What HR3200 Says

[Guest guest]

This is interesting.... word for word what some passages of the health care

bill says, with some commentary by a Duke professor.........

 

 

http://www.classicalideals.com/HR3200.htm

 

 

The Health Care Bill: What HR 3200, ‘‘America’s Affordable Health Choices

Act of 2009,†Says

August 6, 2009

 

What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health

Choices Act of 2009,†actually say about major health care issues? I here pose

a few questions in no particular order, citing relevant passages and offering a

brief evaluation after each set of passages.

 

This bill is 1017 pages long. It is knee-deep in legalese and references to

other federal regulations and laws. I have only touched pieces of the bill here.

For instance, I have not considered the establishment of (1) “Health Choices

Commissio0ner†(Section 141); (2) a “Health Insurance Exchange,†(Section

201), basically a government run insurance scheme to coordinate all insurance

activity; (3) a Public Health Insurance Option (Section 221); and similar

provisions.  

 

This is the evaluation of someone who is neither a physician nor a legal

professional. I am citizen, concerned about this bill’s effects on my freedom

as an American. I would rather have used my time in other ways—but this is too

important to ignore.

 

We may answer one question up front: How will the government will pay for all

this? Higher taxes, more borrowing, printing money, cutting payments, or

rationing services—there are no other options.  We will all pay for this,

enrolled in the government “option†or not.

 

(All bold type within the text of the bill is added for emphasis.)

 

 

1.      1.  WILL THE PLAN RATION MEDICAL CARE?

 

This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY

PREVENTABLE HOSPITAL READMISSIONS:

 

 ‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with

respect to a hospital, excess readmissions shall not include readmissions for an

applicable condition for which there are fewer than a minimum number (as

determined by the Secretary) of discharges for such applicable condition for the

applicable period and such hospital.

 

and, under “Definitionsâ€:

 

‘‘(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means,

subject to subparagraph (, a condition or procedure selected by the Secretary

.. . .

 

and:

 

‘‘(E) READMISSION.—The term ‘readmission’ means, in the case of an

individual who is discharged from an applicable hospital, the admission of the

individual to the same or another applicable hospital within a time period

specified by the Secretary from the date of such discharge.

 

and:

 

‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial

review under section 1869, section 1878, or otherwise of— . . .

‘‘© the measures of readmissions . . .

 

EVALUATION OF THE PASSAGES:

1.       This section amends the Social Security Act

2.      The government has the power to determine what constitutes an

“applicable [medical] condition.â€

3.      The government has the power to determine who is allowed

readmission into a hospital.

4.      This determination will be made by statistics: when enough people

have been discharged for the same condition, an individual may be readmitted.

5.      This is government rationing, pure, simple, and straight up.

6.      There can be no judicial review of decisions made here. The

Secretary is above the courts.

7.      The plan also allows the government to prohibit hospitals from

expanding without federal permission: page 317-318.

 

 

2.                  Will the plan punish Americans who try to

opt out?

 

What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT

ACCEPTABLE HEALTH CARE COVERAGE:

 

 ‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the

requirements of subsection (d) at any time during the taxable year, there is

hereby imposed a tax equal to 2.5 percent of the excess of—

(1) the taxpayer’s modified adjusted gross income for the taxable year, over

(2) the amount of gross income specified in section 6012(a)(1) with respect to

the taxpayer. . . .â€

 

EVALUATION OF THE PASSAGE:

 

1.      This section amends the Internal Revenue Code.

2.      Anyone caught without acceptable coverage and not in the government

plan will pay a special tax.

3.      The IRS will be a major enforcement mechanism for the plan.

 

 

3.                  what constitutes “acceptable†coverage?

 

Here is what the bill says, pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE

DEFINED:

 

 (a) IN GENERAL.—In this division, the term ‘‘essential benefits

package’’ means health benefits coverage, consistent with standards adopted

under section 124 to ensure the provision of quality health care and financial

security . . .

 

( MINIMUM SERVICES TO BE COVERED.—The items and services described in this

subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic 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 . . .

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services . . .

(9) Maternity care.

(10) Well baby and well child care . . .

 

 © REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

 

(3) MINIMUM ACTUARIAL VALUE.—

(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be

designed to provide a level of coverage that is designed to provide benefits

that are actuarially equivalent to approximately 70 percent of the full

actuarial value of the benefits provided under the reference benefits package

described in subparagraph (.

 

EVALUATION OF THE PASSAGES:

 

1.      The bill defines “acceptable coverage†and leaves no room for

choice in this regard.

2.      By setting a minimum 70%  actuarial value of benefits, the bill

makes health plans in which individuals pay for routine services, but carry

insurance only for catastrophic events, (such as Health Savings Accounts)

illegal.

 

 

4.                  Will the PLAN destroy private health

insurance?

 

Here is what it requires, for businesses with payrolls greater than $400,000 per

year. (The bill uses “contribution†to refer to mandatory payments to the

government plan.)  Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF

COVERAGE

 

(a) IN GENERAL.—A contribution is made in accordance with this section with

respect to an employee if such contribution is equal to an amount equal to 8

percent of  the average wages paid by the employer during the period of

enrollment (determined by taking into account all employees of the employer and

in such manner as the Commissioner provides, including rules providing for the

appropriate aggregation of related employers). Any such contribution—

 

(1) shall be paid to the Health Choices Commissioner for deposit into the Health

Insurance Exchange Trust Fund, and

(2) shall not be applied against the premium of the employee under the

Exchange-participating health benefits plan in which the employee is enrolled.

 

(The bill then includes a sliding scale of payments for business with less than

$400,000 in annual payroll.)

 

The Bill also reserves, for the government, the power to determine an acceptable

benefits plan: page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.

 

5 (a) IN GENERAL.—A qualified health benefits plan that uses a provider

network for items and services shall meet such standards respecting provider

networks as the Commissioner may establish to assure the adequacy of such

networks in ensuring enrollee access to such items and services and transparency

in the cost-sharing differentials between in-network coverage and out-of-network

coverage.

 

EVALUATION OF THE PASSAGES:

 

1.      The bill does not prohibit a person from buying private insurance.

2.      Small businesses—with say 8-10 employees—will either have to

provide insurance to federal standards, or pay an 8% payroll tax. Business costs

for health care are higher than this, especially considering administrative

costs. Any competitive business that tries to stay with a private plan will face

a payroll disadvantage against competitors who go with the government

“option.â€

3.      The pressure for business owners to terminate the private plans

will be enormous.

4.      With employers ending plans, millions of Americans will lose their

private coverage, and fewer companies will offer it.

5.      The Commissioner (meaning, always, the bureaucrats) will determine

whether a particular network of physicians, hospitals and insurance is

acceptable.

6.      With private insurance starved, many people enrolled in the

government “option†will have no place else to go.

 

 

5.                  Does the plan TAX successful Americans more

THAN OTHERS?

 

Here is what the bill says, pages 197-198, SEC. 441. SURCHARGE ON HIGH INCOME

INDIVIDUALS

 

 ‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.

‘‘(a) GENERAL RULE.—In the case of a taxpayer other than a corporation,

there is hereby imposed (in addition to any other tax imposed by this subtitle)

a tax equal to—

‘‘(1) 1 percent of so much of the modified adjusted gross income of the

taxpayer as exceeds $350,000 but does not exceed $500,000,

‘‘(2) 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, and

‘‘(3) 5.4 percent of so much of the modified adjusted gross income of the

taxpayer as exceeds $1,000,000.

 

EVALUATION OF THE PASSAGE:

 

1.      This bill amends the Internal Revenue Code.

2.      Tax surcharges  are levied on those with the highest incomes.

3.      The plan manipulates the tax code to redistribute their wealth.

4.      Successful business owners will bear the highest cost of this plan.

 

6.      6.  Does THE PLAN ALLOW THE GOVERNMENT TO set FEES FOR SERVICES?

 

What it says, page 124, Sec. 223, PAYMENT RATES FOR ITEMS AND SERVICES:

 

(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the

Secretary’s authority to correct for payments that are excessive or deficient,

taking into account the provisions of section 221(a) and the amounts paid for

similar health care providers and services under other Exchange-participating

health benefits plans.

 

(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the

authority of the Secretary to establish payment rates, including payments to

provide for the more efficient delivery of services, such as the initiatives

provided for under section 224.

 

EVALUATION OF THE PASSAGES:

 

The government’s authority to set payments is basically unlimited.

The official will decide what constitutes “excessive,†“deficient,†and

“efficient†payments and services.

 

 

7.                  Will THE PLAN increase the power of

government officials to SCRUTINIZE our private affairs?

 

What it says, pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE

EXCHANGE SUBSIDIES.

 

 ‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health

Choices Commissioner or the head of a State-based health insurance exchange

approved for operation under section 208 of the America’s Affordable Health

Choices Act of 2009, shall 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 described in subtitle C of title II of the

America’s Affordable Health Choices Act of 2009. Such return information shall

be limited to—

‘‘(i) taxpayer identity information with respect to such taxpayer,

‘‘(ii) the filing status of such taxpayer,

‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in

section 59B(e)(5)),

‘‘(iv) the number of dependents of the taxpayer,

‘‘(v) 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

‘‘(vi) the taxable year with respect to which the preceding information

relates or, if applicable, the fact that such information is not available.

 

And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS

EMPLOYEE AND DEPENDENT COVERAGE:

 

(3) PROVISION OF INFORMATION.—The employer provides the Health Choices

Commissioner, the Secretary of Labor, the Secretary of Health and Human

Services, and the Secretary of the Treasury, as applicable, with such

information as the Commissioner may require to ascertain compliance with the

requirements of this section.

 

EVALUATION OF THE PASSAGE:

 

1.      This section amends the Internal Revenue Code

2.      The bill opens up income tax return information to federal

officials.

3.      Any stated “limits†to such information are circumvented by

item (v), which allows federal officials to decide what information is needed.

4.      Employers are required to report whatever information the

government says it needs to enforce the plan.

 

 

8.      8.  Does the plan automatically enroll Americans in the GOVERNMENT

plan?

 

What it says, page 102, Section 205, Outreach and enrollment of

Exchange-eligible individuals and employers in Exchange-participating health

benefits plan:

 

(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The

Commissioner shall provide for a process under which an individual who is

described in section 202(d)(3) and has not elected to enroll in an

Exchange-participating health benefits plan is automatically enrolled under

Medicaid.

 

And, page 145, section 312:

 

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of

the employee in accordance with subsection ©.

 

EVALUATION OF THE PASSAGES:

 

1.       Do nothing and you are in.

2.      Employers are responsible for automatically enrolling people who

still work.

 

 

9.      9.  Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?

 

What it says, page 124, Section 223, PAYMENT RATES FOR ITEMS AND SERVICES:

 

(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review

of a payment rate or methodology established under this section or under section

224.

 

And, page 256, SEC. 1123. PAYMENTS FOR EFFICIENT AREAS.

 

‘‘© LIMITATION ON REVIEW.—There shall be no administrative or judicial

review under section 1869, 1878, or otherwise, respecting—

‘‘(i) the identification of a county or other area under subparagraph (A);

or

‘‘(ii) the assignment of a postal ZIP Code to a county or other area under

subparagraph (.

 

EVALUATION OF THE PASSAGES:

 

1.      Sec. 1123 amends the Social Security Act, to allow the Secretary to

identify areas of the country that underutilize the government’s plan “based

on per capita spending.â€

2.      Parts of the plan are set above the review of the courts.