4.9 Trillion Reasons To Contact Your Senator

In the same fashion as the House version of health care reform, the Senate version eliminates lifetime and annual limits on the benefits for any participant or beneficiary, dependent coverage is extended until children turn 26 (although they are very much NOT children by this point), and it prohibits the discrimination of coverage based on salary.

I don’t really get that last one, because employers will be terminating their own health care plans because the government fines and fees for not providing coverage will be much lower than the cost of the plans themselves.

The Senate version provides for immediate access to insurance for those individuals with a pre-existing condition, sets up the “health benefit exchange”, and like the House version, creates so many layers of bureaucracy in health care that you’ll be lucky to make it through the red tape to see an actual doctor.

While reading the Senate’s “amendment in the nature of a substitute” to HR 3590, I realized that even though they worked on it behind closed doors and kept the whole process hush-hush, we’ve seen much of this bill before. Most of the provisions of the Senate version of the bill have been seen twice before, even three times, in the previous versions of the House bills as well as the first Senate bill that was “tossed out there” for all of us to see.

And just like the House version(s), this bill stinks, and it stinks bad. The Senate debated the bill all day today and they are scheduled to debate again all day tomorrow. You can watch the proceedings on CSPAN2, but make sure you contact your senators before you do anything else and tell them to vote against cloture on this bill. A vote for cloture (remember, they need 60 votes to proceed) is a vote for the bill (since they only need 51 votes to pass the bill).

Rather than go section by section (which would take me a couple days to post again) I thought I would cover some of the more pertinent and dangerous portions of the bill. If you read my posts on HR3200 or HR3962 then you are pretty much up to speed with this Senate bill, with a few exceptions.

The Senate bill weighs in at 2,074 pages (the largest one yet) and 20.8 pounds. The average staple weighs roughly 32 milligrams, average paper clip weighs 1 gram, and the average stethoscope weighs about 5 ounces. The Senate bill weighs more than 294,835 staples, 9,434 paper clips or 66 stethoscopes. That’s one heavy bill.

When Medicaid was created years ago, the original estimates put the cost of the bill at $238 million, yet the cost of Medicaid hit $1 billion and have been rising ever since, so let’s get real about the cost of this (or any) health care bill presented thus far by the Democrats.

James Capretta, the Ethics and Public Policy Center fellow for NRO, estimates the true cost of the bill (with the “doc fix” included) to be $4.9 trillion over 20 years with Democrats raising $2.2 in tax hikes and recovering more money by making cuts to Medicare coverage.

At a cost of $2.5 trillion, which is turning out to be a very conservative number itself, the Senate bill will cost us $1.2 billion per page, or $6.8 million per word.

The Senate bill includes provisions which will impose an additional taxes and fees which borderline on ridiculous. Sen. Mitch McConnell (R-KY) said it best when he said,

If you have insurance, you get taxed. If you don’t have insurance, you get taxed. If you need a life-saving medical device, you get taxed. If you need prescription medicines, you get taxed

There is a new marriage penalty which will hit many couples right in the pocketbook, and will increase the federal deficit, which President Obama promised he would not support doing. Of course, when was the last time you heard an honest word come out of his mouth, seriously?

The non-partisan Joint Committee on Taxation released it’s own report which estimates how much revenue taxes in the bill are likely to generate. According to the JCT,

  • Tax on high-end health insurance plans: $149.1 billion
  • Capping flexible spending accounts at $2,500: $14.6 billion
  • Fees for drug makers: $22.2 billion
  • Fees for medical device makers: $19.3 billion
  • Fees for health insurance companies: $60.4 billion
  • Higher floor for deducting medical expenses: $15.2 billion
  • Higher payroll tax for top earners: $53.8 billion
  • Tax on cosmetic surgery: $5.8 billion

The report goes on to list all of the different taxes and fees, which total much more than this initial list which comes to $340.4 billion in new taxes paid by you and me. Notice that last one which reflects the new 5% excise tax on elective cosmetic surgery. Nancy Pelosi is not going to like that provision at all. How much you want to bet that entire paragraph gets stripped in conference if this bill passes the Senate?

One fee not mentioned, until now, is the monthly abortion fee that everyone under the government-run plan will be paying for. According to Section 1303 of the Senate bill, the Secretary of Health and Human Services will have the authority to determine when abortion will be allowed under the government run health plan, and all premiums paid under the government run plan will be paid into the U.S. Treasury account which will be used to pay for abortion services.

HR 3590, “The Patient Protection and Affordable Care Act” will also allow the government to enter your home under “home visitation programs”. Section 2951 will allow the government to send officials into your home to check the “wellness” of your children, to make sure you are parenting your children properly and otherwise taking care of them at some standard which will be set by the government.

Those officials will be checking on low income families, women under the age of 21 who become pregnant, families with a history of substance abuse, families that have members who use tobacco products, families with children who have low student achievement, families with children who have learning disabilities or developmental delays, and families with individuals who are serving or have served in our armed forces.

Just think of the ramifications of section 2951 which is a clear example of invasion of privacy, and that section alone is enough reason not to support the passage of this bill.

There is no doubt that our health care system needs an adjustment, or even reform if you want to call it that, but this bill, as well as all of the other Democrat bills presented thus far is not what we need, or want. We cannot allow this bill to be forced upon us by Barack Obama, with help Harry Reid and Nancy Pelosi.

Remember to take some time out of your day tomorrow to contact your senators and tell them to vote no on cloture. One vote could literally save our country from the downward spiral known as government run health care.

HR3962 : Division C

Once again, I apologize for the brevity of each summary post, but I am hoping I’ll have a little time during the debate on the House floor to discuss some of these provisions in more detail. Here we go with Division C.

Section 2201 establishes the National Health Service Corps, just like HR 3200 did, which will require any member of the Corps to perform “half-time” clinical practice as a contractual obligation under the new scholarship program and/or loan repayment program. There’s nothing like involuntary servitude to make a country stronger.

Not only does HR3962 hail the return of involuntary servitude, but it also opens the door to health care discrimination on a wide-reaching scale in Section 2301.

The term ‘health disparities’ includes health and health care disparities and means population-specific differences in the presence of disease, health outcomes, or access to health care. For purposes of the preceding sentence, a population may be delineated by race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, or rural, urban, or other geographic setting, and any other population or subpopulation determined by the Secretary to experience significant gaps in disease, health outcomes, or access to health care.

In other words, the Secretary of Health and Human Services will be permitted to use race, ethnicity, sex, sexual orientation, age, and any other criteria he/she wants while determining your access to health care. Every other government entity is prohibited from discrimination, yet HR3962 doesn’t just open that door, it props it open with a 1,990 page bill.

Section 2502 states,

A hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of paragraph (4) shall not obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement.

If hospitals are not permitted to participate outpatient drugs in group purchasing organizations, does this mean they have to do so independently, and if so, why? What is the purpose or motive for disallowing such participation?

Section 2502 also sets the requirements for improvement in the 340B program integrity. The 340B program is the drug pricing program which resulted from enactment of Public Law 102-585, the Veterans Health Care Act of 1992, which is codified as Section 340B of the Public Health Service Act. Section 340B limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes and qualified disproportionate share hospitals. Significant savings on pharmaceuticals may be seen by those entities that participate in this program.

This section of the bill authorizes the Secretary of Health and Human Services

to verify the accuracy of ceiling prices calculated by manufacturers under subsection (a)(1) and charged to covered entities

Nothing in this section will prohibit the Secretary from abusing their power to make this decision, and nothing in this section provides for any type of oversight to ensure that the Secretary is acting in the best interest of the American taxpayer.

School based health clinics will be established using grants defined in Section 2511.

Funds awarded under a grant under this section–

(1) may be used for–

(A) providing training related to the provision of comprehensive primary health services and additional health services;

(B) the management and operation of SBHC programs, including through subcontracts; and

(C) the payment of salaries for health professionals and other appropriate SBHC personnel; and

(2) may not be used to provide abortions.

While section 2511 clearly prohibits “in school abortions”, it does not prevent or prohibit the distribution of materials regarding abortion or access to information on accessing facilities which provide abortions.

Why exactly do we need school based health clinics anyway? Shouldn’t schools teach children, and medical facilities treat them?

Section 2513 requires “FEDERALLY QUALIFIED BEHAVIORAL HEALTH CENTERS” to offer a wide range of services.

Make available to individuals served by the center, directly, through contract, or through linkages with other programs, each of the following:

(i) Adult and youth peer support and counselor services.

(ii) Family support services for families of children with serious mental disorders.

(iii) Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, housing agencies and programs, employers, and other social services.

(iv) Onsite or offsite access to primary care services.

(v) Enabling services, including outreach, transportation, and translation.

(vi) Health and wellness services, including services for tobacco cessation.

In other words, these newly named “federally qualified behavioral health centers” will be required to offer counseling services, family support for families of children with serious mental disorders, access to schools and a wide range of other public services, as well as access to primary care services and health and wellness services including services for tobacco cessation.

Which health and wellness services would be offered that wouldn’t be covered by a primary care service provider? Is this an implication of some other health service that normally isn’t performed inside hospitals and other medical facilities? And since when is smoking a mental health issue?

Section 2534 allows community organizations to provide services to low-income and uninsured patients and nothing in the section prevents a community-based collaborative care network from providing care to individuals.

Section 2525 establishes the “Community Based Overweight and Obesity Prevention Program which will be administered by eligible entities which will be awarded grants to run the program.

(a) Program- The Secretary shall establish a community-based overweight and obesity prevention program consisting of awarding grants and contracts under subsection (b).

(b) Grants- The Secretary shall award grants to, or enter into contracts with, eligible entities–

(1) to plan evidence-based programs for the prevention of overweight and obesity among children and their families through improved nutrition and increased physical activity; or

(2) to implement such programs.

These grants will be awarded to “representatives of public and private entities that have a history of working within and serving the community. Think ACORN.

As if this bill wasn’t painful enough, Section 2562 actually deals with pain research. Apparently HR3962 establishes an Interagency Pain Research Coordinating Committee. Just thinking of the bureaucracy of this new committee is painful. You may want to read this section to learn how the committee will be comprised, because this committee will be making decisions that could affect your treatment if you have chronic pain.

Just what you need when you’re in pain. A committee deciding if you have had enough medication, whether or not your pain threshold has changed, and whether or not your treatment protocol needs to be changed. You know, for your well-being, since you’re in pain and all.

Believe me, the fun does not stop there. Under Section 2572, the Secretary of Health and Human Services will be regulating every menu in America.

The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children’s combination meals, through means determined by the Secretary, including ranges, averages, or other methods.

In addition to menus, vending machines will also be tightly regulated.

In the case of an article of food sold from a vending machine that–

(I) does not permit a prospective purchaser to examine the Nutrition Facts Panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase; and

(II) is operated by a person who is engaged in the business of owning or operating 20 or more vending machines,

the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article.

But that’s not all. In addition to deciding which information should be required to appear on menus and next to vending machines, the Secretary of Health and Human Services will also be responsible for the standardization of recipes, methods of preparation, serving size, menu items, space on menus, menu boards, and even human error. Read it if you don’t believe me.

In promulgating regulations, the Secretary shall–

(aa) consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines; and

(bb) specify the format and manner of the nutrient content disclosure requirements under this subclause.

That Secretary of Health and Human Services must be a talented person. In addition to administering the entire Health and Human Services department of the government, they will also need to know everything there is about health care, pharmaceutical drugs, food, recipes, menus, vending machines, and who knows what else by the time we get done here.

Getting back to health care, yeah I know, it’s such a stretch now isn’t it? Section 2581 amends the Public Health Service Act by requiring the automatic enrollment of employees into a health care plan by the employer, and the inability to disenroll except once per year during an annual enrollment period. If I remember correctly, this same provision appeared in HR 3200.

It’s getting late and my mind is turning to mush, but I’m almost done with this review of HR3962. All that remains is Division D, which will be following this post within the next couple hours. We’ll pick up with Division D, “Indian Health Care Improvement” on page 1635 then.

HR3962 : Division B

So far we have learned that HR 3962 brings the single payer health care system to America along with health care rationing, special end-of-life care, and federally funded abortions. Along with all of those headaches it also brings a dictionary full of new taxes, and all of that was written into Division A. Let’s start a quick review of Division B.

Section 1111 starts off by regulating non-therapy ancillary services. It appears that payment for these services will be based on the patients age, physical and mental status, ability to perform activities of daily living, and other information.

The Secretary of Health and Human Services shall analyze payments for non-therapy ancillary services under a future skilled nursing facility classification system to ensure the accuracy of payment for non-therapy ancillary services. Such analysis shall consider use of appropriate predictors which may include age, physical and mental status, ability to perform activities of daily living, prior nursing home stay, diagnoses, broad RUG category, and a proxy for length of stay.

Why should non-medical staff have the authority to decide what type of non-therapy ancillary service you may require? Shouldn’t your doctor, or at least a health care professional be the one choosing your medical treatment?

Payments for stays in skilled nursing facilities will be based on the aggregate costs during that stay and not on the number of days in that stay.

Outlier adjustments or additional payments described in subparagraph (A) shall be based on aggregate costs during a stay in a skilled nursing facility and not on the number of days in such stay.


The Secretary shall reduce estimated payments that would otherwise be made under the prospective payment system under this subsection with respect to a fiscal year by 2 percent. The total amount of the additional payments or payment adjustments for outliers made under this paragraph with respect to a fiscal year may not exceed 2 percent of the total payments projected or estimated to be made based on the prospective payment system under this subsection for the fiscal year.

So rather than base the payment on the number of days a patient stays in the facility, the payments will now be based on aggregate costs minus 2 percent. In other words, facilities will not even be paid for their actual costs for providing treatment.

Section 1112 establishes the standard by which Medicare DSH payments will be reduced to hospitals and service providers based on the “significant” decrease in the numbers of those who are uninsured. A significant decrease will be measured only if there is an 8% decrease in the number of those uninsured. I thought the purpose of this bill was to insure all of the uninsured people in America. Isn’t setting a target goal of only 8% rather lame?

There is a lot more to this bill than I am covering, but like I said when I started, I am trying to cover some of the more important sections of the bill before the debate on the bill begins. You can be sure of one thing. If you followed my review of HR 3200, which was much more in-depth, almost every provision of that bill also exists in this bill.

Section 1156 prohibits the expansion of hospitals without the approval of the Secretary of Health and Human Services. The expansion of facility capacity is completely prohibited.

PROHIBITION ON EXPANSION OF FACILITY CAPACITY- 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.

But the Secretary can determine the process in which those facilities can apply for an exception and be allowed to expand.

The Secretary shall establish and implement a process under which a hospital may apply for an exception from the requirement under paragraph (1)(C).

While these exceptions may be approved and facilities will be allowed to expand, they won’t be allowed to expand to a size which is double the size they were when the bill takes affect.


(i) IN GENERAL- Subject to clause (ii) and subparagraph (D), a hospital granted an exception under the process described in subparagraph (A) may increase the number of operating rooms, procedure rooms, or beds of the hospital above the baseline number of operating rooms, procedure rooms, or beds, respectively, of the hospital (or, if the hospital has been granted a previous exception under this paragraph, above the number of operating rooms, procedure rooms, or beds, respectively, of the hospital after the application of the most recent increase under such an exception).

(ii) 100 PERCENT INCREASE LIMITATION- The Secretary shall not permit an increase in the number of operating rooms, procedure rooms, or beds of a hospital under clause (i) to the extent such increase would result in the number of operating rooms, procedure rooms, or beds of the hospital exceeding 200 percent of the baseline number of operating rooms, procedure rooms, or beds of the hospital.

(iii) BASELINE NUMBER OF OPERATING ROOMS, PROCEDURE ROOMS, OR BEDS- In this paragraph, the term ‘baseline number of operating rooms, procedure rooms, or beds’ means the number of operating rooms, procedure rooms, or beds of a hospital as of the date of enactment of this subsection.

Expansions will be limited only to those hospitals and facilities which have experienced population increases, increased patient admissions in their respective counties, and a higher bed occupancy rate within their state.

In other words, Section 1156 will hasten the end of quality medical care in rural America. If the population isn’t there, it won’t be cost effective to expand (or even build) medical facilities.

Section 1161 gives the Secretary authority to cut payments and even make the determination if Medicare Advantage Plans are qualified health plans.

AUTHORITY TO DISQUALIFY DEFICIENT PLANS- The Secretary may determine that a Medicare Advantage plan is not a qualifying plan if the Secretary has identified deficiencies in the plan’s compliance with rules for Medicare Advantage plans under this part.

The entire section is much longer, but in essence, $150 billion could be cut from Medicare Advantage Plans, which would reduce or eliminate the coverage for millions of senior citizens.

If it wasn’t enough to put their health coverage plans in jeopardy, Section 1236 authorizes the Secretary of Health and Human Services, acting through the Center for Medicare and Medicaid Innovation established under section 1115A of the Social Security Act, to establish a decision making program under the Medicare program using patient decision aids to meet the objective of improving the understanding of medical treatment options in a “shared decision making” process using those patient decision aids.

This section will also waive requirements of the Social Security Act Titles XI and XVIII, seniors will be required to meet attend counseling on Medicare services, and compensation will be granted to providers who generate less cost for care.

Read that last paragraph again people. Compensation if you generate less cost for care. Exactly how do you generate less cost for care with a “patient decision aid”? What decision could a senior citizen possibly make that would reduce the cost for their care? You get the point.

Section 1401 creates the “Center for Comparative Effectiveness Research”. The what? Comparative effectiveness?

The Center shall–

(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;

(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;

(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;

(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and Congress appropriate relevant reports described in subsection (d)(2);

(E) not later than one year after the date of the enactment of this section, enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation and report on standards of evidence for highly credible research;

(F) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data; and

(G) appoint clinical perspective advisory panels for research priorities under this section, which shall consult with patients and other stakeholders and advise the Center on research questions, methods, and evidence gaps in terms of clinical outcomes for the specific research inquiry to be examined with respect to such priority to ensure that the information produced from such research is clinically relevant to decisions made by clinicians and patients at the point of care.

How long until the “Center for Comparative Effectiveness Research” begins to deny access to necessary, life saving treatments because the comparative costs of providing them no longer shows effectiveness in reviews by the center staff?

Again, there is a lot more in this bill. I feel like I haven’t even scratched the surface yet. It’s not that I feel I am missing information, I just don’t feel the need to regurgitate all of the text from HR 3200 that still exists in this bill.

Section 1416 with authorize the all powerful Secretary of Health and Human Services to maintain specific information on all direct care staffing at each and every medical facility in the country.


On and after the first day of the first calendar quarter beginning after the date that is 2 years after the date of enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence–

(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);

(ii) include resident census data and information on resident case mix;

(iii) include a regular reporting schedule; and

(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.

Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.’.

What purpose would the government have for keeping track of every member of the direct care staff, unless they’re just preparing for the new single payer system where every member of the medical community works for the federal government anyway?

Section 1802 establishes the funding for the aforementioned “Center for Comparative Effectiveness Research”, which will be funded by taxes on certain insurance policies. Yes. In addition to the bakers dozen of new taxes already mentioned, Nancy Pelosi intends to tax some specific health care plans in order to fund their comparative effectiveness research.

Back on July 9th, 2009, Speaker of the House Nancy Pelosi pledged that the House would not leave for the August recess without passing a health care overhaul bill, and she promised that any bill from the House would not tax health benefits.

Pelosi said that any bill the House passes will not tax employee health care benefits and will include a robust public insurance option.

We will not be taxing benefits in any bill that passes the House,” she said.

She lied. Section 1802 of HR3962, the bill she herself helped craft and announced last Thursday, clearly states otherwise. So much for the promises of the Speaker of the House. The same can be said for President Obama. He promised not to raise taxes on any family making less than $250,000. Section 1802 breaks that promise as well. I wonder if HR3962 contains a provision for comparative mental health treatment for dilusional politicians who lack effectiveness?

That’s it for Division B. Tonight, I will tackle the remainder of HR 3962, “Affordable Health Care for America Act”. For those of you keeping track, we’ll pick up on page 1209.