter into contracts with, or make grants to, urban Indian organizations to assist such organizations in the establishment and administration, within Urban Centers, of programs which meet the requirements set forth in this title. Subject to section 506, the Secretary, acting through the Service, shall include such conditions as the Secretary considers necessary to effect the purpose of this title in any contract into which the Secretary enters with, or in any grant the Secretary makes to, any urban Indian organization pursuant to this title.

For more information on this blatant encroachment of tribal sovereignty, make sure you read all of the pages from 1805 through 1877.

The bill authorizes the Secretary to decide what constitutes mental illness for the Indian community.

The purposes of this section are as follows:

(1) To authorize and direct the Secretary, acting through the Service, to develop a comprehensive behavioral health prevention and treatment program which emphasizes collaboration among alcohol and substance abuse, social services, and mental health programs.

(2) To provide information, direction, and guidance relating to mental illness and dysfunction and self-destructive behavior, including child abuse and family violence, to those Federal, tribal, State, and local agencies responsible for programs in Indian communities in areas of health care, education, social services, child and family welfare, alcohol and substance abuse, law enforcement, and judicial services.

and also provides for the conversion of existing hospital beds (for medical treatment) to be used in psychiatric wards as needed.

Mental Health Care Need Assessment- Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, the Secretary, acting through the Service, shall make an assessment of the need for inpatient mental health care among Indians and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need.

Why would American Indians need more psychiatric beds anyway? Does the government know something we don’t or are they preparing for something bigger? When it comes to HR3962, it doesn’t get much bigger than this.

The bill makes reference to treatment programs specifically for women,

The Secretary, consistent with section 701, may make grants to Indian Tribes, Tribal Organizations, and urban Indian organizations to develop and implement a comprehensive behavioral health program of prevention, intervention, treatment, and relapse prevention services that specifically addresses the cultural, historical, social, and child care needs of Indian women, regardless of age.

funding for a Fetal Alcohol Disorder Task Force,

The Secretary shall establish a task force to be known as the Fetal Alcohol Disorder Task Force to advise the Secretary in carrying out subsection (b).

and the establishment of a Native American Health and Wellness Foundation.

As soon as practicable after the date of enactment of this title, the Secretary shall establish, under the laws of the District of Columbia and in accordance with this title, the Native American Health and Wellness Foundation.

And with that, I wrap up my quick summary of House Resolution 3962, Affordable Health Care for America Act.

Make sure you read the pertinent parts of this bill. It was a much tougher read than the previous bill, which I think was intentional on the part of Nancy Pelosi and the gang. Almost every provision of HR3962 makes an amendment to some other legislation or act which is already in place, so learning the true intention of many sections was quite painstaking.

I shudder to think what the final Senate version of the bill will look like, if we’re ever allowed to see it, and once the two are merged, it’s going to be completely ridiculous, I am sure.

That’s it for tonight, I’m going to sleep now.

HR3962 : Division A : Part Two

Before I begin tonight, I need to backtrack a bit and remind you that HR3962 establishes the new Health Choices Administration, the Health Choices Commissioner, and the Health Insurance Exchange just like HR 3200 contained. The Secretary of Health and Human Services, as well as this new Commissioner will dictate every aspect of the new government controlled “exchange plans”.

The Health Choices Commissioner will have the authority to audit every qualified health benefits plan to see if the plan meets all government criteria and whether or not that plan has violated any government regulation. As written in this bill (like HR 3200) there is no limit to this authority and leaves the door wide open for abuse by the HCC.

I still have 12 pages of notes on my desk to get through, and somehow I skipped that interesting tidbit in my review last night. In this post I will pick up right where we left off, with additional taxes and “credits” in Section 521 on page 318.

In previous sections we learned that a small business owner could potentially pay almost $28,500 in taxes (as penalties) when he/she makes just $100,000 per year. Section 521 gives that small business owner an “employer health coverage tax credit”.

The default amount for that credit is 50% of what that small business owner pays in health care costs based on the employee, if they have 10 employees or less.

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.

On page 319 we learn that there will be no credit for the employer if the employee makes $80,000 or more. I don’t know about you, but I foresee a big reduction in salaries as a way for employers to receive a larger credit from the government. Oh, and HR3962 makes sure that credit is not permanent. It only applies for two taxable years. Generous huh?

Section 531 changes the way you’ll be able to use your Health Savings Account, Flexible Spending Accounts, or Health Reimbursement Arrangements. Thanks to this section you will no longer be allowed to use those accounts to purchase non-prescription medications which will in turn raise the amount of taxes you pay on your income because you’ll no longer be able to use non-taxed money to make those purchases.

Flexible Spending Accounts help American’s budget their medical and health needs throughout the year, and thus far have been uncapped. Section 532 changes this by capping FSA’s at $2,500 per year. Section 533 increases the penalty for nonqualified distributions (like purchasing non-prescription medication) from 10 percent to 20 percent. Yes, you read that correctly. HR3962 will cut the number of qualified items and services you can purchase with your FSA while doubling the penalty for those non-qualified purchases.

Section 534 eliminates the current tax deduction for employer based health plans which coordinate with Medicare Part D, which will make private health insurance participation in Medicare non existent (while that private health insurance exists anyway).

Section 551 imposes a surtax on anyone who finds success and earns a high income because of that success. According to this section, those individuals who make more than $500,000 (modified adjusted gross income) will pay an additional surtax (yes, this is another reference to another newly defined tax) of 5.4%.

(a) General Rule- 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 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

(b) Taxpayers Not Making a Joint Return- In the case of any taxpayer other than a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), subsection (a) shall be applied by substituting ‘$500,000’ for ‘$1,000,000’.

This new surtax will raise the top tax rate of 39.6% to 45%. Yes. If you make $500,000 per year you will pay 45% income tax. It seems that the lawmakers who wrote this bill are a bit jealous of those who find success and this is their way of sending a message that they would prefer them not to be successful.

Think about it. If you make $500,000, you’ll be paying an additional $27,000 simply for being successful. In total, if you sit at the highest tax rate and you make $500,000, you’ll end up paying $225,000 in taxes and end up with a net total of $275,000. Your counterpart, however, who makes $499,000 will pay $197,604 and end up with a net total of $301,396. In other words, if you make $1,000 more than your counterpart, your counterpart will take home $26,396 more than you will.

Those Democrats sure have a great way of congratulating you for your success, don’t they? Hang in there. At this point you still have some income left and we still have at least five new taxes to discuss here.

Section 552 implements a new excise tax of 2.5% on the manufacture of medical devices, Section 553 requires the reporting the “exchanges of property” in addition to income on 1099-MISC forms as well as requiring corporations to report payments to other corporations, not just individuals, Section 554 delays corporate tax relief from the American Jobs Creation Act for nine years, and Section 561 places limitations on tax treaty benefits for certain deductible payments, which will allow for double taxation on some earnings.

I’ll take a moment to pause right here and reflect on the fact that a delay in tax relief is basically the same as imposing a new tax. I’ll wait another moment too, so those who got lost because we moved so quickly through that last paragraph can have a chance to catch up with the rest of us.

Section 562 gives the Internal Revenue Service a new unbridled power under the title “Economic Substance Doctrine”, where the IRS will be permitted to disallow legitimate tax deductions

ECONOMIC SUBSTANCE DOCTRINE- The term ‘economic substance doctrine’ means the common law doctrine under which tax benefits under subtitle A with respect to a transaction are not allowable if the transaction does not have economic substance or lacks a business purpose.

If the IRS believes the motive for the deduction was not primarily business related, the IRS, in it’s own determination will decide whether or not the deduction is allowed. This section does not define the appeal process, if there is any, regarding the new ‘economic substance doctrine’.

Too bad our own government isn’t required to follow some sort of economic substance doctrine.

According to Section 563, partnerships and corporations that make more than $100,000,000 (100 million dollars) are “more likely than not’ to make underpayments on their taxes and HR 3962 aims to hold them “more likely than not” accountable.

In the case of any specified person, paragraph (1) shall apply to the portion of an underpayment which is attributable to any item only if such person has a reasonable belief that the tax treatment of such item by such person is more likely than not the proper tax treatment of such item.

With that, we have finished Division A. I’ll have another post this afternoon beginning with Division B on page 366.

HR3962 : Division A : Part One

As you know by now, Nancy Pelosi announced the release of HR 3962 : Affordable Health Care for America Act on Thursday of last week.

I took a quick glance at it that afternoon, and mentioned that I would be looking at the bill over the weekend. You will be happy to know that I have spent the better part of my weekend reading through the bill and making notes.

The summary of this bill won’t be quite as detailed as the one I did for HR 3200, but I will cover as much as I can before tomorrow night. I’ve heard rumors that the House will begin debate on the bill this week, and I want to get through as much of the bill as I can so you know what to talk about when you call your Representatives about HR 3962.

While the word rationing does not appear in the text of the bill, Title I, Section 101, authorizes the Secretary of Health and Human Services to monitor the costs of covering the “high-risk pool” of citizens, and to adjust benefits, premiums and such to offset the expenses of treating them. It even goes so far as to establish waiting lists for those in this “pool”.

If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

Twenty-five pages into the bill and they’ve already established the authorization for rationing your health care. Remember my review of HR 3200 and my examples, including those who are elderly with cancer, those who have AIDS/HIV, or those who have lifelong diseases like Parkinsons? It’s only a matter of time before their coverage dries up completely now.

At this point, I thought it might be a good idea to take some Tylenol, while I still have access to it. Based on these first pages, this is going to be an interesting read.

Title II, Section 202 will phase out private health insurance coverage by 2013. This section states,

Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

Can you say hello single payer health care? Seriously. At first I thought this bill was a “Punk’d” prank played by Nancy Pelosi on the House Republicans, but as I read more, I realized this really is our nightmare and if we don’t do something about it, it will come true.

Things get very controversial, and sad, Subtitle C, Section 222 authorizes the use of federal funding for abortions. Yes, the bill actually mentions the word abortion, and they make it blatantly clear that this public health care bill (in it’s current form) will remove all roadblocks of federally funded abortions.

(3) COVERAGE UNDER PUBLIC HEALTH INSURANCE OPTION- The public health insurance option shall provide coverage for services described in paragraph (4)(B). Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A).

(4) ABORTION SERVICES-

(A) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROHIBITED- The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED- The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

Subtitle C, Section 223, establishes the Health Benefits Advisory Committee, much like HR 3200. The HBAC will be authorized to recommend covered benefits and essential, enhanced, and premium plans.

So basically, the Surgeon General, nine Presidential appointees, nine people appointed by the Comptroller General and up to eight Federal employees will be deciding which benefits will be offered, which benefits are essential, and which benefits will be offered with which plans.

Say hello to the RATION BOARD.

We were told early on in the public discussion about HR 3200 that the bill did not include anything to do with end-of-life care, death panels, or any mention of assisted suicide. Then someone decided they would remove that section. You know, the section they say was never there (even though we have copies of it in HR 3200). Well, guess what? It’s back.

While they make several references stating that the section does not promote suicide, assisted suicide, euthanasia, or mercy killing. They also go to great lengths to state that the section shall not presume the withdrawal of treatment. Yet, Subtitle D, Section 240 states,

Nothing in this section shall be construed –

(1) to require an individual to complete an advanced directive or a physician’s order for life sustaining treatment or other end-of-life planning document;

(2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan

In other words, even though nothing in that section will promote suicide, assisted suicide, euthanasia, or mercy killing, we as individuals will not be required to complete an advanced directive, our physicians won’t be required to fulfill an order for life sustaining treatment or end-of-life planning, and we’ll have no say when they begin restricting the amount of medicine and treatment we receive in our “end of life” stage.

Subtitle F, Section 258 brings up the topic of abortion again. At the top of page 147 we learn,

IN GENERAL- Nothing in this Act shall be construed to have any effect on Federal laws regarding

(A) conscience protection;

(B) willingness or refusal to provide abortion; and

(C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.

Read that highlighted part again. Doesn’t this potentially open the door for federally funding organizations such as Planned Parenthood and others which promote (and offer) abortion services?

This section makes sure that nothing in the act shall be construed to have any effect on current laws, and does not explicitly ban funding, it in effect authorizes the federal funding of abortion under the soon to be debated public option.

Subtitle B, Section 321 establishes the “Public Health Insurance Option”. Nanny State Nancy Pelosi spent the better part of last week trying to re-brand the public option into the “consumer option” but the only way to genuinely describe this plan is to call it the “government 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.

Remember now, the Secretary of Health and Human Services primary responsibility will be to create a low-cost plan without compromising quality or access to care, but we learned on page 25 that the same Secretary will also be authorized to cut services (compromise quality) and create waiting lists (cut off access to care), anytime he/she feels it is appropriate. Do you feel like we are running in circles here?

Section 330 permits members of Congress to enroll in the new public option. Like any sane member of Congress is going to turn away from their existing plan to take this option. If they are going to support this thing, they should be required, not permitted, to be covered by the same plan we are.

In Subtitle C, Section 345 we welcome back the income verification section which is quite similar to what we saw in HR 3200, and again, there is no mention of how an individuals information will be verified, only their income. 250 pages into the bill and we still haven’t addressed the coverage for millions of illegal immigrants.

Program Integrity; Income Verification Procedures-

(1) PROGRAM INTEGRITY- The Commissioner shall take such steps as may be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle.

(2) INCOME VERIFICATION-

(A) IN GENERAL- Upon an initial application of an individual for an affordability credit under this subtitle (or in applying section 342(b)) or upon an application for a change in the affordability credit based upon a significant change in modified adjusted gross income described in subsection (c)

(1)–

(i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application; and

(ii) the Commissioner shall use the information so disclosed to verify such information.

(B) ALTERNATIVE PROCEDURES- The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.

As I mentioned after my first glance at the bill, Title IV, Subtitle B, Section 413 imposes a mandatory tax on employers who do not meet the “minimum employer contribution”, by charging them up to 8% of the employee’s average wages paid by the employer.

Title V, Subtitle A, Section 501 makes amendments to the Internal Revenue Code of 1986, by implementing the 2.5% tax (yes, they reference this penalty as a tax) on those who do not possess “acceptable health care coverage” and Section 511 adds an additional $100 per day fee (per employee) for employers who fail to satisfy the health coverage participation requirements.

Let’s say you make $100,000 per year. If you do not have insurance through your employer, your employer will be paying as much as $8,000 per year as a penalty for not offering you insurance. If this continues for 100 days, they will pay an additional $10,000. Then, on top of that you will be paying an additional $2,500 per year for not possessing acceptable health care coverage. Remember, these are just the penalties, not the actual cost of health care coverage for you. One individual. Hold on though, it doesn’t stop there.

Section 512 goes on to add yet another “tax” on firms who elect not to offer, or cannot afford to offer, coverage. This Employer Excise Tax (yes, again they define this penalty as another tax) will amount to another 8% of the employee’s average wages.

So, if you, the person I just mentioned above, work for a small firm, or you own your own small firm, you will be paying an additional $8,000 “excise tax”. At this point, as a self-employed individual, you will have paid $28,500 out of pocket in additional taxes thanks to HR 3962.

So in review, under HR 3962, if you make $100,000 per year in wages, you could be paying an additional $28,500 in taxes before you even begin to calculate your income taxes, self-employment taxes, or any other taxes and fees that will be thrown at you.

According to what we’ve covered so far, that $28,500 will buy you the right to have your health care rationed, the transformation to a single payer health care system, special end-of-life care, and even more taxes which I’ll discuss in my next post. Your contribution will also help cover the health care costs of millions of illegal immigrants and women who choose to obtain abortions.

For those of you keeping track and reading along (cough) this brings us to page 316.

More to follow…