Monday, August 10, 2009

Debunking the Healthcare Viral Email

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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)


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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
24 vice;


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
15 ERAGE.
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
24 tribution—


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
13 payer,
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
18 taxpayer,
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
5 IMPROVEMENTS.


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
3 WHEELCHAIRS.
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
6 amended—
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
21 of—
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
3 year..’’.


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
23 as—
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
6 pital;
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
18 Act.


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
13 tion.


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;
15 and

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
21 measure.


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
10 dividual.
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.


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
21 ting;
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
17 zation.
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
8 law;
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.]

7 comments:

  1. This is the most thorough analysis of the bill I have been able to find. Thanks for your work.

    ReplyDelete
  2. Great stuff, are you going to analyze the second half of the bill?

    ReplyDelete
  3. HELLO AMERICA DICK: SAID DON'T BELIEVE EVERYTHING YOU READ! 2,000 ONE SIDED PAGES OF HC REFORM BILL I'M SURE WE COULD CHANGE A FEW WORDS AND NO BODY WILL EVER NOTICE UN'TILL IT'S ALL TO LATE. REMEMBER AFTER OBAMA WENT TO WORK PEOPLE STARTED YELLING JUST MONTHS AFTER ''THIS IS'NT THE KIND OF CHANGE WE ASKED FOR!'' IF YOU VOTED FOR OBAMA AND ARE IN FAVOR OF HIS PLAN THEN YOUR PART OF THE PROBLEM PEOPLE. DON'T FOREGET TO PUT YOUR SEAT BELT ON IT'S GOING TO BE A ROUGH RIDE AHEAD.....THANK YOU AND GOOD NIGHT!

    ReplyDelete
  4. How many people will lose jobs because of this bill? If you think your employer can afford this think again. Do you think your employer will cut your pay/hours/lay you off or just sit back and cough up money. DUH!!!!Think they are your boss for a reason! THis is the worst way to go about health care. The federal government has the worst audit opionion there is. Heard of the Sarbanes-Oxley act for companies? If the same procedures were done on the govn't they would file bankruptcy and no one would ever trust them. This is who is charge of everyone's health care?

    ReplyDelete
  5. Oh my gosh this man used his brain and experience to interpret what this bill means and how it will be used and you are contridicting it by what-restating it?

    ReplyDelete
  6. Whats with the ACOR obsession is they lobbied and paid to help get this bill paid b/c they are some of the few people to make money off this, along with AARP and pharm. companies. The person who wrote this blog is obviously too uneducated to even debate these topics!

    ReplyDelete