"The List" on Health Care (Insurance) Reform Bill

There are a few "lists" of page numbers with descriptions of supposed horrors within the Health Care Reform Bill, also known as H.R. 3200.  Page numbers mean nothing, really, when it comes to Bills, since these can change over time.  Sections, Subsections and paragraph references are the only sure way to point the readers to the right resources.  This is the misdirection many of these “lists” depend on.  This article will attempt to clarify some points on one of those "Lists."

For the purpose of this article, I've use http://thomas.loc.gov to look up the bill number "h.r. 3200" and click the 'text of legislation' link.  Also, I've used the GPO link[1] to see a PDF that has page numbers, although it loads very slowly.

Page 16: States that if you have insurance at the time of the bill becoming law and change, you will be required to take a similar plan. If that is not available, you will be required to take the gov option!

This refers to Sec. 102 Protecting the Choice to keep current coverage.  They pull this out of the definition of Grandfathered Health Insurance Coverage.  The Truth is that you can choose to keep your current, non-conforming, health insurance plan as long as there are no changes made to it by the issuer.  You can change your options as normal.  If and when you go to get a totally new plan, you will get a plan that conforms to the requirements in the bill.  Whether you get it from a Private Health Insurer or take the government option is up to you.

Page 22: Mandates audits of all employers that self-insure!

Page 22 is part of Sec. 113 Insurance Rating Rules.  It is part (b) dealing with Study and Reports.  It talks about a study to examine overall, not individual employers :

(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.

(B) The similarities and differences between typical insured and self-insured health plans.

(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.

(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent.

(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure

Page 29: Admission: your health care will be rationed!

For one thing, Health Insurance Companies already ration your care using co-pays, deductibles, denial of care and annual/lifetime limits on coverage (see this[2]).  However, the page referred to is in Sec. 122 (c) Requirements relating to cost-sharing... and it limits how much you will have to 'share' the cost of your treatments to $5,000 per individual and $10,000 per family.

Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)

This is Sec. 123 Health Benefits Advisory Committee.  It is not until page 32 where it defines what the committee will do.  The Committee is "to recommend covered benefits and essential, enhanced, and premium plans." They make these recommendations, which may or may not be adopted by the Secretary of Health and Human Services.  It will set what Private Health Insurers have to cover as a minimum.  It will no more determine what treatments and benefits you get than what happens now. (See this[3])

Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.

This is Sec. 142 Duties and Authority of Commissioner.  It is also another absurd claim.  You will have as much choice about those matters as you do now.  The Commissioner will be over compliance to make sure that Insurance companies comply with the minimum standards.  You still get to choose which offering you choose.

Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.

Sec 152 Prohibiting Discrimination in Health Care, which is at the very bottom of page 50.  It states "(a) In General- Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services."  So if you can pull their claim out of that, then, okay, I guess so.  More rational people make take it to mean Health Coverage shall not be denied based on Race, Gender, Sexual Orientation or Lifestyle Choices, Hair color, Eye color, Sense of Humor or any other Personal Characteristics.

Page 58: Every person will be issued a National ID Healthcard.

This is part of Sec 163, subSec. 1173A - Standardize Electronic Administrative Transactions. They pull it from a snippet of Sec 163, subSec 1173A (a)(2)(D) "...which may include utilization of a machine-readable health plan beneficiary identification card." So, do you carry a Health Insurance Card now or do you refuse to do so?  I guess I'd have to give this one a "Possibly."

Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.

This is still on the same Section. (a)(4) Requirements for Specific Standards - (C) "enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;"  So, it seems to me, this would set a standard to have an EFT between the doctor's office and the Private Health Insurance Company offices to handle payments of benefits quickly and without so much room for human error delays.  Find and talk to someone in Medical Billing to find out how many different programs, forms, contact methods and such are in use currently and ask them if getting them all standardized on one platform would be a good idea.

Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (example: SEIU, UAW and ACORN)

Sec. 164 - Reinsurance Program for Retirees.  It seems to be assistance for ALL Retirees from an employer.  I can't find anywhere in the text where they pull the part about Union and Community Organizers from, so here is the section I think they are pulling it from :

(a) Establishment-

(1) IN GENERAL- Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the `reinsurance program') to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees.

Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.

Subtitle A - Health Insurance Exchange. Yes, this one is true! Wow, I feel like celebrating.  They did leave out some details, though.  Employers can still go directly to the Insurance companies to choose the coverage they offer their employees.  The Health Care Exchange can only be used by Individuals (who don't have acceptable coverage already) and (in two years) by Employers with less than 20 employees.  So, the plans offered in the HIE will be able to have a greater risk pool when insuring individuals.  Basically, it will give Individuals and Small Businesses the group-negotiating power of a larger employer and the Insurers a larger risk pool for their policies. It is a Win-Win situation in my opinion.

Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)

I am totally lost here.  I've read pages 80 - 90 and no idea where they get this idea.  Since Employers over 20 employees CAN'T use the Health Insurance Exchange, this idea seems pretty far-fetched.  I am going to have to say this claim has no basis in reality.

Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens

Sec. 204(b)(7).  "The entity shall provide for culturally and linguistically appropriate communication and health services."  In order to be in the HIE, the plan must cover these services. The "translation" is a bit... loony.  We have many Legal U.S. Citizens who live in culturally and linguistically unique places as "Little Tokyo", "Little Italy" and other places.  Saying this means giving services to illegal aliens is just hate-mongering and fear-mongering. 

Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.

Sec. 205.  The section does set up "Outreach" to spread information about the Health Insurance Exchange.  Actually, on page 99, (4) states that "individuals enrolled in an Exchange-participating health benefits plan shall pay such plans directly, and not through the Commissioner or the Health Insurance Exchange."  On page 100, it does say that in addition to the HIE's own outreach efforts "(3) USE OF OTHER ENTITIES- In carrying out this subsection, the Commissioner may work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph (2)."  No mention anywhere of ACORN or AmeriCorps. Yet another Hate and Paranoia fueled delusional interpretation.

 Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.

Sec. 205(d)(3) - Kind of correct.  If you 1) do not have coverage, 2) qualify for Medicaid, 3) choose to not enroll in an Exchange-participating health benefits plan - The Commissioner shall provide a process under which you will be automatically enrolled under Medicaid.  You can choose to enroll in another plan instead.

 Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.

This Refers to Subsection B - Public Health Insurance Option, Sec. 223(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."  However, Sec. 222 says that "(1) IN GENERAL- The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner (A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and (B) at a level sufficient to fully finance the costs of (i) health benefits provided by the public health insurance option; and (ii) administrative costs related to operating the public health insurance option." Plus, a "(2) CONTINGENCY MARGIN- In establishing premium rates under paragraph (1), the Secretary shall include an appropriate amount for a contingency margin."
So, while some CEOs of Private Health Insurance companies may be 'crushed' that their bonus falls under the Two Million mark, I don't think a legitimate and responsible Insurer will be pushed out of business.

Page 127: The AMA sold doctors out: the government will set wages.

Under Subtitle B - the Public Option - Sec. 225(c)(1) It sets out the Payment for Services that the public option insurance will pay Preferred and Non-Preferred Physicians.  Just like any other Health Coverage Policy will do.

Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.

Sec. 312(a)(4) - "AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c)."  But then you must look at subsection (c) starting at the bottom of page 147, which says, yes, they must auto enroll the employee, but not in the Public Option specifically.  Then, in (2), they can choose to opt out. "OPT-OUT.— In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan"

Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.

I am going to assume they meant Page 146.  Only if by "healthcare bills" you mean an employer contribution to their insurance coverage premiums.  Sec. 312(b)(3), by the way.

Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll

Sec. 313.  Almost true.  The listed employers can NOT offer the Public Option, but if they do not offer any coverage at all,  the 8% tax on the payroll will go into the Health Insurance Exchange Trust Fund. 

Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income.

Just a note, first, the typo is theirs, not mine. Sec59B(a). This goes under the "not exactly, but close" category.  Its oversimplified, but yes, if you don't have acceptable health coverage, you will be taxed "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." As long as that tax "shall not exceed the applicable national average premium for such taxable year."

Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).

Sec59B(c)(2).  Non-Resident aliens who don't have acceptable health coverage won't be taxed as though they were a Citizen.  Nobody will pay for them.  There is actually a whole long list of people who won't have to pay the tax for not being covered.  Read it.

Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.

Sec. 431(a)(21)(A). If you apply for an "Affordability Credit" to help pay for your Health Coverage and your income is relevant to the approval decision, then the "Health Choices Administration or such State-based health insurance exchange, as the case may be" will get to look at your Tax Return.  Not anything else.  Sec. 431(a)(21)(B) says they can't use the tax return information for any other purposes.  This is just like when you apply for a student loan, food stamps and many other items where income is important. 

Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.

Sec.59C - Surcharge on High Volume Individuals. (f)(4) – Kind of.  It says, “The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.” Only, by reading the rest of the section, it means the tax on High Income people shall not be considered as a deduction itself.  In effect, closing a loophole that I'm sure somebody would try to exploit.  But, I do have to agree that the wording on that one is very funny.

Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected.

Sec. 1121(c) - okay, this one references the Social Security Act and makes changes to it in order to update it to current times.  I'm just this guy, so without examining the changes to the Social Security Act in its entirety, there is really no way to see what this paragraph actually does.  Given the track record of the previous entries, I think it is fairly safe to say that it will not reduce physician services for Medicaid.  Again, I can't be sure on this one.

Page 241: Doctors: no matter what speciality you have, you'll all be paid the same

Sec. 1121(d)(5) - the last paragraph of this subsection.  It is describing "Service Categories" and doesn't seem to be related in any way to payment.  It does say, "Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service."  The section is establishing service categories for Growth Rates of the payment schedule under Medicare.  It might be fair to say that every doctor in the same Service Category will see their payments grow at the same rate.  It is, however, totally misleading to say they will all be paid the same.

Page 253: Government sets value of doctors' time, their professional judgment, etc.

Sec. 1122 - MISVALUED CODES UNDER THE PHYSICIAN FEE SCHEDULE. (a) Under the adjustment section (L).  This sets up a review of Service Codes and their related Medicare part B payout to see if any of them are off the mark on their 'value.'  Technically, these payouts could be adjusted up or down.  Really, though, this already exists in Government and Private Health Insurance, only now Doctors have to file appeals to get the rates adjusted.

Page 265: Government mandates and controls productivity for private healthcare industries.

Sec. 1131 - still under the Medicare Part B section.  It appears that this section will take improvements in productivity into account when adjusting the Fee Schedule during Medicare’s "Market Basket Updates."  What that really means, I am not clear on.  I am, however, positive that it has no effect on private healthcare industries - other than adjusting Medicare’s fee schedule.

Page 268: Government regulates rental and purchase of power-driven wheelchairs.

This is still under the Medicare section in Sec. 1141.  So, it only applies to Medicare and adjusts items already in place.  It seems the change will make it so Medicare doesn't pay for just any old power driven wheelchair, it now has to be a Complex Rehabilitative Power Drive Wheelchair, classified in group 3 or higher. 

Page 272: Cancer patients: welcome to the wonderful world of rationing!

Sec. 1145 - Sets up a study to determine whether Cancer Hospitals charge more for similar care than other hospitals.  It then goes on to say that if the Cancer Hospitals charges are excessively higher, an adjustment will be made to the payment.  It appears as though it will increase the Medicare payment to those hospitals to meet more of their charges.  Also, on a side note, Rationing takes place now and is done by your current insurance provider.  Ever run into a test or procedure that they won't cover? That is Rationing.  Have a high deductible or co-pay? That is Rationing.  For more info, see : http://healthinsurance.about.com/od/faqs/f/rationing.htm

Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.

 Subtitle C - Medicare parts A & B - Sec. 1151.  This one is true!  That makes two out of thirty one?  What this section does is, if you have to be readmitted several times for the same issue, Medicare will reduce its payments to the hospital.  Let’s look at an example situation here.  You take your car in because the engine is sputtering when you try to accelerate.  They 'fix' it and charge you an arm and a leg.  Then, a week later, it’s sputtering again just as bad.  You take it back and they fix it again, but don't charge you as much.  Another four days, the sputtering is back, again.  By this time, you're sure they are not being as thorough as they should and you've already paid twice, you tell them to fix it this time and you're not paying to fix the same problem a third time!  It is the same situation here with the hospital - they're screwing up and charging you (and Medicare) for it over and over again.  This gives the hospital more incentive to get it right the first or second time, because they get less money the third and fourth time now, instead of getting the same high amount over and over for not fixing your problem. 

Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.

This is the same section, only (d).  This is actually setting up a Study to see how best to apply encouragement to reduce excessive readmission to physicians.  Many options are set forth, the payment reduction being one.  Again, only applies to patients using Medicare coverage.

Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!

SEC. 1156. LIMITATION ON MEDICARE EXCEPTIONS TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS MADE TO HOSPITALS.  (i)(1)(B).  No, they are not prohibited from owning and investing in healthcare companies.  In order to qualify for Exceptions in Medicare, they are prohibited from referring patients to places they own or have a financial interest in.  It’s called Ethics.  Apparently, the people who made the list don't have any.

Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.

Again, this is for qualifying for exceptions from certain Medicare requirements.  I think this one falls under the qualifying as a Rural Provider.  In other words, Hospitals are not prohibited from expanding without government approval.  They may lose some exemptions under Medicare, if they had any, but that's about it.

Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.

This is still on the Qualifying for Medicare Exceptions section. What is their hang-up with ACORN and why do they think everything ties into them?  There is no ACORN where I live, so this statement is absurd.  Anyway, this section they refer to is talking about applying to keep the qualification for the exception and expand anyway.  It provides an opportunity for community input on the application to keep exception status.  Basically, if a Rural Hospital wants to expand and keep their rural exceptions to a lot of Medicare requirements, they can apply to do so and community input will be taken into consideration during the approval process.  Further down, it says they can't more than double capacity.

Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.

Sec. 1162(a)(3)(B)(ii), is still under Medicare-related items. This is specifically Medicare Advantage reforms.  It is also on Reporting.  Measurements of Performance.  It’s a report.  Not a mandate.

Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.

Again, Medicare Advantage, again, is reporting.  They can disqualify a plan from being included in the Ranking report.

Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.

Sec. 1177 - actually, it extends the ability to restrict enrollment into special needs plans from ending in 2011 to 2013 or 2016 in certain cases.  What is the restriction?  They can't enroll except during Open Enrollment period or within a small time period when they are first diagnosed with a qualifying condition.

Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).

Subtitle F : Medicare Rural Access Protections - Sec. 1191  this section expands and Enhances an already existing service called Telehealth.  It is actually pretty cool - and it is not by phone.  It includes having a patient go to a satellite clinic and having a Teleconference with their primary care physician or a specialist from far off, reducing patient travel.  For more information on Telehealth, visit http://tie.telemed.org/default.asp.  It is tough to find information on it, because it is fairly new.

Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
Page 425: Goverment provides approved list of end-of-life resources, guiding you in death.
Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
Page 430: Government will decide what level of treatments you may have at end-of-life.

Sec. 1233 - Advanced Care Planning Consultation.  What the section actually does is adjust it so that Medicare will pay for such consultations with a physician, nurse practitioner or physician's assistant.  How much do you know, right now, about Living Wills, Hospice Care, Durable Power of Attorney, Nursing Home care and how to make your wishes known and enforceable regarding life-sustaining treatment and whether or not you want it done and for how long?  Do you really think that having a consultation about what your situation is and what options are available is a bad thing?  Remember, it’s YOUR doctor of choice providing the service, the bill just lets Medicare pay for it (once every five years or more often in certain cases).  Also, it is not mandatory; it is just like everything else in Medicare - an option.

Page 469: Community-based Home Medical Services: more payoffs for ACORN.

Sec. 1302 Medical Home Pilot Program.  Home Health Care exists already today.  Mostly, Medicare does not cover it, unless it is hospice care.  This section sets up a feasibility study to see what the costs of providing coverage for such services would be. They are complaining about section (d)(1)(B) which is defining what a Community-Based Home Medical Service would be.  The list writers seem to have some serious issues and hang-ups about Community and ACORN.  ( See http://www.acorn.org/ for some reality based information )

Page 472: Payments to Community-based organizations: more payoffs for ACORN.

This is under the same section, a paragraph about establishing payments to the pilot program. 

Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.

Sec. 1308 - Coverage of Marriage and Family Therapist Services and Mental Health Counselor Services.  Sure, if Medicare paying for Marriage and Family counseling services in government intervention.

Page 494: Government will cover mental health services: defining, creating and rationing those services.

... I have no words for this one.

So, that is the truth behind "The List" about H.R. 3200.  It appears that the compiler of the list skimmed through looking for scary phrases in the bill, took them out of context and came up with the worst possible interpretation to write down.

For the Record, there were only 3 True statements out of 49 points in the list.

[1] http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

[2] http://patients.about.com/od/patientempowermentissues/a/rationing.htm

[3] http://patients.about.com/lr/denial_of_care/345083/2/