Tuesday, November 17, 2009
If you check his website you notice a disturbing skew to everything. In the health care section http://garrett.house.gov/Issues/Issue/?IssueID=5208, he posts a report from the Lewin Group, as if this was some non-biased source of information, but the reality is that this company is fully owned by United Healthcare - a huge insurance company.
Then you take a look at the "Health Care Comments" on this page, which supposedly represents the emails from his constituents. However, there is not a single email in favor, even though the majority of Americans do favor health care reform. Really, not one email?
Probably the most misleading section is one titled "Reading Guide for Reform" http://garrett.house.gov/UploadedFiles/Pelosi_HC_Bill_Reading_Guide_102909.pdf. This is essentially the contents of the email that Garrett sent out to his constituents, and was easily dissected in my earlier post as being full of misinformation. What's really disturbing is that this is clearly a prepared "talking points" document for Republicans, so they have a list of alarming (but untrue) statements with which to get misinformed voters riled up. Apparently, but not surprising, Garrett doesn't have the integrity to stand up to those in his party that are trying to push this drivel.
With this lack of honesty about such an important issue, I really don't understand how this congressman can sleep at night.
PS Apparently I'm not the only one noticing Garrett isn't really being honest - there is a good deal of content about his reckless positioning at this informative web site http://blogthefifth.blogspot.com/ !
Friday, November 6, 2009
Once again, we dissect the supposed claims for this legislation by copying the actual bill text and some commentary between [block parentheses] right below the claim that Garrett is making.
Please feel free to get this posted around the Internet...
November 5, 2009
As you know, the issue of health care reform is being hotly debated in the halls of Congress and throughout America. House Speaker Nancy Pelosi is bringing the latest version of the health care bill to the floor of the House of Representatives this week. At more than $1 trillion and nearly 2,000 pages, H.R. 3962 is considered by many to be the antithesis of patient-centered reforms that would empower Americans to own and control their health coverage. This bill has the potential to limit choices, competition, and the possibilities for innovation. Conversely, I support health care reform that will ensure that America remains competitive in the 21st Century by making our system more portable, affordable, sustainable, effective and innovative.
I will be making my concerns known today, November 5 at noon on the West Front steps of the U.S. Capitol (House side), where I will join my Republican colleagues, as well as Americans from across the nation, for a House Call on Washington.
Given the significant changes to our health care system which would take place if this piece of legislation is enacted, I want to ensure that you have access to a copy of this bill, as well as the summary and report of H.R. 3962 compiled by the Congressional Budget Office (CBO), and a reading guide to the legislation.
The text of H.R. 3962 - Affordable Health Care for America Act as introduced can be found here: http://docs.house.gov/rules/health/111_ahcaa.pdf
The CBO Report of H.R. 3962 can be found here:
I would also like to point out some sections that I thought you might find of particular interest, as noted by this reading guide:
Page 94—Section 202(c) prohibits the sale of private individual health insurance policies, beginning in 2013, forcing individuals to purchase coverage through the federal government
[A complete fabrication, look at the text from the document below, it clearly states that people are free to buy any additional insurance if they want coverage beyond the minimum standards - "Nothing ... shall prevent the offering of excepted benefits ... so long as such benefits are offered outside the Health Insurance Exchange and are priced separately from health insurance coverage"]
1 (c) LIMITATION ON INDIVIDUAL HEALTH INSURANCE
3 (1) IN GENERAL.—Individual health insurance
4 coverage that is not grandfathered health insurance
5 coverage under subsection (a) may only be offered
6 on or after the first day of Y1 as an Exchange-par
7 ticipating health benefits plan.
8 (2) SEPARATE, EXCEPTED COVERAGE PER
9 MITTED.—Nothing in—
10 (A) paragraph (1) shall prevent the offer
11 ing of excepted benefits described in section
12 2791(c) of the Public Health Service Act so
13 long as such benefits are offered outside the
14 Health Insurance Exchange and are priced sep
15 arately from health insurance coverage; and
16 (B) this division shall be construed—
17 (i) to prevent the offering of a stand
18 alone plan that offers coverage of excepted
19 benefits described in section 2791(c)(2)(A)
20 of the Public Health Service Act (relating
21 to limited scope dental or vision benefits)
22 for individuals and families from a State
23 licensed dental and vision carrier; or
24 (ii) as applying requirements for a
25 qualified health benefits plan to such a
1 stand-alone plan that is offered and priced
2 separately from a qualified health benefits
Page 110—Section 222(e) requires the use of federal dollars to fund abortions through the government-run health plan—and, if the Hyde Amendment were ever not renewed, would require the plan to fund elective abortions
[This section states that abortions would be paid for only if specifically funded by law.]
17 (B) ABORTIONS FOR WHICH PUBLIC FUND
18 ING IS ALLOWED.—The services described in
19 this subparagraph are abortions for which the
20 expenditure of Federal funds appropriated for
21 the Department of Health and Human Services
22 is permitted, based on the law as in effect as
23 of the date that is 6 months before the begin
24 ning of the plan year involved.
Page 111—Section 223 establishes a new board of federal bureaucrats (the “Health Benefits Advisory Committee”) to dictate the health plans that all individuals must purchase—and would likely require all Americans to subsidize and purchase plans that cover any abortion
[The new "board of federal bureaucrats" is actually a much more representative committee than what any insurance company uses today to determine health plan benefits (see the actual text below) and will help insure that the plans meet needs of subscribers. Section 223 has nothing to do with abortion, but notice how Garrett inserts a contentious issue.]
20 (5) PARTICIPATION.—The membership of the
21 Health Benefits Advisory Committee shall at least
22 reflect providers, patient representatives, employers
23 (including small employers), labor, health insurance
24 issuers, experts in health care financing and deliv
25 ery, experts in oral health care, experts in racial and
1 ethnic disparities, experts on health care needs and
2 disparities of individuals with disabilities, represent
3 atives of relevant governmental agencies, and at
4 least one practicing physician or other health profes
5 sional and an expert in child and adolescent health
6 and shall represent a balance among various sectors
7 of the health care system so that no single sector
8 unduly influences the recommendations of such
Page 211—Section 321 establishes a new government-run health plan that, according to non-partisan actuaries at the Lewin Group, would cause as many as 114 million Americans to lose their existing coverage
[Another blatent lie. What Garrett does not mention is that the Lewin Group is WHOLLY OWNED BY AN INSURANCE COMPANY, United Health http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072203696.html. Once again, another example of how Garrett is wholly owned by campaign contributors, and does not bother to represent the interests of his constituents.]
Page 225—Section 330 permits—but does not require—Members of Congress to enroll in government-run health care
[Under this bill NO Americans, even members of Congress, are required to enroll in the Public Option]
1 SEC. 330. ENROLLMENT IN PUBLIC HEALTH INSURANCE
2 OPTION BY MEMBERS OF CONGRESS.
3 Notwithstanding any other provision of this Act,
4 Members of Congress may enroll in the public health in
5 surance option.
Page 255—Section 345 includes language requiring verification of income for individuals wishing to receive federal health care subsidies under the bill—while the bill includes a requirement for applicants to verify their citizenship, it does not include a similar requirement to verify applicants’ identity, thus encouraging identity fraud for undocumented immigrants and others wishing to receive taxpayer-subsidized health benefits
[Another lie. The section specifically gives the government authority to take steps to determine fraud is not taking place.]
1 (1) PROGRAM INTEGRITY.—The Commissioner
2 shall take such steps as may be appropriate to en
3 sure the accuracy of determinations and redeter
4 minations under this subtitle.
Page 297 - Section 501 imposes a 2.5 percent tax on all individuals who do not purchase “bureaucrat-approved” health insurance - the tax would apply on individuals with incomes under $250,000
[Yes, in order for universal healthcare to exist, everyone has to participate. Without a penalty individuals would skip insurance till they got sick.]
Page 313—Section 512 imposes an 8 percent “tax on jobs” for firms that cannot afford to purchase “bureaucrat-approved” health coverage; according to an analysis by Harvard Professor Kate Baicker, such a tax would place millions “at substantial risk of unemployment”—with minority workers losing their jobs at twice the rate of their white counterparts
[Large companies (who this section applies to) already spend about 8% on employee healthcare. Any unemployment caused by high healthcare costs is already happening, and has nothing to do with implementing universal healthcare with the same costs for employers.]
Page 336—Section 551 imposes additional job-killing taxes, in the form of a half-trillion dollar “surcharge,” more than half of which will hit small businesses; according to a model developed by President Obama’s senior economic advisor, such taxes could cost up to 5.5 million jobs
[This section has nothing to do with small businesses. It is a tax on individuals who earn more than $1M a year. This is actually responsible legislation that insures there is revenue to support it.]
Page 520—Section 1161 cuts more than $150 billion from Medicare Advantage plans, potentially jeopardizing millions of seniors’ existing coverage
[Interesting assertion, given that AARP, whose whole existence is to protect the interests of seniors, has endorsed this plan.]
Page 733—Section 1401 establishes a new Center for Comparative Effectiveness Research; the bill includes no provisions preventing the government-run health plan from using such research to deny access to life-saving treatments on cost grounds, similar to Britain’s National Health Service, which denies patient treatments costing more than £35,000
[To not use effectiveness research is beyond comprehension - why would we expect policyholders (and in some cases, taxpayers) to pay for ineffective treatments. Private insurance companies already practice this, but not with any transparency for customers.]
Page 1174 - Section 1802(b) includes provisions entitled “TAXES ON CERTAIN INSURANCE POLICIES” to fund comparative effectiveness research, breaking Speaker Pelosi’s promise that “We will not be taxing [health] benefits in any bill that passes the House.”
[No. This is simply a renaming of a chapter in the Internal Revenue Code of 1986. See text below.]
11 (A) Chapter 34 of such Code is amended
12 by striking the chapter heading and inserting
13 the following:
14 ‘‘CHAPTER 34—TAXES ON CERTAIN
15 INSURANCE POLICIES
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS
Thank you for taking time to listen to my concerns with this legislation. Should you have any further questions or comments about this or any legislative issue, please do not hesitate to contact me in my Washington, D.C. office at (202) 225-4465. Also, please visit my website at www.house.gov/garrett to sign up for my e-newsletter with the latest updates.
Member of Congress
Wednesday, August 19, 2009
Just received an email from Representative Scott Garrett (New Jersey's 5th Congressional District). This email is a perfect example of how some one who is supposed to be a leader looking out for the interests of his constituency, is instead a shill for entrenched businesses who will be impacted by a change in the status quo for health care.
I've added some comments in italics to show the hypocrisy...
Health Care Update Take My New Health Care Survey
August 18, 2009
Health care in this country is built around the doctor-patient relationship. Doctors devote a great deal of time and money to their medical education, and patients seek out their expertise. Unlike in England, where there is little-to-no choice in which doctor you see, patients in America develop a trust with their doctor, often times remaining with the same practice for decades or even generations.
Completely untrue - since all doctors in England are participants in the Health Care system the patient has the ability to choose any doctor he prefers. The limits in which doctors a patient can see are actually in the present US system, where each private health plan has it's own roster of doctors.
I believe all this could change, however, if some in Congress get their way and impose a one-size-fits-all government-regulated health care system.
In my opinion, the health care bill currently in Congress would disrupt this important relationship by placing a series of Washington bureaucrats between you and your doctor. I feel this bill could create dozens of new agencies, programs, and offices to regulate your health care, and that number will only grow as the plan expands.
In this bill, government bureaucrats could potentially prohibit your family doctor from seeing patients who are not enrolled in a government-regulated public option health care plan.
The only way you would be prevented from seeing your doctor is if your doctor does not participate in the plan you are enrolled in - whether that is a private plan or the public option.
Under my understanding of the bill, these same bureaucrats could then turn around and revoke seniors’ choice in Medicare plans by requiring them to use the government plan.
There is nothing in the bill that forces seniors to use a government plan instead of Medicare (the statement makes no sense since Medicare is already a "government" plan). Notice the weasel wording "Under my understanding of the bill.." - this is obvious mis-information meant to alarm seniors. You would think that a congressman would actually read the bill he is stating opinions about!
A new “Health Benefits Advisory Committee,” if implemented, could determine what health coverage you’ll be allowed to purchase, and could potentially tax you if the coverage you buy does not meet its standards or have an “adequate” list of participating doctors.
There is nothing in the bill that will "determine what health coverage you’ll be allowed to purchase". The bill actually sets minimum standards for four levels of coverage, and also allows individuals to buy supplementary coverage above and beyond these if desired. Notice how he adds in the inflammatory and false "tax you" phrase. The reality is that there is a provision that if you don't enroll you will be charged a tax penalty - remember the goal is universal coverage, and it only works if virtually everyone is participating and spreading the insurance risk.
The bureaucrats could decide how much your doctors and hospitals will be paid, and could offer no board of review or other recourse for doctors to appeal their decision.
As in private plans, the government plan will set a reimbursement schedule for doctors and hospitals. Just like with private plans, doctors and hospitals are free to "vote with their feet", and not participate if reimbursement levels are too low.
In the end, I believe any government plan will crowd out private insurance, and with it, any competition or need for innovation.
An incredible statement, given that the only way a government option will crowd out private insurance is if private insurers don't deliver what patients value. Truly a bizarre assertion from some one who is trying to make the case that only the private sector can innovate and deliver value.
President Obama recently told the American Medical Association, “To most Americans, you are the health care system. Americans - me included - just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you.”
I couldn't agree more, and I don’t understand, then, why the President would support a plan that would place a massive bureaucracy between practicing physicians and their patients.
Again, throwing around the inflammatory "massive bureaucracy" assertion while the real fact is that government programs like Medicare, Medicaid and the VA system typically have 30% less overhead than private plans.
Some in Washington seem to think that health care reform simply affects them. We know this isn’t true, though. Health care reform will profoundly affect health care professionals in their ability to practice medicine and save lives. I have spent much time this summer meeting with doctors, hospital administrators, specialists, primary care providers, patients’ advocacy groups, and others who have a stake in this issue to find out what works best for them, and not just for government officials in Washington.
Representative Garrett has only been listening to stakeholders who will profit from having the incredibly wasteful and expensive present system continue. These are the organizations who fund his campaigns, not his constituents who he should be looking out for.
American health care is by no means perfect, and there is need for reform. We should not, however, throw the good out with the bad. My plan for health care would help to cut the cost of private insurance, encourage medical and pharmaceutical innovation, give small businesses greater freedom to enroll in association health plans, and protect doctors from frivolous tort lawsuits in order to keep prices affordable for patients. By doing so, we will make health care and health insurance more affordable for all Americans without bureaucratizing the doctor-patient relationship or rationing primary care.
Here he spells out his "plan for health care" - which is to do nothing! Throwing around the apple pie statements ("cut the cost", "encourage innovation", "greater freedom", "protect doctors", "keep prices affordable") while including nothing concrete. Unfortunately, he is the epitome of the Republican stance of health care reform obstruction.
The American people deserve the freedom to choose the health care that is best for their families. I believe we need meaningful health care reform that would increase accessibility, decrease costs, and improve on what is already the best health care system in the world. In the coming weeks I will continue to work with my colleagues in the House of Representatives to try to improve the bill. In the meantime, I welcome your comments. I have set up a special email account so that you can share your thoughts and concerns about health care reform at: email@example.com.
Should you have any further questions or comments about this or any legislative issue, please do not hesitate to contact me in my Washington, D.C. office at (202) 225-4465. Also, please visit the health care page of my website and sign up for my e-newsletter with the latest updates.
Member of Congress
Truly an embarrassment - the do-nothing Congressman from NJ's 5th District, Scott Garrett!
Friday, August 14, 2009
The only real wierdness came from a few right-wing nutjobs, who were obviously there to disrupt but not add anything useful to the discussion. I must say they made a real good show of themselves - screaming non-sense (death panels!..) from the back of the room when reasoned participants were given the microphone. Somehow speaking in turn was too much to ask of these few participants, who were obviously egged on by the misinformation being spewed on conservative talk shows.
The most telling incident was when everyone was actually leaving the session and there was a woman ranting, at the top of her lungs "Obama is the Anti-Christ". It really showed the credibility of these people, who make great TV but are in no way representative of Americans in general.
Thursday, August 13, 2009
Hopefully the confused citizens who have been attending town-hall meetings will actually read this and get their facts straight. Unfortuately, its much easier to rant about alarming and untrue statements, than to be informed and ask relevant questions about what the reform is actually proposing.
Please feel free to forward this and and get some accurate information circulating around the Internet!
8 ways reform provides security and stability to those with or without coverage:
Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
Learn more and get details: http://www.WhiteHouse.gov/health-insurance-consumer-protections/
8 common myths about health insurance reform
Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.
Learn more and get details:
8 Reasons We Need Health Insurance Reform Now
Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html
Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html
Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html
Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes
Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline
The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction
Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html
The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf
Monday, August 10, 2009
You may have seen this viral email about the proposed healthcare reform. It is full of blatant fabrications meant to alarm people. The use of page numbers and sections from the bill make it seem like it was well documented, but the alarming comments don't actually match what the sections really say.
Its fine to argue against health care reform, but you should make a case against what is actually being proposed.
I went to the sections of the health care bill referred to in the email (http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf) to check it out (I obviously lead an exciting life). Take a look below to see the original alarming claim of the writer, my comment [in brackets] on what it really means, and the actual sections of the bill(italics):
Please feel free to email this post and help virally spread accurate information about the proposed healthcare reform bill (click on the button at the bottom of this blog post)
Pg 22 of the HC Bill - MANDATES the Government will audit books of ALL EMPLOYERS that self insure!!
[No, the only thing mandated is a study.]
The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets.
Pg 30 Sec 123 of HC Bill A government committee will decide what treatments/benefits you get.
[No. There will be a choice of essential, enhanced, premium and premium plus plans. You get to choose what you want to pay for beyond 'essential', as well as the option to buy more coverage if you want.]
There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced,and premium plans.
Pg 29 lines 4-16 in the HC Bill - your health care will be rationed.
[No. This refers to a limit on how much you will pay out of pocket.]
4 (A) ANNUAL LIMITATION.The cost-shar
5 ing incurred under the essential benefits pack
6 age with respect to an individual (or family) for
7 a year does not exceed the applicable level spec
8 ified in subparagraph (B).
9 (B) APPLICABLE LEVEL.The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con
15 sumer Price Index (United States city average)
16 applicable to such year.
Pg 42 of HC Bill - The Health Choices Commissioner will choose your HC Benefits for you. You have no choice!
[No. The choice is yours. The plan you choose is your decision. The goverment will only insure that plans meet minimum standards.]
3 SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.4 (a) DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.
PG 50 Section 152 in HC bill - HC will be provided to ALL NON US citizens, illegal or otherwise!
[This section says nothing about non-citizens, only prohibiting discrimination. Think color, religion, sex...]
21 SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE.22 (a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
Pg 58HC Bill Government will have real-time access to individual’s finances and a National IDHealthcard will be issued! Private citizen’s health records will be held by the government.
[No. There is no statement about "real-time access to individual finances". This is referring to electronic submissions. A huge efficiency over paper. Yes, you get a healthcare card.]
‘‘(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—The goals for standards under paragraph (1) are that such standards shall—‘‘(A) be unique with no conflicting or redundant standards;‘‘(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;‘‘(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;‘‘(D) enable the real-time (or near realtime) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;‘‘(E) enable, where feasible, near real-time adjudication of claims;‘‘(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;‘‘(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and‘‘(H) harmonize all common data elements across administrative and clinical transaction standards.
Pg 59 HC Bill lines 21-24 Government will have direct access to your banks accounts for electronic funds transfer.
[No. This is referring to how healthcare providers get paid. Not access to patient bank accounts]
21 ‘‘(C) enable electronic funds transfers, in
22 order to allow automated reconciliation with the
23 related health care payment and remittance ad
PG 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions and community organizations [ACORN].
[This is available for "employment-based plans". Nothing in there specifically for unions or ACORN]
SEC. 164. REINSURANCE PROGRAM FOR RETIREES.(a) ESTABLISHMENT.—(1) IN GENERAL.—Not later than 90 days afterthe date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the ‘‘reinsurance program’’) to provide reim bursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees
Pg 72 Lines 8-14 Government is creating a Health Care Exchange to bring private HC plans under Government control.
[This insures a large choice of private plans. They are private, not government run]
6 SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE EX7CHANGE; OUTLINE OF DUTIES; DEFINITIONS.
8 (a) ESTABLISHMENT.—There is established within
9 the Health Choices Administration and under the direc
10 tion of the Commissioner a Health Insurance Exchange
11 in order to facilitate access of individuals and employers,
12 through a transparent process, to a variety of choices of
13 affordable, quality health insurance coverage, including a
14 public health insurance option.
PG 84 Sec 203 HC bill Government mandates ALL benefit packages for private HC plans in the Exchange
[This specifies that to offer higher-end plans you must also offer the lower-end plans. In other words, no cherry picking only wealthy customers.]
SEC. 203. BENEFITS PACKAGE LEVELS. (a) IN GENERAL.—The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, con sistent with subtitle C of title I and this section.(b) LIMITATION ON HEALTH BENEFITS PLANS OFFERED BY OFFERING ENTITIES.—The Commissioner may not enter into a contract with a QHBP offering entity under section 204(c) for the offering of an Exchange-par ticipating health benefits plan in a service area unless the following requirements are met:(1) REQUIRED OFFERING OF BASIC PLAN.—The entity offers only one basic plan for such service area.(2) OPTIONAL OFFERING OF ENHANCED PLAN.—If and only if the entity offers a basic plan for such service area, the entity may offer one enhanced plan for such area.(3) OPTIONAL OFFERING OF PREMIUM PLAN.—If and only if the entity offers an enhanced plan for such service area, the entity may offer one premium plan for such area. (4) OPTIONAL OFFERING OF PREMIUM-PLUS PLANS.—If and only if the entity offers a premium plan for such service area, the entity may offer one or more premium-plus plans for such area. All such plans may be offered under a single contract with the Commissioner.
PG 85 Line 7 HC Bill Specifications of Benefit Levels for Plans = the Government will ration your Healthcare!
[No. While the plan benefits will be specified, there is no prohibition against getting any additional coverage you may want. Specifically, on page 19 it states:
6 (2) SEPARATE, EXCEPTED COVERAGE PER7 MITTED.—Excepted benefits (as defined in section8 2791(c) of the Public Health Service Act) are not9 included within the definition of health insurance10 coverage. Nothing in paragraph (1) shall prevent the11 offering, other than through the Health Insurance12 Exchange, of excepted benefits so long as it is of13 fered and priced separately from health insurance14 coverage.]
47 (c) SPECIFICATION OF BENEFIT LEVELS FOR8 PLANS.—9 (1) IN GENERAL.—The Commissioner shall es10 tablish the following standards consistent with this11 subsection and title I:12 (A) BASIC, ENHANCED, AND PREMIUM13 PLANS.—Standards for 3 levels of Exchange14 participating health benefits plans: basic, en15 hanced, and premium (in this division referred16 to as a ‘‘basic plan’’, ‘‘enhanced plan’’, and17 ‘‘premium plan’’, respectively).18 (B) PREMIUM-PLUS PLAN BENEFITS.—19 Standards for additional benefits that may be20 offered, consistent with this subsection and sub21 title C of title I, under a premium plan (such22 a plan with additional benefits referred to23 this division as a ‘‘premium-plus plan’’) .
PG 91 Lines 4-7 HC Bill Government mandates linguistic appropriate services. Example - Translation for illegal aliens.
[There are millions of citizens who have a native language other than English. For personal discussions like healthcare it only makes sense to try to support them.]
4 (7) CULTURALLY AND LINGUISTICALLY APPRO
5 PRIATE SERVICES AND COMMUNICATIONS.—The en
6 tity shall provide for culturally and linguistically ap
7 propriate communication and health services.
Pg 95 HC Bill Lines 8-18 The Government will use groups i.e., ACORN and Americorps to sign up individuals for Government HC plan
[There must be an attempt made to reach health care the most (such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments). Nothing about using ACORN and Americorps (what's with the ACORN obsession?).
8 (1) OUTREACH.—The Commissioner shall con9 duct outreach activities consistent with subsection10 (c), including through use of appropriate entities as11 described in paragraph (4) of such subsection, to in12 form and educate individuals and employers about13 the Health Insurance Exchange and Exchange-par14 ticipating health benefits plan options. Such out15 reach shall include outreach specific to vulnerable16 populations, such as children, individuals with dis17 abilities, individuals with mental illness, and individ18 uals with other cognitive impairments.
Pg 85 Line 7 HC Bill Specifications of Benefit Levels for Plans. #AARP members - your Health care WILL be rationed
[No. While the plan benefits will be specified, there is no prohibition against getting any additional coverage you may want. ]
47 (c) SPECIFICATION OF BENEFIT LEVELS FOR8 PLANS.—
9 (1) IN GENERAL.—The Commissioner shall es
10 tablish the following standards consistent with this
11 subsection and title I:
12 (A) BASIC, ENHANCED, AND PREMIUM
13 PLANS.—Standards for 3 levels of Exchange
14 participating health benefits plans: basic, en
15 hanced, and premium (in this division referred
16 to as a ‘‘basic plan’’, ‘‘enhanced plan’’, and
17 ‘‘premium plan’’, respectively).
18 (B) PREMIUM-PLUS PLAN BENEFITS.—
19 Standards for additional benefits that may be
20 offered, consistent with this subsection and sub
21 title C of title I, under a premium plan (such
22 a plan with additional benefits referred to
23 this division as a ‘‘premium-plus plan’’) .
Pg 102 Lines 12-18 HC Bill Medicaid Eligible individuals will be automatically enrolled in Medicaid. No choice.
[If you don't sign up for a private plan you automatically get placed into Medicaid. Which part of this is bad?]
12 (3) AUTOMATIC ENROLLMENT OF MEDICAID EL13 IGIBLE INDIVIDUALS INTO MEDICAID.—The Com14 missioner shall provide for a process under which an15 individual who is described in section 202(d)(3) and16 has not elected to enroll in an Exchange-partici17 pating health benefits plan is automatically enrolled18 under Medicaid.
Pg 124 lines 24-25 HC Bill No company can sue GOVERNMENT on price fixing. No "judicial review" against Government monopoly!
[There is no government monopoly. No healthcare provider is forced to participate in the public health plan option. Just as in the free market, if providers think prices are set too low they can simply not participate.]
24 (f) LIMITATIONS ON REVIEW.—There shall be no ad
25 ministrative or judicial review of a payment rate or methodology established under this section or under section 224.
Pg 127 Lines 1-16 HC Bill The Government will tell doctors how much they can earn.
[No. No limits on physician income. If they decide to participate in the public plan they will get the reimbursement rates of the plans (just like participating with any private insurance plan).]
1 (1) PHYSICIANS.—The Secretary shall provide
2 for the annual participation of physicians under the
3 public health insurance option, for which payment
4 may be made for services furnished during the year,
5 in one of 2 classes:
6 (A) PREFERRED PHYSICIANS.—Those phy
7 sicians who agree to accept the payment rate
8 established under section 223 (without regard
9 to cost-sharing) as the payment in full.
10 (B) PARTICIPATING, NON-PREFERRED
11 PHYSICIANS.—Those physicians who agree not
12 to impose charges (in relation to the payment
13 rate described in section 223 for such physi
14 cians) that exceed the ratio permitted under
15 section 1848(g)(2)(C) of the Social Security
16 Act.17 (2) OTHER PROVIDERS.—The Secretary shall
18 provide for the participation (on an annual or other
19 basis specified by the Secretary) of health care pro
20 viders (other than physicians) under the public
21 health insurance option under which payment shall
22 only be available if the provider agrees to accept the
23 payment rate established under section 223 (without
24 regard to cost-sharing) as the payment in full.
Pg 145 Line 15-17 An Employer MUST automatically enroll employees into public option plan. NO CHOICE.
[No. You are automatically enrolled in your employer plan, unless you opt out and decide to join the public plan.]
15 (4) AUTOENROLLMENT OF EMPLOYEES.—The
16 employer provides for autoenrollment of the em
17 ployee in accordance with subsection (c).
20 (c) AUTOMATIC ENROLLMENT FOR EMPLOYER SPON
21 SORED HEALTH BENEFITS.—
22 (1) IN GENERAL.—The requirement of this sub
23 section with respect to an employer and an employee
24 is that the employer automatically enroll suchs em
25 ployee into the employment-based health benefits1 plan for individual coverage under the plan option
2 with the lowest applicable employee premium.
3 (2) OPT-OUT.—In no case may an employer
4 automatically enroll an employee in a plan under
5 paragraph (1) if such employee makes an affirmative
6 election to opt out of such plan or to elect coverage
7 under an employment-based health benefits plan of
8 fered by such employer. An employer shall provide
9 an employee with a 30-day period to make such an
10 affirmative election before the employer may auto
11 matically enroll the employee in such a plan.
Pg 126 Lines 22-25 Employers MUST pay for HC for part-time employees AND their families.
[There is nothing in this section about health care for part-timers and their families.]
20 (b) LICENSURE OR CERTIFICATION.—The Secretary
21 shall not allow a health care provider to participate in the
22 public health insurance option unless such provider is ap
23 propriately licensed or certified under State law.
Pg 149 Lines 16-24 ANY Employer with payroll 400 and above who does not provide public option pays 8% tax on all payroll.
[Right. Large employers can't dump their existing health plans without chipping in support for the employees who would now have to sign up for a government plan. Keep the employer plan and there is no tax.]
14 SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COV
16 (a) IN GENERAK.—A contribution is made in accord
17 ance with this section with respect to an employee if such
18 contribution is equal to an amount equal to 8 percent of
19 the average wages paid by the employer during the period
20 of enrollment (determined by taking into account all em
21 ployees of the employer and in such manner as the Com
22 missioner provides, including rules providing for the ap
23 propriate aggregation of related employers). Any such con
Pg 150 Lines 9-13 Businesses with payroll between $251K - $400K who don’t provide public option, pay 2-6% tax on all payroll!
[Right. Health care is not free, but smaller employers will pay less to support the employees who have to sign up for a government plan.]
8 (b) SPECIAL RULES FOR SMALL EMPLOYERS.—9 (1) IN GENERAL.—In the case of any employer
10 who is a small employer for any calendar year, sub
11 section (a) shall be applied by substituting the appli
12 cable percentage determined in accordance with the
13 following table for ‘‘8 percent’’:If the annual payroll of such employer forthe preceding calendar year:
The applicablepercentage is:Does not exceed $250,000 ..................................... 0 percentExceeds $250,000, but does not exceed $300,000 2 percentExceeds $300,000, but does not exceed $350,000 4 percentExceeds $350,000, but does not exceed $400,000 6 percent
Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.
[Right. Its universal coverage, everyone has to chip in, since everyone will have access to the benefits.]
8 ‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE
19 HEALTH CARE COVERAGE.
20 ‘‘(a) TAX IMPOSED.—In the case of any individual
21 who does not meet the requirements of subsection (d) at
22 any time during the taxable year, there is hereby imposed
23 a tax equal to 2.5 percent of the excess of—
1 ‘‘(1) the taxpayer’s modified adjusted gross in
2 come for the taxable year, over
3 ‘‘(2) the amount of gross income specified in
4 section 6012(a)(1) with respect to the taxpayer.
5 ‘‘(b) LIMITATIONS.—
6 ‘‘(1) TAX LIMITED TO AVERAGE PREMIUM.—
7 ‘‘(A) IN GENERAL.—The tax imposed
8 under subsection (a) with respect to any tax
9 payer for any taxable year shall not exceed the
10 applicable national average premium for such
11 taxable year.
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Only Americans will pay!)
[A non-resident alien is classified as a resident alien for tax purposes if they were physically present in the U.S. for 31 days. So after a month new aliens will also be paying into the system.]
1 ‘(2) NONRESIDENT ALIENS.—Subsection (a)2 shall not apply to any individual who is a non3 resident alien.
Pg 195 HC Bill Officers and employees of HC Administration (GOVERNMENT) will have access to ALL Americans financial/personal records.
[If (and only if) you are going to get subsidized by the government you have to prove you need it. What's wrong with that?]
18 ‘‘(21) DISCLOSURE OF RETURN INFORMATION19 TO CARRY OUT HEALTH INSURANCE EXCHANGE SUB20 SIDIES.—
21 ‘‘(A) IN GENERAL.—The Secretary, upon
22 written request from the Health Choices Com
23 missioner or the head of a State-based health
24 insurance exchange approved for operation
25 under section 208 of the America’s Affordable
1 Health Choices Act of 2009, shall disclose to of
2 ficers and employees of the Health Choices Ad
3 ministration or such State-based health insur
4 ance exchange, as the case may be, return in
5 formation of any taxpayer whose income is rel
6 evant in determining any affordability credit de
7 scribed in subtitle C of title II of the America’s
8 Affordable Health Choices Act of 2009. Such
9 return information shall be limited to—
10 ‘‘(i) taxpayer identity information
11 with respect to such taxpayer,
12 ‘‘(ii) the filing status of such tax
14 ‘‘(iii) the modified adjusted gross in
15 come of such taxpayer (as defined in sec
16 tion 59B(e)(5)),
17 ‘‘(iv) the number of dependents of the
19 ‘‘(v) such other information as is pre
20 scribed by the Secretary by regulation as
21 might indicate whether the taxpayer is eli
22 gible for such affordability credits (and the
23 amount thereof), and
24 ‘‘(vi) the taxable year with respect to
25 which the preceding information relates or,
1 if applicable, the fact that such informa
2 tion is not available.
3 ‘‘(B) RESTRICTION ON USE OF DISCLOSED
4 INFORMATION.—Return information disclosed
5 under subparagraph (A) may be used by offi
6 cers and employees of the Health Choices Ad
7 ministration or such State-based health insur
8 ance exchange, as the case may be, only for the
9 purposes of, and to the extent necessary in, es
10 tablishing and verifying the appropriate amount
11 of any affordability credit described in subtitle
12 C of title II of the America’s Affordable Health
13 Choices Act of 2009 and providing for the re
14 payment of any such credit which was in excess
15 of such appropriate amount.’’.
Pg 203 Line 14-15 HC "The tax imposed under this section shall not be treated as tax" Yes, it says that
[Section 55 referred to in the section is the Alternative Minimum Tax (see http://www.law.cornell.edu/uscode/html/uscode26/usc_sec_26_00000055----000-.html). This paragraph just means that any subsidy credits received would not be taxable under AMT]
13 ‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS
14 CHAPTER FOR CERTAIN PURPOSES.—The tax im
15 posed under this section shall not be treated as tax
16 imposed by this chapter for purposes of determining
17 the amount of any credit under this chapter or for
18 purposes of section 55.’’.
Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid; senior citizens, low income, poor affected
[This is a definition change in the Payment for Physicians Services section of the Social Security Act. It has nothing to do with reducing services, it is referring to what is included when calculating the resulting health care savings of implementing this bill.]
14 (c) LIMITATION ON PHYSICIANS’ SERVICES IN
15 CLUDED IN TARGET GROWTH RATE COMPUTATION TO
16 SERVICES COVERED UNDER PHYSICIAN FEE SCHED
17 ULE.—Effective for services furnished on or after January
18 1, 2009, section 1848(f)(4)(A) of such Act is amended
19 striking ‘‘(such as clinical’’ and all that follows through
20 ‘‘in a physician’s office’’ and inserting ‘‘for which payment
21 under this part is made under the fee schedule under this
22 section, for services for practitioners described in section
23 1842(b)(18)(C) on a basis related to such fee schedule,
24 or for services described in section 1861(p) (other than
1 such services when furnished in the facility of a provider
2 of services)’’.
Pg 241 Line 6-8 HC Bill All doctors, regardless of specialty, will be paid the same!
[Actually it states that the same set of procedure codes will be used by all doctors]
6 Service categories established under this paragraph
7 shall apply without regard to the specialty of the
8 physician furnishing the service.’
Pg 253 Line 10-18 Government sets value of Doctor's time, professional judging, etc. This literally sets value of humans.
[This statement means that all of the effort by the physician is included when determining the value of the care. It has nothing to do with "setting the value of humans"]
10 ‘‘(ii) COMPONENTS AND ELEMENTS11 OF WORK.—The process described in
12 clause (i) may include validation of work
13 elements (such as time, mental effort and
14 professional judgment, technical skill and
15 physical effort, and stress due to risk) in
16 volved with furnishing a service and may
17 include validation of the pre, post, and
18 intra-service components of work.
Pg 265 Sec 1131 Government mandates and controls productivity for private HC industries.
[Makes sure that productivity improvements are considered when setting reimbursement rates. Insures that savings are passed on to taxpayers]
2 SEC. 1131. INCORPORATING PRODUCTIVITY IMPROVE
3 MENTS INTO MARKET BASKET UPDATES
4 THAT DO NOT ALREADY INCORPORATE SUCH
Pg 268 Sec 1141 Government regulates rental and purchase of power driven wheelchairs.
[A definition change, so all types of wheelchairs can be included in the program]
2 SEC. 1141. RENTAL AND PURCHASE OF POWER-DRIVEN
4 (a) IN GENERAL.—Section 1834(a)(7)(A)(iii) of the
5 Social Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is
7 (1) in the heading, by inserting ‘‘CERTAIN COM
8 PLEX REHABILITATIVE’’ after ‘‘OPTION FOR’’; and
9 (2) by striking ‘‘power-driven wheelchair’’ and
10 inserting ‘‘complex rehabilitative power-driven wheel
11 chair recognized by the Secretary as classified within
12 group 3 or higher’’.
Pg 272 SEC. 1145 TREATMENT at CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
[Nothing about rationing - just states that "cancer hospitals' get paid the same as any other hospital for the same procedures and care.]
4 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS.
5 Section 1833(t) of the Social Security Act (42 U.S.C.
6 1395l(t)) is amended by adding at the end the following
7 new paragraph:
8 ‘‘(18) AUTHORIZATION OF ADJUSTMENT FOR
9 CANCER HOSPITALS.—
10 ‘‘(A) STUDY.—The Secretary shall conduct
11 a study to determine if, under the system under
12 this subsection, costs incurred by hospitals de
13scribed in section 1886(d)(1)(B)(v) with respect
14 to ambulatory payment classification groups ex
15 ceed those costs incurred by other hospitals fur
16 nishing services under this subsection (as deter
17 mined appropriate by the Secretary).
18 ‘‘(B) AUTHORIZATION OF ADJUSTMENT.—
19 Insofar as the Secretary determines under sub
20 paragraph (A) that costs incurred by hospitals
21 described in section 1886(d)(1)(B)(v) exceed
22 those costs incurred by other hospitals fur
23 nishing services under this subsection, the Sec
24 retary shall provide for an appropriate adjust
25 ment under paragraph (2)(E) to reflect those
1 higher costs effective for services furnished on2 or after January 1, 2011
Pg 280 Sec 1151 Government will penalize hospitals for what Government deems preventable readmissions.
[This section is meant to reimburse hospitals for outcomes, not procedures. In other words, they will be incentivized to do whats right for the patient, not what runs up the bill.]
2 Medicare Parts A and B
3 SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOS
4 PITAL READMISSIONS.
5 (a) HOSPITALS.—
6 (1) IN GENERAL.—Section 1886 of the Social
7 Security Act (42 U.S.C. 1395ww), as amended by
8 section 1103(a), is amended by adding at the end
9 the following new subsection:
10 ‘‘(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR
11 EXCESS READMISSIONS.—
12 ‘‘(1) IN GENERAL.—With respect to payment
13 for discharges from an applicable hospital (as de
14 fined in paragraph (5)(C)) occurring during a fiscal
15 year beginning on or after October 1, 2011, in order
16 to account for excess readmissions in the hospital,
17 the Secretary shall reduce the payments that would
18 otherwise be made to such hospital under subsection
19 (d) (or section 1814(b)(3), as the case may be) for
20 such a discharge by an amount equal to the product
22 ‘‘(A) the base operating DRG payment
23 amount (as defined in paragraph (2)) for the
24 discharge; and
1 ‘‘(B) the adjustment factor (described in
2 paragraph (3)(A)) for the hospital for the fiscal
Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission will be penalized by the Government.
[No, this section pertains to performing a STUDY about how to discourage doctors from providing poor treatment that just sends the patient back to the hospital for more tests and procedures (and runs up the bill without benefiting the patient).]
17 (1) STUDY.—The Secretary of Health and
18 Human Services shall conduct a study to determine
19 how the readmissions policy described in the pre
20 vious subsections could be applied to physicians.
21 (2) CONSIDERATIONS.—In conducting the
22 study, the Secretary shall consider approaches such
24 (A) creating a new code (or codes) and
25 payment amount (or amounts) under the fee
1 schedule in section 1848 of the Social Security
2 Act (in a budget neutral manner) for services
3 furnished by an appropriate physician who sees
4 an individual within the first week after dis
5 charge from a hospital or critical access hos
7 (B) developing measures of rates of read
8 mission for individuals treated by physicians;
9 (C) applying a payment reduction for phy
10 sicians who treat the patient during the initial
11 admission that results in a readmission; and
12 (D) methods for attributing payments or
13 payment reductions to the appropriate physi
14 cian or physicians.
15 (3) REPORT.—The Secretary shall issue a pub
16 lic report on such study not later than the date that
17 is one year after the date of the enactment of this
Pg 317 L 13-20 PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.
[No, this is to prevent doctors from profiting from running unneeded expensive tests on their own machines with taxpayer money. This prohibition is no different than making sure your doctor who prescribes drug is also not allowed to be your pharmicist.]
13 ‘‘(B) PROHIBITION ON PHYSICIAN OWNER
14 SHIP OR INVESTMENT.—The percentage of the
15 total value of the ownership or investment in
16 terests held in the hospital, or in an entity
17 whose assets include the hospital, by physician
18 owners or investors in the aggregate does not
19 exceed such percentage as of the date of enact
20 ment of this subsection.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion; Government is mandating hospitals cannot expand.
[Not a prohibition on hospitals. This is an exception to allow existing doctor owned facilities to contiue to exist, but not expand. Unfortunate, but this is the result of heavy lobbying by doctors who already own clinics (and have a built-in conflict of interest).]
21 ‘‘(C) PROHIBITION ON EXPANSION OF FA
22 CILITY CAPACITY.—Except as provided in para
23 graph (2), the number of operating rooms, pro
24 cedure rooms, or beds of the hospital at any
25 time on or after the date of the enactment of
1 this subsection are no greater than the number
2 of operating rooms, procedure rooms, or beds,
3 respectively, as of such date.
Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. [Can you say ACORN?]
[This allows for exceptions to restrictions on doctor owned facilities, but only if the community thinks its a good idea (perhaps in underserved areas). Not sure what the random ACORN comment has to do with this.]
2 ‘‘(i) ESTABLISHMENT.—The Secretary
3 shall establish and implement a process
4 under which a hospital may apply for an
5 exception from the requirement under
6 paragraph (1)(C).
7 ‘‘(ii) OPPORTUNITY FOR COMMUNITY
8 INPUT.—The process under clause (i) shall
9 provide persons and entities in the commu
10 nity in which the hospital applying for an
11 exception is located with the opportunity to
12 provide input with respect to the applica
Pg 335 L 16-25 Pg 336-339 Government mandates establishment of outcome-based measures. HC the way they want. Rationing
[For some reason the writer seems to think that paying for better outcomes is not a worthy goal. How is it better to pay for more procedures and tests, but get less results?]
16 ‘‘(ii) ESTABLISHMENT OF OUTCOME
17 BASED MEASURES.—By not later than for
18 2013 the Secretary shall implement report
19 ing requirements for quality under this
20 section on measures selected under clause
21 (iii) that reflect the outcomes of care expe
22 rienced by individuals enrolled in Medicare
23 Advantage plans (in addition to measures
24 described in clause (i)). Such measures
25 may include—
1 ‘‘(I) measures of rates of admis
2 sion and readmission to a hospital;
3 ‘‘(II) measures of prevention
4 quality, such as those established by
5 the Agency for Healthcare Research
6 and Quality (that include hospital ad
7 mission rates for specified conditions);
8 ‘‘(III) measures of patient mor
9 tality and morbidity following surgery;
10 ‘‘(IV) measures of health func
11 tioning (such as limitations on activi
12 ties of daily living) and survival for
13 patients with chronic diseases;
14 ‘‘(V) measures of patient safety;
16 ‘‘(VI) other measure of outcomes
17 and patient quality of life as deter
18 mined by the Secretary.
19 Such measures shall be risk-adjusted as
20 the Secretary deems appropriate. In deter
21 mining the quality measures to be used
22 under this clause, the Secretary shall take
23 into consideration the recommendations of
24 the Medicare Payment Advisory Commis
25 sion in its report to Congress under section
1 168 of the Medicare Improvements for Pa
2 tients and Providers Act of 2008 (Public
3 Law 110–275) and shall provide pref
4 erence to measures collected on and com
5 parable to measures used in measuring
6 quality under parts A and B.
7 ‘‘(iii) RULES FOR SELECTION OF
8 MEASURES.—The Secretary shall select
9 measures for purposes of clause (ii) con
10 sistent with the following:
11 ‘‘(I) The Secretary shall provide
12 preference to clinical quality measures
13 that have been endorsed by the entity
14 with a contract with the Secretary
15 under section 1890(a).
16 ‘‘(II) Prior to any measure being
17 selected under this clause, the Sec
18 retary shall publish in the Federal
19 Register such measure and provide for
20 a period of public comment on such
Pg 341 Lines 3-9 Government has authority to disqualify Medicare Advantage Plans, HMOs, etc. thereby forcing people into Government plan.
[If a Medicare Advantage plan is a ripoff, should taxpayers have to pay for it? There will be plenty of private plans, no one is forced into a government plan.]
3 ‘‘(iv) AUTHORITY TO DISQUALIFY
4 CERTAIN PLANS.—In applying clauses (ii)
5 and (iii), the Secretary may determine not
6 to identify a Medicare Advantage plan if
7 the Secretary has identified deficiencies in
8 the plan’s compliance with rules for such
9 plans under this part.
Pg 354 Sec 1177 Government will RESTRICT enrollment of Special needs plan! [What if my sister has Downs Syndrome?]
[This section is about creating a study about special needs plans, and then making recommendations about how they will be included.]
3 SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS
4 PLANS TO RESTRICT ENROLLMENT.
5 (a) IN GENERAL.—Section 1859(f)(1) of the Social
6 Security Act (42 U.S.C. 1395w–28(f)(1)) is amended by
7 striking ‘‘January 1, 2011’’ and inserting ‘‘January 1,
8 2013 (or January 1, 2016, in the case of a plan described
9 in section 1177(b)(1) of the America’s Affordable Health
10 Choices Act of 2009)’’.
11 (b) GRANDFATHERING OF CERTAIN PLANS.—
12 (1) PLANS DESCRIBED.—For purposes of sec
13 tion 1859(f)(1) of the Social Security Act (42
14 U.S.C. 1395w–28(f)(1)), a plan described in this
15 paragraph is a plan that had a contract with a State
16 that had a State program to operate an integrated
17 Medicaid-Medicare program that had been approved
18 by the Centers for Medicare & Medicaid Services as
19 of January 1, 2004.
20 (2) ANALYSIS; REPORT.—The Secretary of
21 Health and Human Services shall provide, through
22 a contract with an independent health services eval
23 uation organization, for an analysis of the plans de
24 scribed in paragraph (1) with regard to the impact
25 of such plans on cost, quality of care, patient satis-
1 faction, and other subjects as specified by the Sec
2 retary. Not later than December 31, 2011, the Sec
3 retary shall submit to Congress a report on such
4 analysis and shall include in such report such rec
5 ommendations with regard to the treatment of such
6 plans as the Secretary deems appropriate.
Pg 379 Sec 1191 Government creates more bureaucracy: Telehealth Advisory Committee. [ HC by phone?]
[Telehealth is huge productivity improvement - it lets specialists from all over the country deliver services to remote locations using video and remote tools. The plan creates a committee of doctors to make recommendations as to how to include it in health care.]
6 ‘‘(c) TELEHEALTH ADVISORY COMMITTEE.—
7 ‘‘(1) IN GENERAL.—The Secretary shall appoint
8 a Telehealth Advisory Committee (in this subsection
9 referred to as the ‘Advisory Committee’) to make
10 recommendations to the Secretary on policies of the
11 Centers for Medicare & Medicaid Services regarding
12 telehealth services as established under section
13 1834(m), including the appropriate addition or dele
14 tion of services (and HCPCS codes) to those speci
15 fied in paragraphs (4)(F)(i) and (4)(F)(ii) of such
16 section and for authorized payment under paragraph
17 (1) of such section.
Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultant. Think Senior Citizens end of life
[This states that the plans will cover an optional consultation about end-of-life considerations. Things like wills, power-of-attorneys, hospice care, health care proxys...]
5 ‘‘Advance Care Planning Consultation
6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
7 term ‘advance care planning consultation’ means a con
8sultation between the individual and a practitioner de
9scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation shall include the following:
13 ‘‘(A) An explanation by the practitioner of ad
14 vance care planning, including key questions and
15 considerations, important steps, and suggested peo
16 ple to talk to.
17 ‘‘(B) An explanation by the practitioner of ad
18 vance directives, including living wills and durable
19 powers of attorney, and their uses.
20 ‘‘(C) An explanation by the practitioner of the
21 role and responsibilities of a health care proxy.
Pg 425 Lines 17-19 Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!
[Coverage for a consultation is mandatory. Its not mandatory to have the consultation!]
17 ‘‘(B) An explanation by the practitioner of ad
18 vance directives, including living wills and durable
19 powers of attorney, and their uses.
Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you to death.
[A list of resources for those who want to learn. Is it better to be blindsided and helpless at the end of life?]
22 (D) The provision by the practitioner of a list
23 of national and State-specific resources to assist con
24 sumers and their families with advance care plan
25 ning, including the national toll-free hotline, the ad-
1 vance care planning clearinghouses, and State legal
2 service organizations (including those funded
3 through the Older Americans Act of 1965).
Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.
[This section has nothing to do with "orders for end of life". It says that states that already have a similar program don't have to use the federal one.]
15 ‘‘(iii) A program for orders for life sustaining
16 treatment for a States described in this clause is a
17 program that—
18 ‘‘(I) ensures such orders are standardized
19 and uniquely identifiable throughout the State;
20 ‘‘(II) distributes or makes accessible such
21 orders to physicians and other health profes
22 sionals that (acting within the scope of the pro
23 fessional’s authority under State law) may sign
24 orders for life sustaining treatment;
Pg 429 Lines 1-9 An "advisory care planning consult" will be used frequently as patients health deteriorates
[If desired by the patient, more consultations will be paid for.]
1 ‘‘(B) An advance care planning consultation with re
2 spect to an individual may be conducted more frequently
3 than provided under paragraph (1) if there is a significant
4 change in the health condition of the individual, including
5 diagnosis of a chronic, progressive, life-limiting disease, a
6 life-threatening or terminal diagnosis or life-threatening
7 injury, or upon admission to a skilled nursing facility, a
8 long-term care facility (as defined by the Secretary), or
9 a hospice program.
Pg 429 Lines 10-12 "Advisory care consultation" may include an ORDER for end of life plans. AN ORDER FROM GOVERNMENT!
[No, there is no order from the government. Any decision is made by the patient and signed by a doctor]
10 ‘‘(4) A consultation under this subsection may in
11 clude the formulation of an order regarding life sustaining
12 treatment or a similar order.
13 ‘‘(5)(A) For purposes of this section, the term ‘order
14 regarding life sustaining treatment’ means, with respect
15 to an individual, an actionable medical order relating to
16 the treatment of that individual that—
17 ‘‘(i) is signed and dated by a physician (as de
18 fined in subsection (r)(1)) or another health care
19 professional (as specified by the Secretary and who
20 is acting within the scope of the professional’s au
21 thority under State law in signing such an order, in
22 cluding a nurse practitioner or physician assistant)
23 and is in a form that permits it to stay with the in
24 dividual and be followed by health care professionals
25 and providers across the continuum of care;
1 ‘‘(ii) effectively communicates the individual’s
2 preferences regarding life sustaining treatment, in
3 cluding an indication of the treatment and care de
4 sired by the individual;
5 ‘‘(iii) is uniquely identifiable and standardized
6 within a given locality, region, or State (as identified
7 by the Secretary); and
8 ‘‘(iv) may incorporate any advance directive (as
9 defined in section 1866(f)(3)) if executed by the in
11 ‘‘(B) The level of treatment indicated under subpara
12 graph (A)(ii) may range from an indication for full treat
13 ment to an indication to limit some or all or specified
Pg 429 Lines 13-25 Government will specify which doctors can write an end of life order.
[No. Look at the lines directly from the bill above. There is no mention that the government will specify which doctors]
Pg 430 Lines 11-15 Government will decide what level of treatment you will have at end of life.
[No, you and your doctor will decide.]
11 ‘‘(B) The level of treatment indicated under subpara
12 graph (A)(ii) may range from an indication for full treat
13 ment to an indication to limit some or all or specified
14 interventions. Such indicated levels of treatment may in
15 clude indications respecting, among other items—
16 ‘‘(i) the intensity of medical intervention if the
17 patient is pulse less, apneic, or has serious cardiac
18 or pulmonary problems;
19 ‘‘(ii) the individual’s desire regarding transfer
20 to a hospital or remaining at the current care set
22 ‘‘(iii) the use of antibiotics; and
23 ‘‘(iv) the use of artificially administered nutri
24 tion and hydration.’’.
Pg 469 - Community Based Home Medical Services=Non-profit organizations.
[Is this bad? Why?]
Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATIONS.
[Yes, community based home health care organizations will get paid, like everyone else who does the same service.]
14 ‘‘(i) PAYMENT TO COMMUNITY-BASED
15 ORGANIZATION.—One monthly payment to
16 a community-based or State-based organi
18 ‘‘(ii) PAYMENT TO PRIMARY OR PRIN
19 CIPAL CARE PRACTICE.—One monthly pay
20 ment to the primary or principal care prac
21 tice for such beneficiary.
Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into your marriage
[Idiotic statement. Where is the government inserted into your marriage? ]
11 (2) DEFINITION.—Section 1861 of the Social
12 Security Act (42 U.S.C. 1395x), as amended by sec
13 tions 1235 and 1305, is amended by adding at the
14 end the following new subsection:
15 ‘‘Marriage and Family Therapist Services
16 ‘‘(jjj)(1) The term ‘marriage and family therapist
17 services’ means services performed by a marriage and
18 family therapist (as defined in paragraph (2)) for the diag
19 nosis and treatment of mental illnesses, which the mar
20 riage and family therapist is legally authorized to perform
21 under State law (or the State regulatory mechanism pro
22 vided by State law) of the State in which such services
23 are performed, as would otherwise be covered if furnished
24 by a physician or as incident to a physician’s professional
25 service, but only if no facility or other provider charges
1 or is paid any amounts with respect to the furnishing of
2 such services.
3 ‘‘(2) The term ‘marriage and family therapist’ means
4 an individual who—
5 ‘‘(A) possesses a master’s or doctoral degree
6 which qualifies for licensure or certification as a
7 marriage and family therapist pursuant to State
9 ‘‘(B) after obtaining such degree has performed
10 at least 2 years of clinical supervised experience in
11 marriage and family therapy; and
12 ‘‘(C) is licensed or certified as a marriage and
13 family therapist in the State in which marriage and
14 family therapist services are performed.’’.
Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.
[Yes, Mental Health Services are covered. You need to define and create those services. Mental health coverage today is the most "rationed" health care today, with limits and loopholes.]