We all knew the first big, fat, unread “stimulus” bill shoved through by the Democrats last year would be useless and some had noticed it contained frightening encroachments upon American liberties. And even though all the money from the first “stimulus” hasn’t even been spent, the Democrats are ramming another one through Congress under the wolfskin guise of “jobs”. But this one is not only going to be more more wasted money, it is, in fact, the death blow to the foundation of freedom upon which this country was founded.
I spent yesterday watching the wankers in Washington, specifically the House of unrepresenting Representatives, debate and then vote on HR 3962, the health care “reform” bill. A nauseating experience, really; it left me feeling almost shameful, the way one feels after gawking at a trainwreck. It was clear most hadn’t taken the time to read all of the legislation; few stances or rebuttals were based on facts versus the MSM campaign talking points so every chair’s gavel got a workout as the unrepresenting representatives squabbled like little schoolchildren.
In the end, despite the announcement of 10.2% unemployment and a $1.2 trillion price tag, the Speaker of the Nuthouse got what she wanted. The bill passed 220 to 215. It was aided by the defection of Republican Louisana Representative Cao. True to form, he again fell for the lies of the likes of Rahm Emmanuel and Nancy-Ann Deparle and President Walking Eagle. Closed-door “promises” of future financial and campaign support were the 30 pieces of silver by which they secured his vote, thereby allowing great crowing about “bipartisan support” for the takeover of the entire field of medicine in America.
But I think “bipartisan” is more clearly shown by the sensible 39 Democrats who refused to vote for this abomination. Of course, President Walking Eagle’s campaign arm, MoveOn.org, is now loudly raising money and threatening those Democrats in their reelection bids. My suspicion is, however, they will fare better than their fair-weather counterparts who voted in favor of HR 3962 after passage of the “Stupak amendment”, which rightly locked down the language preventing the use of taxpayer monies to pay for abortions. While passage of the amendment allowed some Democrats to vote yes for the containing bill, it is almost a given that the amendment will quietly disappear in committee since allowing it a vote on the floor was only a reluctant appeasement move on the part of Pelosi to get those yes votes.
Dick Morris provides a further peek into the machinations behind the curtain:
- The American Medical Association (AMA) was facing a 21 percent cut in physicians’ reimbursements under the current law. Obama promised to kill the cut if they backed his bill. The cuts are the fruit of a law requiring annual 5-6 percent reductions in doctor reimbursements for treating Medicare patients. Bravely, each year Congress has rolled the cuts over, suspending them but not repealing them. So each year, the accumulated cuts threaten doctors. By now, they have risen to 21 percent. With this blackmail leverage, Obama compelled the AMA to support his bill…or else! [ My note: this endorsement may be repealed, after it was revealed that the AMA did not follow its own procedure for providing endorsements and thereby rightly raised the ire of both members and non-members. ]
- The AARP got a financial windfall in return for its support of the healthcare bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.
- The drug industry backed ObamaCare and, in return, got a 10-year limit of $80 billion on cuts in prescription drug costs. (A drop in the bucket of their almost $3 trillion projected cost over the next decade.) They also got administration assurances that it will continue to bar lower-cost Canadian drugs from coming into the U.S. All it had to do was put its formidable advertising budget at the disposal of the administration.
- Insurance companies got access to 40 million potential new customers. But when the Senate Finance Committee lowered the fine that would be imposed on those who don’t buy insurance from $3,500 to $1,500, the insurance companies jumped ship and now oppose the bill, albeit for the worst of motives.
The only industry that refused to knuckle under was the medical device makers. They stood for principle and wouldn’t go along with Obama’s blackmail. So the Senate Finance Committee retaliated by imposing a tax on medical devices such as automated wheelchairs, pacemakers, arterial stents, prosthetic limbs, artificial knees and hips and other necessary accoutrements of healthcare.
There is still a long road ahead of this insane, tyrannical Democratic endeavor and while many feel the Senate is a more sensible group and some have assured me it doesn’t stand a snowball’s chance in hell of passing there, where money and control are concerned, I’ve no more personal faith in the Senate than I do in those inhabiting the Nuthouse. To be honest, Harry Reid is just as scary as Nancy Pelosi; they are two peas in a mean and withered old pod, and it will take every bit of Conservative strength to put them soundly in their place.
Have YOU read all 1,900-plus pages of HR 3962 yet? Introduced not quite one week ago, it’s doubtful that all of the unrepresenting representatives in the House have, either. But nonetheless, debate and a vote is being scheduled for Saturday.
I’ve been reading the bill and analyses of it, and as stated earlier, it’s a disaster. And I’m being very, very kind. The devil is, of course, in the details, and common sense tells us that when key details remain unresolved it’s pure insanity to force a vote. But Washington today is purely contrived insanity, designed to baffle Americans into submission so, personally, I’m not the least bit surprised.
But let’s consider a couple of those critical details; the ones the Democrats want to gloss over since they are well aware the majority of tax-paying Americans want nothing to do with them.
Abortion funding: there is still no language specifically excluding federal funding for abortions. There is talk about denying it but including language saying women could pay for an abortion themselves, but that doesn’t exclude the woman’s insurance plan from receiving federal funds. Adding a “third party” to handle the financial transactions is just needlesslly padding someone’s wallet without addressing the issue. Bottom line: a gimmick does not an exclusion make and tax-payer money may be sent around twisting corners to pay for abortions.
Illegal immigrants: House leaders with an eye on 2010 elections desperately want illegal immigrants to be able to buy health insurance from their government option. Bottom line: what part of “illegal” do they still not understand? Enforce the immigrations laws on the books; don’t force American taxpayers to subsidize the health care of criminals. To even suggest that criminals paying their own premiums is somehow ok is a most blatant blowing of smoke in the faces of real Americans. It proves only that those in Washington, Democrats espcially, really and truly believe the American people are stupid. Health insurance premiums do not now and will never cover the entire cost of anyone’s medical care. No matter how you try to spin it, this leaves the rest of us picking up the tab to give criminals a benefit of citizenship.
Bottom line of the bottom line: exactly where in the United States Constitution does it mandate this kind of legislation anyway? That this isn’t even being question or debated is a sign that everyone in Washington needs to go. Now.
While this column has been quiet due to other priorities (like working so that the mortgage is paid, and volunteering so that others may improve their lot in life), it doesn’t mean we haven’t been watching the wankers in Washington as they continue their dangerous attempts to complete the progressive’s long-planned enslavement of the citizens of these United States. Indeed, our silence is due, in part, to head-shaking amazement that writing fresh material for this column becomes harder and harder because every day has become Groundhog Day. President “I Won” continues to use our hard-earned tax monies to hump his campaign stump; appearing on television almost every day in order to jolly Americans into thinking he’s just a normal guy via some talk show or to actively campaign for Democrat candidates in upcoming elections around the country. Speaker of the Nuthouse, Nancy Pelosi, hasn’t stopped her deer-in-the-headlights, utterly non-sensical evasion of legitimate questions; like, for example, exactly where in the Constitution does it give Congress the power to, among other oversteps, mandate health care be purchased by every American?
And true to their lying form, “the most transparent administration in history”, this legend-in-their-own-minds gang of thugs and thieves, scuttled off like the rats they are and locked themselves into an obviously airless room in order to poke and prod and breathe some semblance of life back into deadly, massive HR 3200, their first blatant, sweeping attempt at the usurpation of the private-sector, free market-driven business of American health care. What came out of that headlong rush into madness is HR 3962. A veritable Frankenstein’s monster at 1,990 pages and about 400,000 words, this latest incarnation of mandated submission to government welfare is designed to take over and, as is the case with anything run by the government, annihilate a full ONE-FIFTH of the nation’s economy.
It is a monster only progressives and idiots could love. Like its predecessor, HR 3962 sets up a financial shell game by front-loading revenue and postponing serious spending to later years (years when those who would otherwise be called on the carpet for such reckless misuse of hard-earned taxpayer monies will be far away, enjoying their taxpayer-funded retirements). It contains 13 tax hikes that will hit everyone one way or another:
Employer Mandate Excise Tax (Page 275): If an employer does not pay 72.5 percent of a single employee’s health premium (65 percent of a family employee), the employer must pay an excise tax equal to 8 percent of average wages. Small employers (measured by payroll size) have smaller payroll tax rates of 0 percent (<$500,000), 2 percent ($500,000-$585,000), 4 percent ($585,000-$670,000), and 6 percent ($670,000-$750,000).
Individual Mandate Surtax (Page 296): If an individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of 2.5 percent of modified adjusted gross income (MAGI) or the average premium. MAGI adds back in the foreign earned income exclusion and municipal bond interest.
Medicine Cabinet Tax (Page 324): Non-prescription medications would no longer be able to be purchased from health savings accounts (HSAs), flexible spending accounts (FSAs), or health reimbursement arrangements (HRAs). Insulin excepted.
Cap on FSAs (Page 325): FSAs would face an annual cap of $2500 (currently uncapped).
Increased Additional Tax on Non-Qualified HSA Distributions (Page 326): Non-qualified distributions from HSAs would face an additional tax of 20 percent (current law is 10 percent). This disadvantages HSAs relative to other tax-free accounts (e.g. IRAs, 401(k)s, 529 plans, etc.)
Denial of Tax Deduction for Employer Health Plans Coordinating with Medicare Part D (Page 327): This would further erode private sector participation in delivery of Medicare services.
Surtax on Individuals and Small Businesses (Page 336): Imposes an income surtax of 5.4 percent on MAGI over $500,000 ($1 million married filing jointly). MAGI adds back in the itemized deduction for margin loan interest. This would raise the top marginal tax rate in 2011 from 39.6 percent under current law to 45 percent—a new effective top rate.
Excise Tax on Medical Devices (Page 339): Imposes a new excise tax on medical device manufacturers equal to 2.5 percent of the wholesale price. It excludes retail sales and unspecified medical devices sold to the general public.
Corporate 1099-MISC Information Reporting (Page 344): Requires that 1099-MISC forms be issued to corporations as well as persons for trade or business payments. Current law limits to just persons for small business compliance complexity reasons. Also expands reporting to exchanges of property.
Delay in Worldwide Allocation of Interest (Page 345): Delays for nine years the worldwide allocation of interest, a corporate tax relief provision from the American Jobs Creation Act
Limitation on Tax Treaty Benefits for Certain Payments (Page 346): Increases taxes on U.S. employers with overseas operations looking to avoid double taxation of earnings.
Codification of the “Economic Substance Doctrine” (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.
Application of “More Likely Than Not” Rule (Page 357): Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties. If there is a tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability.
Note for the record that those individuals paying the “individual mandate” tax don’t get anything for their money. It is a penalty, cleverly set up to be enforced (as a criminal liability) by the IRS. Those folks still have to buy health insurance, and the government’s option contains higher premiums that low- and moderate-income individuals and families would have to pay for health coverage to avoid the tax.
Like its predecessor, HR 3962 includes yet another uncontrolled and unaccountable czar who will determine the requirements for health insurance policies. For ALL health insurance policies; which means, as before, if your employer’s plan doesn’t meet the czar’s requirements, it will be determined to be illegal and you will be forced to make another “choice”. Read: take the government’s plan.
Of course, mandating requirements that are unsustainable, such as no exclusions for pre-existing conditions and specific items and services than must be covered as well as the minimum frequency or duration of a required covered service and the maximum allowable patient cost sharing, sets the stage for failure of the free market. The government will simply regulate the free market for health insurance out of existence. Leaving you with no choice but what the government wants to give you.
And with that lack of choice must, by definition, come rationing. The same rationing that exists in the free market and with welfare programs like Medicare and Medicaid today, though the former driven (and therefore avoidable) by consumer choice and the latter driven by its inherent purpose of pulling the unsuspecting under the control of the government for the gains of a few who consider themselves above those they see as the stupid, great unwashed masses (citizens of these United States whom they are, by oath, supposed to represent).
There’s nothing new in this warmed-over, dung-filled bowl of swamp water soup. Those who work hard and play by the rules are going to continue to pay for those who buy into the progressive mindset that they are entitled to something for nothing for the price of their freedom.
HR 3200 was wrong. Its latest incarnation as HR 3962 does nothing to fix any problems and, indeed, only serves to make them worse.
Courtesy of James Taranto, writing at the Wall Street Journal:
“So, let’s review the arguments:
• Republicans are bad, they lost the last election, and they have partisan motives for wanting to stop ObamaCare.
• People who are angry about this are crackpots who display swastikas and other invidious symbols. Also, their anger is insincere, and they are shills of the RNC. They wear nice clothes, and this is not to their credit.
• Some of the arguments against ObamaCare are false, according to Obama.
• If ObamaCare is defeated, Obama would be hurt.
“Is there any argument for ObamaCare? In all the material we reviewed for this item, only this, from the Obama email:
“In other words, the “crisis” is so urgent that any thoughtful deliberation would entail intolerable delay. This is the same old argument that has already failed.
“If this is the best the president can do, he deserves to lose resoundingly. If that hurts him, there’s always aspirin.”
We’ve already pointed out that intentions in the Obama administration’s plans to reform health care includes taking over your job of parenting. If you think that’s out of line, consider just how far this kind of “for the common good” ideology (read: socialist) has gone in Great Britain, who is well-experienced in the muck and mire of socialized medicine.
The “Children’s Secretary” has proposed $400million pounds-worth of plans to put 20,000 “problem families” under 24-hour CCTV supervision in their own homes.
Yes, you read that right. The “Parenting Czar” has gone Big Brother on parents they deem to be unfit.
They will be monitored to ensure that children attend school, go to bed on time and eat proper meals.
Private security guards will also be sent round to carry out home checks, while parents will be given help to combat drug and alcohol addiction.
Around 2,000 families have gone through these Family Intervention Projects so far.
But ministers want to target 20,000 more in the next two years, with each costing between £5,000 and £20,000 – a potential total bill of £400million.
“This is pretty tough and non-negotiable support for families to get to the root of the problem. There should be Family Intervention Projects in every local authority area because every area has families that need support.” (Children’s Secretary Ed Balls)
But Shadow Home Secretary Chris Grayling said: “This is all much too little, much too late.
“This Government has been in power for more than a decade during which time anti-social behaviour, family breakdown and problems like alcohol abuse and truancy have just got worse and worse.”
That last sentence sums up just how well socializing health care works when you take it out of its little Ivy League bubble and force it onto the real world.
Run away, America. Run away.
Both the House and Senate are putting on their best Sunday-go-to-meetin’ faces and telling the media that work on “health care reform” is 80% complete. This means that 80% of the endless laundry list of economic and personal-rights negatives in the bills in both House and Senate are in place and they’re not going to go anywhere.
This means that it is a sword of Damocles that hangs over the heads of the American people as the Obama administration prepares for a complete government takeover of the practice of medicine in the United States.
If that doesn’t frighten you to death, rest assured that with their kind of government “help”, you’ll be dead soon enough. Especially if you look at who’s going to be making decisions about what kind of care the government is going to allow you.
One of them is Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel and the health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. His biography shows him to be a “bioethicist” and a fellow at the right-to-die Hastings Center. Here are some of his views about modern medicine.
“Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change.” (Health Affairs Feb. 27, 2008)
(It’s more efficient to start with the root cause: reduce the number of people alive and needing treatment?)
Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others.” (Journal of the American Medical Association, June 18, 2008)
(Remind that cancer patient whose treatment allowed them be around just long enough to see their son or daughter take their first steps, or graduate from college and their family about this, ok?)
Medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia.” (Hastings Center Report, Nov.-Dec. ’96)
(But it’s all right with the Obama administration if dead people vote.)
“Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.” (Lancet, Jan. 31)
(You’re already 52, Dr. Emanuel. Ready to start moving to the back of the line?)
“Hospital rooms in the United States offer more privacy . . . physicians’ offices are typically more conveniently located and have parking nearby and more attractive waiting rooms” (JAMA, June 18, 2008)
(Heaven forbid that people who are sick might find some modicum of comfort in the place they receive treatment.)
“Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health-reform effort.” (Nov. 16, 2008, Health Care Watch)
(So that explains why the UAW retirees now have to pay for their own Viagra!)
Maybe this is why Ted Kennedy has been keeping such a low profile.
The actual text of health care reform legislation is starting to percolate up from the depths of the committees, and it contains a plethora of hard stops on the freedoms that Americans are guaranteed and have come to expect. President Obama remains inordinately fond of continuing to campaign about all the “choice” he wants us to see in his vision of health care reform, but what’s in this House version of the bill contains anything but.
Since our unrepresenting representatives can’t be bothered to do so, let’s put on our waders and tiptoe through the alligator-infested swamp and take a gander at it, shall we?
The Biggest and Baddest provision turns President Obama into a bald-faced liar. The party line is that if you currently have health insurance, sure, you can keep it. They call this “grandfathering” in your plan. But Section 102: PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE doesn’t protect anything except the government-run “gateways” and “exchanges” because the day you decide to give up your current plan, it’s all over but the shouting because unless you enroll in an employer-provided plan (that must provide no less than exactly the same benefits as the government’s plan), it’s straight into the machine for you.
These are the key excerpts:
(1) LIMITATION ON NEW ENROLLMENT-
(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(Notice that this is the sum total of verbiage in “this paragraph”. There are NO exceptions. Health insurers may no longer enroll new plan participants.)
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
This means that if a health insurance company wants to stay in business, it must get in bed with the government.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
How very kind of them. Separate insurance policies will be “permitted” by the government. If you didn’t ask “What are excepted benefits?” then you deserve the government we’ve got today and don’t come crying to us when Pater Obama tells you that your life isn’t worth the cost of saving it. But because I’m feeling generous today, I’ll ask the question for you. What are these “excepted benefits”? Well, basically anything except what we all think of as common medical treatments, such as:
- Coverage only for accident, or disability income insurance, or any combination thereof.
- Coverage issued as a supplement to liability insurance.
- Liability insurance, including general liability insurance and automobile liability insurance.
- Workers’ compensation or similar insurance.
- Automobile medical payment insurance.
- Credit-only insurance.
- Coverage for on-site medical clinics
- Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
Not exactly the “choice” the President, Pelosi, Reid, and those other generous progressives (gag) are leading you to believe, is it?
So just what happens to your “health care” once the government gets their guaranteed hold of it? Pull out your airsickness bag and read on.
What is covered:
From section 122 (Essential benefits)
(b) Minimum Services To Be Covered-
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
This is the 2008 list of those “preventative services” from the U.S. Preventive Services Task Force:
Cervical cancer screening for women
Colorectal cancer screening for men and women over 50
Discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease
Screening for high blood pressure in adults aged 18 and older
Screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older nonpregnant women who are at increased risk
Prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum
Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit
Screening for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection
Screening all pregnant women for HIV
Screening persons at increased risk for syphilis infection
Screening all pregnant women for syphilis infection
Screening all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco
Screening all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke
Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care
Screening for sickle cell disease in newborns
One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked
Genetic counseling and evaluation for women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (breast & ovarian cancer)
Chemoprevention for women at high risk for breast cancer and at low risk for adverse effects of chemoprevention
Screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older
Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk
Screening all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors)
Screening and behavioral counseling interventions to reduce alcohol misuse (go to Clinical Considerations) by adults, including pregnant women, in primary care settings
Screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and followup
Intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians
Routine screening for iron deficiency anemia in asymptomatic pregnant women
Routine iron supplementation for asymptomatic children aged 6 to 12 months who are at increased risk for iron deficiency anemia
Screening all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults
Screening women aged 65 and older routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures
Structured breastfeeding education and behavioral counseling programs to promote breastfeeding
Primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride
Screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years
(2) ANNUAL LIMITATION-
Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
Pay particular attention to this. It’s your annual out-of-pocket expenses for for anything not included in the Grade A or Grade B list of “preventative items and services”. So although a preventative test may be covered, you’ll still be liable for co-pay expenses to walk in the door to get it. And just like with most plans today, you’ll still be liable to share the costs of fixing anything found wrong with you by those tests.
Of course we have to have a “Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.” This will be chaired by the Surgeon General and will have “9 members who are not Federal employees or officers and who are appointed by the President”, “9 members who are not Federal employees or officers and who are appointed by the Comptroller General”, and an “even number of members (not to exceed 8 ) who are Federal employees and officers, as the President may appoint.” A committe with up to 27 members, 18 of whom are picked by the President. The bill says these people will “reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least one practicing physician or other health professional and an expert on children’s health”. But with no checks and balances on the selection of this group, you can bet they will reflect the President’s personal opinions and/or especially those to whom he owes campaign favors.
And, of course we have to have a Health Choices Administration and a Health Choices Commissioner. At least the commissioner will be appointed by the President “by and with the advice and consent of the Senate”. This will be an independent agency that will audit and enforce compliance for all “qualified health benefit plans”, whether or not the plan participates in the government’s “exchange”. They will be able to levy financial penalties and shut down plans that fail to make their grade. The Commissioner will appoint a “Qualified Health Benefits Plan Ombudsman” to help people stuck in the maze of government’s plan find their way out, but must do so “in a linguistically appropriate manner” (read: “press 1 for English”).
Section 1173a of the bill discusses “Standardizing Electronic Administrative Transactions”. Everything from enrollment to payment for services will be automated. A good thing? The bill allows up to 5 years to implement it so in the meantime we may look forward to not only the lumbering pace of bureaucracy, but utter chaos and confusion.
Section 164 outlines a “Reinsurance Program For Retirees”. The government intends to pick up some of the tab for “participating employment-based plans” in order to lower the costs to the plan’s participants. It includes the word “temporary”, but in the interim it is your tax dollars that will go to cushion employers who perhaps bit off more than they could chew with regards to retiree health benefits. (Why do unions immediately come to mind?)
The “Health Insurance Exchange” is such a behemoth that it gets its own title within the bill. It’s essentially the “Obama Does Costco”, one-stop shopping center where you can go to choose from the various government-seal-of-approval plans, including the government’s “public health insurance option”. Meaning you can choose between vanilla and vanilla via “culturally and linguistically appropriate communication”.
Section 205, “OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN”, is interesting. It defines “outreach” as informing and educating “individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.” Nice. But down in (d)(1) we reach “COVERAGE FOR CERTAIN NEWBORNS” and weasel words that are sure to have the hearts of La Raza going pitter-patter with excitement. And I don’t mean just the closing, “In carrying out this section, the Commissioner shall establish effective methods for communicating in plain language and a culturally and linguistically appropriate manner.”
(A) IN GENERAL- In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed–
(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and
(ii) to have elected to enroll in Medicaid through the application of paragraph (3).
Since the bill makes is mandatory for every American to have health insurance, I’ll let you figure out how a child will be born here without being covered.
To pay for the “Health Insurance Exchange”, we’ll have a “Health Insurance Trust Fund”. And where will we get the money for it? Easy!
Section 207 (c)(1) DEDICATED PAYMENTS- There is hereby appropriated to the Trust Fund amounts equivalent to the following:
(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE– The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).
Yes, Harry & Louise, if you choose to not buy health insurance or want to pay for a plan that is structured differently than the government wants a health insurance plan to be structured, the IRS is going to make you pay for it anyway.
(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE– The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).
(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS– The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).
(2) APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS– There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).
Numerous other “trust funds” are also embedded in the bill for enormous and far-flung entire government-run programs to fund the education of doctors and nurses and all kinds of research, which is essentially a huge step smack into the middle of the private sector.
Sections 241-245 are essentially premium subsidies for those who fall “below 400 percent of the Federal poverty level for a family of the size involved” and individuals; this also includes subsidizing “unaffordable employer coverage”, which is defined as “full-time employees for which the cost of the employee premium for coverage under a group health plan would exceed 11 percent of current family income”.
In the “Employer Responsibility” part of the bill, a nice double-dip can be found in section 311: “if an employee declines [their employer’s plan]but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee”. What this is saying is that employers will be penalized 8% of the employee’s average salary if their employees don’t want what they offer. The employer isn’t paying the employee’s premiums, either. This money goes right into the Health Insurance Exchange Trust Fund.
Small businesses get hit with this double-dip penalty, too, though “only” up to 6% on a sliding scale up to an annual payroll of $400,000.
Employers will be held liable for “civil penalties” if they do not provide health insurance; to the tune of $100/day up to $500,000. Interestingly, the money collected “shall be deposited as miscellaneous receipts in the Treasury of the United States” instead of funding the government’s snake-oiled medicine machine. The IRS will also be involved, collecting employment taxes on employers who “fail” to participate – 10% of what should have been paid up to $500,000.
Section 2793 addresses what’s required if an employer wants to use the government’s plan. “Such election shall be treated as the establishment and maintenance of a group health plan” and because, say, Joe’s Plumbing & Heating is now Joe’s Plumbing & Heating Health Insurance Plan, the now-infamous “Secretary shall regularly audit…and conduct investigations and other activities…so as to discover noncompliance with the health coverage participation requirements….” Anything wrong will be sent to the “Secretary of the Treasury and the Health Choices Commissioner. The Secretary shall take such timely enforcement action as appropriate to achieve compliance.” The same civil and IRS-driven penalties noted above will also apply if Joe’s Plumbing & Heating Health Insurance Plan fails to “satisfy the health coverage participation requirements with respect to any employee.”
Of course, complying is going to be as easy as filing with the IRS, because the “Secretary” is given the authority to make up “such regulations as may be necessary or appropriate to carry out the provisions of this section”. Section 6050X spells out how information will be provided to about everyone that Joe’s Plumbing & Heating Health Insurance Plan covers; provided both to the IRS and Joe’s employees, of course.
Because the federal government intends to not just reform health care for Americans, but to control it from birth to (early) death, section 324 has to spell out that cooperation between “the Secretary of Labor, the Secretary of the Treasury, the Secretary of Health and Human Services, and the Health Choices Commissioner” will insure that everyone is singing from the same songbook when it comes to “enforcing” adherence to this sweeping new law of the land.
Title IV of the bill amends the already impossible tonnage of the Internal Revenue Code of 1986. Here is where individuals without coverage will be forced to pay a 2.5% tax, except for non-resident aliens and anyone living outside the United States, or folks who have a “religious exemption” on file. If Joe’s Plumbing & Heating decides not to provide any kind of health insurance for its employees, Joe will pay a tax equal to 8% of his employee’s salaries, though if his business is very small and his payroll is less than $400,000, he’ll pay on a sliding scale up to 6%.
And just in case you were wondering, go ahead and substitute “state” for “Joe’s Plumbing & Heating”. In a behind-the-scenes look at the crafting of this bill, the House Energy & Commerce Republicans reported that:
An amendment offered by Rep. Nathan Deal, R-GA., would prohibit the Federal government from taxing or withholding benefits from States whose health plans don’t comply with the new arbitrary essential benefits mandates that the HHS Secretary is authorized to make under this legislation. These could include mandated coverage of abortion or Botox injections, and if States don’t comply they would face an 8% tax on their employee payroll or drastic cuts in Federal grants.
The issue was outlined starkly in questions posed by the ranking Republican, Joe Barton of Texas, to the committee’s chief Democratic staff counsel:
Barton: “Is it true that if we don’t strike this and the bill stays as is, the federal government could withhold grants from states if they didn’t comply with some of the mandated requirements for health coverage of their state employees?
Democratic counsel: “Yes.”
Barton: “Is it true under the provisions of the bill if not struck or amended that if the federal government required abortions to be covered, a state would have to do that or lose grants?
Democratic counsel: “If the secretary, acting on advice of the benefits advisory commission, had made abortion a minimum benefit for any acceptable insurance package, yes, sir. They could withhold that.”
“We can’t tell states what to do directly,” Waxman said later, explaining why withholding funding would be necessary. “We have to use whatever leverage we have over them.”
Deal pointed out that the requirement seemed at odds with the Democrats’ long-stated intention to enact health care reform in order to cover people without insurance. “If the thrust of this bill is to cover the uninsured, state employees are not uninsured,” Deal pointed out. “Local municipal employees are not uninsured.”
However, Health Subcommittee Chairman Frank Pallone, D-N.J., stuck with the story that states might require federal intervention, “All we’re doing here is saying the state has to act like other employers.”
Nice, eh? Anything the “Secretary’s” black little hole-where-the-heart-should-be desires will be funded by your hard-earned tax dollars. Including abortions.
In Section 45R, “Health Coverage Expenses”, the smallest “qualified” businesses will get a 50% tax credit on the cost of providing health insurance, and there’s a sliding scale that decreases the credit based on the number of employees and their pay. Starting in 2012.
Gee whiz. Such generosity, eh?
In “Subtitle C—Disclosures to Carry Out Health Insurance Exchange Subsidies“, it states that the “Secretary” can “disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit”. Just what information about you will be made available?
Taxpayer identity information
Modified adjusted gross income
Number of dependents
Such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
The taxable year with respect to which the preceding information relates or,if applicable, the fact that such information is not available.
The government will spend $750 million to tell you just how you should raise your children. Section 1904: GRANTS TO STATES FOR QUALITY HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN, subpart 3: Support for Quality Home Visitation Programs, Section 440: HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN intends to provide parents with a “one size fits all” —
- knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);
- knowledge of realistic expectations of age-appropriate child behaviors;
- knowledge of health and wellness issues for children and parents;
- modeling, consulting, and coaching on parenting practices;
- skills to interact with their child to enhance age-appropriate development;
- skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and
- activities designed to help parents become full partners in the education of their children
If you’re a woman pregnant with your first child or have a child under the age of 2 and use the government’s plan the government is going to monitor you. And don’t be surprised to find someone knocking at your door to check on you, in part to increase “birth intervals between pregnancies”. (Can’t have poor people reproducing too quickly, can we?)
Other invasions of privacy are found in Section 2521, NATIONAL MEDICAL DEVICE REGISTRY, where private sector health-related electronic data (such as pharmaceutical purchase data and health insurance claims data) will be gathered to “facilitate analyses of postmarket safety and patient outcomes for devices.” It is intended to be viewable by the general public but, of course, “in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.”
The government intends to spend $88 billion for a “PUBLIC HEALTH INVESTMENT FUND” (Section 2002) to pay for
- Community health centers
- The National Health Service Corps Program
- The National Health Service Corps Scholarship and Loan Repayment Programs
- Primary care loan funds (including funds appropriated for schools of medicine or osteopathic medicine under the authority of section 735(f) of such Act (42 U.S.C. 292y(f))
- Primary care education programs
- Nursing workforce development
- The National Center for Health Statistics
- The Agency for Healthcare Research and Quality
So how do we pay for all this? Subtitle D—Other Revenue 8 Provisions cuts out the heart of the American dream so that the federal government can River Dance on it until it resembles British comfort food.
- SURCHARGE ON HIGH INCOME INDIVIDUALS
1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000
- 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000
- 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000
In 2013, the amounts go up from 1% to 2%, and from 1.5% to 3% unless the “excess Federal health reform savings is more than $150,000,000,000 but not more than $175,000,000,000”. If the “excess Federal health reform savings” is more than $175,000,000,000, then this tax won’t apply.
From what we’ve seen so far, I’m not going to hold my breath on those “savings” happening. (And we’re only up to page 199.) Not when section 4 of this Subtitle states, “The tax imposed under this section shall not be treated as tax….”
DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS has a 7-page table of contents. Suffice it to say that is bodes ill for those who use the systems. Skimming through it find that home infusion therapy will be reassessed, as will the effectiveness of “bone mass measurements”. Hospitals with high readmission rates will see their Medicare payments reduced, and hospitals will be “monitored” to insure they aren’t turning people away. The bill will control a hospital’s growth (number of beds, procedure or operating rooms, etc.) but research will be conducted and a “demonstration program” deployed to find out “the extent to which Medicare service providers utilize, offer, or make available language services” so that “on-site interpreters, including interpreters who work as independent contractors and interpreters who work for agencies that provide on-site interpretation…could directly bill Medicare”.
And how about seeing if “contracting directly with agencies that provide off-site interpretation including telephonic and video interpretation” so they, too, could directly bill Medicare? Including “languages not frequently encountered in the United States”. The participants providing language services in the “demonstration program” can use up to 10% of the “grant money” for their “administrative expenses”.
Maybe it’s just me, but it’s a little disconcerting to read that these “demonstration program” grantees “must ensure that their network providers receive at least 50 percent of the grant funds to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient, including physicians and pharmacies.” Does anyone else wonder how a United States-licensed doctor or pharmacist functions without being proficient in English? The bill itself defines “limited English proficient” as “an individual who speaks a primary language other than English and who cannot speak, read, write or understand the English language at a level that permits the individual to effectively communicate with clinical or nonclinical staff at an entity providing health care or health care related services.”
There are lots more outlays included as well (explaining in part why what doctors do is called “practice”?).
I’d say here’s the kicker in the Medicare portion of the bill, but that sounds almost cruel. Section 1233 ADVANCE CARE PLANNING CONSULTATION actually spells out a 5-year doctor-patient talk that must include:
- An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
- An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
- An explanation by the practitioner of the role and responsibilities of a health care proxy.
- The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
- An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes
the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy)
An advance care planning consultation with respect to an individual may be conducted more frequently…if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
…the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
And to top it off, they’ll update the “MEDICARE & YOU HANDBOOK” so it contains information about:
- Living wills
- Durable power of attorney
- Orders of life-sustaining treatment
- Health care proxies
- A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—
- Available State legal service
- Organizations to assist individuals with advance care planning
- Wbsite links or addresses for state-specific advance directive forms
- Any additional information, as determined by the Secretary
I don’t know about you, but as insane as this whole bill reads, this is among the worst of it. The government has no business mandating that my doctor to stick his or her nose into my personal life nor mandating how someone manages their personal affairs or how they want their life to end.
Now let’s run through some more of the laundry list of federal expenditures:
SEC. 1301. ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM
SEC. 1302. MEDICAL HOME PILOT PROGRAM
SEC. 1304. INCREASED REIMBURSEMENT RATE FOR CERTIFIED NURSE-MIDWIVES
SEC. 1305. COVERAGE AND WAIVER OF COST-SHARING FOR PREVENTIVE SERVICES
SEC. 1306. WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS REGARDLESS OF CODING, SUBSEQUENT DIAGNOSIS, OR ANCILLARY TISSUE REMOVAL
SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES (80% covered)
Under TITLE IV:
SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED
COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND; FINANCING FOR THE TRUST FUND.—For provision establishing a Comparative Effectiveness Research Trust Fund and financing such Trust Fund, see section 1802.
Subtitle B—Nursing Home Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
In a nutshell, if you own, operate, serve on the board of, provide services to, or simply work in any kind of managerial position for a nursing home, the government wants your name made available to the general public. (The better for ACORN to march outside your home, my dear.)
The government is also going to supervise nursing home operations with an even bigger magnifying glass than it does today, down to the level of requiring reporting of even the staff’s qualifications, the hours they work, and their tenure, and there are civil fines waiting for those who fail to comply. The feds even mandate how states can impose fines. All of which results in yet another “pilot program”: SEC. 1422. NATIONAL INDEPENDENT MONITOR PILOT PROGRAM
Let’s not forget government training: SECTION 1431. DEMENTIA AND ABUSE PREVENTION TRAINING. But then we have to figure out just what should be required: SEC. 1432. STUDY AND REPORT ON TRAINING REQUIRED FOR CERTIFIED NURSE AIDES AND SUPERVISORY STAFF.
And, of course, “The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.” To the tune of $2 million each year.
We’ll spend $5 million a year for SECTION 1192. DEVELOPMENT OF NEW QUALITY MEASURES, which is intended to be done with a broad cross-section of “stakeholders” and includes the word “transparency” and states that public input will be allowed, too. Kinda like recovery.gov and allowing 5 days for public viewing of bills, I suppose?
Subtitle D—Physician Payments Sunshine Provision makes into law similar ethical constraints under which the private sector normally operates and puts it all out for public viewing. (SECTION 1451. REPORTS ON FINANCIAL RELATIONSHIPS BETWEEN MANUFACTURERS AND DISTRIBUTORS OF COVERED DRUGS, DEVICES, BIOLOGICALS, OR MEDICAL SUPPLIES UNDER MEDICARE, MEDICAID, OR CHIP AND PHYSICIANS AND OTHER HEALTH CARE ENTITIES AND BETWEEN PHYSICIANS AND OTHER HEALTH CARE ENTITIES.)
TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION, SEC. 1501. DISTRIBUTION OF UNUSED RESIDENCY POSITIONS is where the government will allocate how many residents a hospital may have.
The Secretary shall give preference to:
Hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine
Hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings
Hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department
Hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act)
And, of course, we’ll pay for these “preferred” hospitals to have residents on staff, too.
“The Secretary of Health and Human Services shall conduct a demonstration project under which an approved teaching health center…would be eligible for payment …for its own direct costs of graduate medical education activities for primary care residents, as well as for the direct costs of graduate medical education activities of its contracting hospital for such residents, in a manner similar to the manner in which such payments would be made to a hospital if the hospital were to operate such a program.”
Oxymoron alert! “TITLE VI—PROGRAM INTEGRITY Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse”. (There are also increased penalities, and even unannounced “surprise” on-site visits.)
Section 1636 reduces the maximum amount of time allowed to file Medicare claims from 36 down to 12 months. “Narrowing the window for claims processing will not overburden providers and will reduce fraud and abuse.” If you believe that, I have a bridge for sale….
Section 1639 says you can forget ordering that motorized scooter from the companies that advertise them on tv. Your doctor must provide proof of a face-to-face visit with you first or else Medicare won’t pay for it.
Now if I’m reading it correctly, state’s rights to control how they administer Medicaid are eliminated. SECTION 1702, REQUIREMENTS AND SPECIAL RULES FOR CERTAIN MEDICAID ELIGIBLE INDIVIDUALS removes the state’s ability to determine eligibility for Medicaid, and must accept anyone the government decides is to be covered. And buried in SECTION 1703. CHIP AND MEDICAID MAINTENANCE OF EFFORT, “a State is not eligible for payment…for a calendar quarter …if eligibility standards, methodologies, or procedures under its plan…that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan…as in effect on June 16, 2009.” And, “a State is not eligible for payment…for a calendar quarter…if the State applies any asset or resource test in determining (or redetermining) eligibility of any individual.”
Section 1704 outlines the elimination of Medicaid DSH.
Section 1712 allows coverage for tobacco cessation outpatient drugs.
Section 1741 PAYMENTS TO PHARMACISTS includes drug pricing that is determined, in part, by providing “opportunity for public comment”. Not that some drugs do seem to be priced solely as a get-rich scheme, but I fail to understand how forcing a business to charge a certain price for something will do anything except stifle innovation in the private sector. Which is, actually, a prime directive of the Obama administration. But I digress.
Section 1744 describes how we’ll all pay for doctors to go to school; states will be reimbursed by the government for “graduate medical education”.
Section 1801 is where the bill describes how your federal tax return will be used to determine whether or not you’re eligible for a low-income prescription drug subsidy.
Section 4375 is where you’ll find the tax they are calling a “fee equal to the fair share per capita amount” that will be levied on all private sector health insurance plans (even auto insurance plans will be taxed if they contain any kind of medical coverage). It takes great pains, however, to exempt government plans, of course.
If it isn’t clear to you already, the final sections of the bill are chock-full of spending on what is nothing short of a government takeover of the field of human medicine in the United States, including a handover of states’ sovereignty:
DIVISION C—PUBLIC HEALTH AND WORKFORCE DEVELOPMENT
TITLE I—COMMUNITY HEALTH CENTERS
Sec. 2101. Increased funding
Subtitle A—Primary Care Workforce
PART 1—NATIONAL HEALTH SERVICE CORPS
Sec. 2201. National Health Service Corps
Sec. 2202. Authorizations of appropriations
PART 2—PROMOTION OF PRIMARY CARE AND DENTISTRY
Sec. 2211. Frontline health providers
SUBPART XI—HEALTH PROFESSIONAL NEEDS AREAS
Sec. 340H. In general
Sec. 340I. Loan repayments
Sec. 340J. Report
Sec. 340K. Allocation
Sec. 2212. Primary care student loan funds
Sec. 2213. Training in family medicine, general internal medicine, general pediatrics, geriatrics, and physician assistantship. Preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.
Sec. 2214. Training of medical residents in community-based settings. Preference give to individuals who are from underrepresented minority groups or disadvantaged backgrounds; or individuals who practice in settings having the principal focus of serving underserved areas or populations experiencing health disparities.
Sec. 2215. Training for general, pediatric, and public health dentists and dental hygienists. Preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds; practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities; teaching programs that address the dental needs of vulnerable populations.
Sec. 2216. Authorization of appropriations
Subtitle B—Nursing Workforce
ADVANCED EDUCATION NURSING GRANTS…to train advanced education nurses who will practice in health professional shortage areas (and) to increase diversity among advanced education nurses.
Sec. 2221. Amendments to Public Health Service Act
Subtitle C—Public Health Workforce
Sec. 2231. Public Health Workforce Corps
SUBPART XII—PUBLIC HEALTH WORKFORCE
Sec. 340L. Public Health Workforce Corps
Ensures an adequate supply of public health professionals throughout the Nation. The Corps shall consist of such officers of the Regular and Reserve Corps of the Service as the Secretary may designate; and such civilian employees of the United States as the Secretary may appoint.
Sec. 340M. Public Health Workforce Scholarship Program
Sec. 340N. Public Health Workforce Loan Repayment Program
Sec. 2232. Enhancing the public health workforce
Sec. 2233. Public health training centers
Sec. 2234. Preventive medicine and public health training grant program
Sec. 2235. Authorization of appropriations
Subtitle D—Adapting Workforce to Evolving Health System Needs
PART 1—HEALTH PROFESSIONS TRAINING FOR DIVERSITY
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance in the health professions regarding individuals from disadvantaged backgrounds.
Sec. 2242. Nursing workforce diversity grants.
Sec. 2243. Coordination of diversity and cultural competency programs.
PART 2—INTERDISCIPLINARY TRAINING PROGRAMS
Sec. 2251. Cultural and linguistic competency training for health care professionals, including nurse professionals, consisting of awarding grants and contracts to test, develop, evaluate and implement models of cultural and linguistic competency training (including continuing education) for health professionals. Preference given (in part) to “entities” placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border.
Sec. 2252. Innovations in interdisciplinary care training.
Awards and grants to test, develop, evaluate, then implement health professional training programs (including continuing education) designed to promote the delivery of health services through interdisciplinary and team-based models, which may include patient-centered medical home models, medication therapy management models, and models integrating physical, mental, or oral health services; and coordination of the delivery of health care within and across settings, including health care institutions, community-based settings, and the patient’s home.
PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND ASSESSMENT
This is a permanent advisory committee, 15 members appointed by the Secretary, to be known as the Advisory Committee on Health Workforce Evaluation and Assessment, providing recommendations on the supply, diversity, and geographic distribution of the health workforce; the retention of the health workforce to ensure quality and adequacy of such workforce; and policies to carry out the recommendations. These are to include health professionals within the health workforce; health care patients and consumers; employers; labor unions; and third-party health payors.
Sec. 2261. Health workforce evaluation and assessment.
PART 4—HEALTH WORKFORCE ASSESSMENT
Sec. 2271. Health workforce assessment.
Collect data about the supply (including retention) of and demand for health professionals; the diversity of health professionals (including with respect to race, ethnic background, and gender); the geographic distribution of health professionals; and data on individuals participating in the programs authorized by subtitles A, B, 14 and C and part 1 of subtitle D of title II of division 15 C of the America’s Affordable Health Choices Act of 16 2009
PART 5—AUTHORIZATION OF APPROPRIATIONS
Sec. 2281. Authorization of appropriations.
TITLE III—PREVENTION AND WELLNESS
Sec. 2301. Prevention and wellness.
TITLE XXXI—PREVENTION AND WELLNESS
Subtitle A—Prevention and Wellness Trust
Sec. 3111. Prevention and Wellness Trust
Subtitle B—National Prevention and Wellness Strategy
Sec. 3121. National Prevention and Wellness Strategy
This is for our own good. To improve our health “through evidence-based clinical and community prevention and wellness activities (in this section referred to as ‘prevention and wellness activities’), including core public health infrastructure improvement activities; identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures and standards, including departmental measures and standards (including Healthy People and National Public Health Performance Standards).
Establishment of national priorities for prevention and wellness, taking into account unmet prevention and wellness needs.
Establishment of national priorities for research on prevention and wellness, taking into account unanswered research questions on prevention and wellness.
Identification of health disparities in prevention and wellness.
A plan for addressing and implementing them.
Subtitle C—Prevention Task Forces
Sec. 3131. Task Force on Clinical Preventive Services
This is a group of 30 members, all appointed by the Secretary to identify clinical preventive services for review; review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of them for the purpose of developing, updating,publishing, and disseminating evidence-based recommendations on the use of such services; then as appropriate, take into account health disparities in developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services; identify gaps in clinical preventive services research and evaluation and recommend priority areas for such research and evaluation.
Sec. 3132. Task Force on Community Preventive Services.
Subtitle D—Prevention and Wellness Research
Sec. 3141. Prevention and wellness research activity coordination
Sec. 3142. Community prevention and wellness research grants
Subtitle E—Delivery of Community Prevention and Wellness Services
Sec. 3151. Community prevention and wellness services grants
Subtitle F—Core Public Health Infrastructure
Sec. 3161. Core public health infrastructure for State, local, and tribal health departments.
Sec. 3162. Core public health infrastructure and activities for CDC
Subtitle G—General Provisions
Sec. 3171. Definitions.
TITLE IV—QUALITY AND SURVEILLANCE
Sec. 2401. Implementation of best practices in the delivery of health care
Sec. 2402. Assistant Secretary for Health Information
Sec. 2403. Authorization of appropriations
TITLE V—OTHER PROVISIONS
Subtitle A—Drug Discount for Rural and Other Hospitals
Sec. 2501. Expanded participation in 340B program
Sec. 2502. Extension of discounts to inpatient drugs
Sec. 2503. Effective date
Subtitle B—School-Based Health Clinics
Sec. 2511. School-based health clinics
Subtitle C—National Medical Device Registry
Sec. 2521. National medical device registry
Subtitle D—Grants for Comprehensive Programs To Provide Education to Nurses and Create a Pipeline to Nursing
Enormous and far-flung; includes employer-match for tuition and paid leave time from a job to go to school
Sec. 2531. Establishment of grant program
Subtitle E—States Failing To Adhere to Certain Employment Obligations
Sec. 2541. Limitation on Federal funds
Federal funds are available “only if the State agrees to be subject in its capacity as an employer to each obligation under division A of this Act and the amendments made by such division applicable to persons in their capacity as an employer; and assures that all political subdivisions in the State will do the same.”
Welcome to the end of 1,017 pages. Is your head spinning? Does your head hurt? Mine sure did. But through the pain, one thing is crystal clear: this is NOT what America needs to help make sure that those who need medical care can receive it in a way that is affordable.
Only the gods know how this version will end up, if it ever makes it out of all the committees. But the cost estimates for this bill show a 10-year “net increase in the deficit of an estimated $65 billion.” The Congressional Budget Office also caveats that “…the figures do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill’s provisions on other federal programs, and they do not reflect any modifications or amendments made after the bill was introduced.”
The Republican Ways & Means Committee staff put together a spiffy graph that demonstrates this, and projects the numbers beyond the 10 years forecasted by the CBO:
“We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount,” Douglas Elmendorf, director of the Congressional Budget Office, told the Senate Budget Committee. “On the contrary, the legislation significantly expands the federal responsibility for health-care costs,” he added.
Of course, Pelosi and Reid were quick to poo-poo them, trotting out the empty old, sad (and unmeasurable) sack of “better health care decreases health care costs”.
In his appearance, Mr. Elmendorf suggested lawmakers could take steps to control costs. Among other things, he said Congress could reduce the tax subsidy that critics say encourages employers to offer large health-insurance policies. That idea was being considered by members of the Senate Finance Committee, but dropped after Senate Democratic leaders — including Mr. Reid — voiced concern. The proposal has been sharply opposed by labor unions, among other groups, that have big tax-advantaged plans.
On Thursday, Mr. Reid expressed disdain when asked by reporters about Mr. Elmendorf’s suggestion. “What he should do is maybe run for Congress,” the Nevada Democrat said.
That’s an excellent idea, Harry. How about we start by replacing YOU? And replacing every other wanker in Washington who thinks that this is a road down which America should be driven.
Having otherwise-intelligent liberal friends still hawking past-expiration-date Obama campaign Kool-Aid makes it easy to find the spin being put out by the administration and the media. So-called “health care reform” is the next big attack looming over American freedoms and it was with interest I read a article sent to impress me and my friend’s other correspondents with the “efforts” of the current Chicago politicians holding Americans hostage from Washington.
These are some excerpts from the rather long article that ought to make everyone with common sense shudder:
Rather than laying out an intricate plan and then trying to sell it on the Hill, as Clinton did, Obama’s strategy seems to be exactly the opposite — to sell himself to Congress first and worry about the details later. As Emanuel likes to tell his West Wing staff: “The only nonnegotiable principle here is success. Everything else is negotiable.”
Obama’s aggressive courtship of Congress is plotted and directed by Emanuel…[and he] has taken an unusually personal role in handling Congress. One of the first things he did as chief of staff was to give out his cellphone number to every Democratic senator (and some Republicans too)…his social calendar is taken up by dinners with former House colleagues on both sides of the aisle, often at one of the trendy downtown restaurants he favors.
The second tenet of Emanuel’s theory is that the White House itself comes with strategic assets you can put to good use, if you allocate them properly. There’s the White House theater, where guests can watch movies and sporting events; formal state dinners; smaller gatherings in the first family’s residence, which spouses can join; tickets to the Easter-egg roll for kids; tickets to the White House tours that members like to give out to their constituents. …in Obama’s nascent administration, they are considered carefully and accounted for obsessively. Emanuel holds a daily legislative meeting at which aides discuss the status of pending legislation, and often they go over the distribution of White House assets during those sessions. “We have a tracking system,” Emanuel told me. “Who came to watch the football game? Who came to watch the basketball game?”
…friction between House and Senate Democrats now seems to have reached a point where they might want to build their own virtual fence down the middle of the rotunda. [Obama] simply encourages the House to go wild, and then he relies on centrists in the Senate to do the unpleasant work of scaling back the legislation, which yields a more politically palatable bill…. And while House and Senate leaders may end up wanting to throttle one another, Obama gets to play the reluctant arbiter between the two, rather than actually having to challenge his base.
It’s an impressive balancing act, but it may not be sustainable as the emotional debate over health care unfolds. Some House Democrats I talked to have already begun to wonder audibly why they’re the ones who always have to surrender in Emanuel’s middle-of-the-night negotiating sessions. They accuse Reid and his lieutenants of repeatedly placating Republicans to avoid a filibuster, rather than taking a stand on principle now and then. Why not force centrist Democrats to vote against their party and let Republicans filibuster the agenda on national television? What would the voters think then? Centrists in the Senate, meanwhile, have grown furious at some of Pelosi’s backroom maneuvering — most notably, the final negotiations over the stimulus bill, when she brazenly reinserted $50 million in arts funding that had been struck as part of an earlier compromise.
During his campaign last year, Obama took at least two positions on health care that he may soon find hard to maintain. First, in the primaries, he differentiated his plan from Hillary Clinton’s by refusing to back an “individual mandate” — that is, the provision that would require every American to obtain insurance. Then, during the fall campaign, Obama criticized John McCain for proposing to tax employer-based health benefits. If he were to offer a detailed proposal of his own right now, Obama might have to…reverse himself on one or both positions. But with Baucus urging him to leave the details to his committee, Obama can instead wait for a plan to emerge from the Senate and then, if need be, reluctantly change his mind in the interest of compromise. Thus he preserves the option of backing away from his previous anti-big-government stances, and he gets to appear statesmanlike and pragmatic in the process.
[Senator] Baucus remarked … offhandedly that Obama “didn’t really serve in the Senate,” which seems to be the prevailing sentiment among senators who saw him for only a brief time before he took off to run for president.
Obama seems to have decided early on that his model for pursuing legislation would be something closer to Ronald Reagan, a president whose political savvy he has often expressed admiration for.
Though such machinations have been the unfortunate part and parcel of politics since the first caveman bartered a piece of meat for a lump of burning coal, I can only imagine that Ronnie is rolling over in his grave. As a small but critical prelude to our upcoming focus on the dangers inherent in and lies surrounding the next Obama agenda item for his destruction of America, I think it fitting to let Ronald Reagan himself speak to us one more time about the topic of “socialized medicine”. Words spoken while he was “just” another American citizen, like you and me:
“Now back in 1927 an American socialist, Norman Thomas, six times candidate for president on the Socialist Party ticket, said the American people would never vote for socialism. But he said under the name of liberalism the American people will adopt every fragment of the socialist program.
One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it.
Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We had an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this.
Let’s take a look at social security itself. Again, very few of us disagree with the original premise that there should be some form of savings that would keep destitution from following unemployment by reason of death, disability or old age. And to this end, social security was adopted, but it was never intended to supplant private savings, private insurance, pension programs of unions and industries.
Now in our country under our free enterprise system we have seen medicine reach the greatest heights that it has in any country in the world. Today, the relationship between patient and doctor in this country is something to be envied any place. The privacy, the care that is given to a person, the right to chose a doctor, the right to go from one doctor to the other.
But let’s also look from the other side, at the freedom the doctor loses. A doctor would be reluctant to say this. Well, like you, I am only a patient, so I can say it in his behalf. The doctor begins to lose freedoms; it’s like telling a lie, and one leads to another. First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him you can’t live in that town, they already have enough doctors. You have to go some place else. And from here it is only a short step to dictating where he will go.
This is a freedom that I wonder whether any of us have the right to take from any human being. All of us can see what happens once you establish the precedent that the government can determine a man’s working place and his working methods, determine his employment. From here it is a short step to all the rest of socialism, to determining his pay and pretty soon your children won’t decide when they’re in school where they will go or what they will do for a living. They will wait for the government to tell them where they will go to work and what they will do.
What can we do about this? Well, you and I can do a great deal. We can write to our congressmen and our senators. We can say right now that we want no further encroachment on these individual liberties and freedoms. And at the moment, the key issue is, we do not want socialized medicine.
Former Representative Halleck of Indiana has said, “When the American people want something from Congress, regardless of its political complexion, if they make their wants known, Congress does what the people want.”
So write, and if your representative writes back to you and tells you that he or she, too, is for free enterprise, that we have these great services and so forth, that must be performed by government, don’t let them get away with it. Show that you have not been convinced. Write a letter right back and tell them that you believe in government economy and fiscal responsibility; that you know governments don’t tax to get the money the need; governments will always find a need for the money they get and that you demand the continuation of our free enterprise system. You and I can do this. The only way we can do it is by writing to our congressmen even we believe that he is on our side to begin with. Write to strengthen his hand. Give him the ability to stand before his colleagues in Congress and say “I have heard from my constituents and this is what they want.”
Write those letters now; call your friends and them to write them. If you don’t, this program I promise you, will pass just as surely as the sun will come up tomorrow, and behind it will come other federal programs that will invade every area of freedom as we have known it in this country. Until, one day, as Normal Thomas said we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days we are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.“