HR3200 : Division B : Day Six

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

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

Subtitle E sets payments to pharmacists (Section 1741),

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Subtitle H covers technical corrections to the Social Security Act.

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

If they are mandating a minimum income to “qualify” for low-income Medicare, someone has to draw the line somewhere and I can guarantee you that the “we cover everyone” line is nowhere near the low-income line when they are drawn.

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

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

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

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

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

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

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

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

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

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

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

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

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

“SEC. 4375. Health insurance.

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

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

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

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

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

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

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

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

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

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

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

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

The results of a statewide needs assessment that describes—

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

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

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

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

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

And the government must received certain assurances from the State.

Assurances from the State that—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– George Orwell, 1984, Book 1, Chapter 5

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

HR3200 : Division B : Day Five : Part Two

This evening we begin with Division B, Title VII (Medicaid and CHIP), Subtitle A (Medicaid and Health Reform), Section 1701, “Eligibility for individuals with income below 133 1/3 percent of the federal poverty level”.

Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i) is amended—

(A) by striking “or” at the end of subclause (VI);

(B) by adding “or” at the end of subclause (VII); and

(C) by adding at the end the following new subclause:

“(VIII) who are under 65 years of age, who are not described in a previous subclause of this clause, and who are in families whose income (determined using methodologies and procedures specified by the Secretary in consultation with the Health Choices Commissioner) does not exceed 1331/3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;”.

According to the Department of Health and Human Services, the poverty rate for a family of five (like mine) is $25,790. Using the brilliant calculation above we know that I could make as much as (but not more than) $34,385.80 and still qualify for Medicaid. We all know what happens to those people who make $34,385.81 or more, don’t we? Yes, they fall through the cracks just like they do now!

Remember, this plan is about health care for everyone. Everyone who can be covered by existing plans (which will be phased out), everyone who can choose to be covered through the public plan through their employer, and everyone who can pay an additional 2.5% tax on their income to pay for the public plan on their own. But not everyone, really. Get real people.

If they are mandating a minimum income to “qualify” for low-income Medicare, someone has to draw the line somewhere and I can guarantee you that the “we cover everyone” line is nowhere near the low-income line when they are drawn.

Let’s read on to see what happens to those people who fall into the “gap”.

The first thing we learn is that States may not add someone to the managed care entity unless the entity has the capacity to meet all of the needs of that person being added.

A State may not require under paragraph (1) the enrollment in a managed care entity of an individual described in section 1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the satisfaction of the Secretary, that the entity, through its provider network and other arrangements, has the capacity to meet the health, mental health, and substance abuse needs of such individuals.”

How many health care plans do you know of, right now, that have the capacity to meet the health, mental health, and substance abuse needs of every person enrolled under that plan?

Sure. Uh-huh. What if everyone on that plan goes loopy tomorrow, do they still have that capacity? This provision simply provides a loophole for not covering people that cannot pay their fair share.

Section 1703 addresses CHIP and Medicaid maintenance. Where they allow states to impose limitations on coverage in order to limit expenditures under their child health plan.

Paragraph (1) shall not be construed as preventing a State from imposing a limitation described in section 2110(b)(5)(C)(i)(II) for a fiscal year in order to limit expenditures under its State child health plan under title XXI to those for which Federal financial participation is available under section 2105 for the fiscal year.

Subtitle B, Section 1711 defines the “Required Coverage of Preventive Services” where vaccines will now be required.

The preventive services described in this subsection are services not otherwise described in subsection (a) or (r) that the Secretary determines are—

“(1)(A) recommended with a grade of A or B by the Task Force for Clinical Preventive Services; or

“(B) vaccines recommended for use as appropriate by the Director of the Centers for Disease Control and Prevention; and

“(2) appropriate for individuals entitled to medical assistance under this title.”.

Nothing in this section indicates there will be a “religious exemptions” where administration of these vaccines is concerned. Will people no longer have the right to refuse vaccinating their children for religious reasons?

Section 1712 tells us that Medicaid will not cover tobacco cessation. I actually laughed when I read this section.

Section 1927(d)(2) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amended—

(1) by striking subparagraph (E);

(2) in subparagraph (G), by inserting before the period at the end the following: “, except agents approved by the Food and Drug Administration for purposes of promoting, and when used to promote, tobacco cessation”; and

(3) by redesignating subparagraphs (F) through (K) as subparagraphs (E) through (J), respectively.

(b) Effective date.—The amendments made by this section shall apply to drugs and services furnished on or after January 1, 2010.

It’s a given that the government is not going to pay for this. Of course they won’t. The government is not going to pay for something that helps you quit smoking. The taxes you pay for those cigarettes are going to help fund this program you moron.

The way they see it, every time someone lights up a cigarette another Medicaid recipient gets treatment (think bells and angel wings here people). They forget that a lot of those low-income people smoke too, defeating the purpose.

While the word “abortion” never appears in this version of the bill, Section 1713 does make reference to something you might find interesting.

The term ‘nurse home visitation services’ means home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age), who is eligible for medical assistance under this title, but only, to the extent determined by the Secretary based upon evidence, that such services are effective in one or more of the following:

“(1) Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.

“(2) Reducing the incidence of child abuse, neglect, and injury, improving family stability (including reduction in the incidence of intimate partner violence), or reducing maternal and child involvement in the criminal justice system.

“(3) Increasing economic self-sufficiency, employment advancement, school-readiness, and educational achievement, or reducing dependence on public assistance.”.

Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies?

Notice they don’t say they will work to help “prevent pregnancies”, but they will work to “increase birth intervals”. How do you increase “birth” intervals, without preventing the pregnancies in the first place. Yeah. Enough said. The word “abortion” never appears in the bill, but it’s implied much more strongly (and subtly) than even I thought it would be.

If that wasn’t enough, Section 1714 covers the state eligibility option for family planning services. We all know what kind of services are offered and what advice is given at family planning clinics. They don’t have to use the word abortion if they don’t want too. We can all read, can’t we? Abortion will be covered by this bill. These last two sections leave no doubt about that.

I can’t take anymore of this tonight. I need sleep. Tomorrow we will begin with Division B, Title VII, Subtitle C, on page 778.

HR3200 : Division B : Day Five : Part One

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

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

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

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

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

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

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

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

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

“(2) by demographic information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– George Orwell, 1984, Book 1, Chapter 1

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