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 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).


(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.


(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)


(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…

HR3200 : Division B : Day Four

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some of these penalties are defined in the bill.

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

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

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

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

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

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

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

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

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

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

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

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

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

Oh Lord, here it comes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“(i) Gift, food, or entertainment.

“(ii) Travel or trip.

“(iii) Honoraria.

“(iv) Research funding or grant.

“(v) Education or conference funding.

“(vi) Consulting fees.

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

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

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

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

HR3200 : Division B : Day Three : Part Two

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

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

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

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

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

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

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

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

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

Section 1236 will establish “patient decision aids”.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Marriage and Family Therapist Services

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HR3200 : Division B : Day Three : Part One

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

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

David writes,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and the “automatic enrollment” section, to state,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HR3200 : Division B : Day Two

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

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

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

Anyway, let’s get on with the bill…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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