December 17, 2009

CMS is the Centers for Medicare & Medicaid Services. I'm underlining areas of the document just as a highlight for you. My comments will be bolded)

For Immediate Release: Wednesday, July 01, 2009
Contact: CMS Office of Public Affairs
202-690-6145


CMS PROPOSES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010

The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment ratesfor more than 7,000 types of services in physician offices, hospitals, and other settings.

CMS is making several proposals to refine Medicare payments to physicians, which are expected to increase payment rates for primary care services. (Recall that the healthcare legislation wants to move AWAY from specialty care and lump everyone into care by primary doctors and physician assistants.) The proposals include an update to the practice expense component of physician fees. For 2010, CMS is proposing to include data about physicians’ practice costs from a new survey,the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. (Which represents 17% of this country's physicians - most doctors despise this political organization.) 
The Medicare law requires CMS to adjust the MPFS payment rates annually based on an update formula which includes application of the Sustainable Growth Rate or SGR that was adopted in the Balanced Budget Act of 1997. This formula has yieldednegative updates every year beginning in CY 2002, (That means doctors get a pay cut every year as expenses go up...can YOU live like that?) although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. Based on current data, CMS is projecting a rate reduction of -21.5 percent for CY 2010. 
As part of health care reform, the Administration supports comprehensive, but fiscally responsible, reforms to the physician payment formula. Consistent with this goal, the Administration announced in the FY 2010 President’s Budget that it would explore the breadth of options available under current authority to facilitate such reforms, including an assessment of whether the cost of physician-administered drugs should continue to be included in the payment formula. Thus, while working with Congress to develop a more appropriate mechanism for updating physician payment rates, CMS is proposing to remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments. While the proposal will not change the projected update for services during CY 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update. (This means if your doctor administers a medication to you during your care he no longer gets paid for it. Do the math on THAT one. The statement behind it means that instead of cutting physician pay year after year, he just won't get paid for certain services.)
CMS is also proposing to stop making payment for consultation codes, (I already explained that this compromises the communication between your physicians)which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management (E/M) services. Practitioners will use existing E/M service codes when providing these services instead. Resulting savings would be redistributed to increase payments for the existing E/M services. 
CMS is proposing to increase the payment rates for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. The IPPE benefit was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to pay for an initial assessment of key elements of a beneficiary’s health status within six months of the beneficiary’s enrollment in Medicare Part B. Subsequently, Congress extended the time period for the IPPE benefit to within one year of the beneficiary’s enrollment in Part B.

In addition, CMS is proposing to refine how Medicare recognizes the cost of professional liability insurance in its payment system. While these changes would have a modest impact, they will promote payment equity by redirecting the portion of Medicare’s payment for professional liability insurance to those physicians that have the highest malpractice costs.

Taken together, refining the practice expenses, eliminating payment for the consultation codes and revising the treatment of malpractice premiums would increase payments to general practitioners, family physicians, internists, and geriatric specialists by between 6 and 8 percent (before taking into account the proposed update and other proposed changes to the fee schedule).

The proposed rule would also implement provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that added new Medicare benefit categories for cardiac and pulmonary rehabilitation services, and for chronic kidney disease (CKD) education, beginning January 1, 2010. The proposed rule outlines what these programs would entail, how they would be paid under the MPFS, and the criteria for covering these services.
CMS is proposing two changes to address concerns from the Medicare Payment Advisory Commission (MedPAC) and the U.S. Government Accountability Office (GAO)about rapid growth in high cost imaging services. First, CMS is proposing to reduce payment for services that require the use of expensive equipment which wouldproduce a redistribution of the resulting savings to increase payments for other services, including primary care services. The current payment rates assume that a physician who owns this type of equipment will use it about 50 percent of the time, but recent survey data suggest this expensive equipment is being used more frequently. As the use of this type of equipment increases, the per-treatment costs for purchasing, maintaining and operating the expensive equipment declines, making a reduction in payment appropriate.

Second, CMS is proposing to implement a requirement in the MIPPA that suppliers of the technical component of advanced imaging services be accredited beginning January 1, 2012 by designating accrediting organizations (AOs) for these suppliers and utilizing the imaging quality standards that have been developed by the AOs. The accreditation requirement would apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but would not apply to the physician who interprets them. According to the GAO, spending on advanced imaging services, such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), is growing almost twice as fast as spending on other types of imaging services, and is a significant contributor to the rapid growth in health care spending in recent years, but there is little administrative oversight to ensure the quality of care. In a separate regulatory action, CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management. 

The proposed rule contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) (We thought this system would be great - it's nothing but a pain in the ass. The programs are limited and don't jibe with what the doctor sometimes needs to prescribe...example: liquid antibiotics for youngsters. They're not linking up with the electronic medical records system that is being mandated, at your doctor's cost...GE/NBC is the proponent behind that movement. Power outages put the entire patient care system down. E-prescriptions get lost in cyberspace ALL the time. A great many drugs cannot be e-prescribed - they require a written script...example: Ativan. Pharmacies, especially WalMart, CONSTANTLY claim/lie we never sent the scripts, which they can't do when the patient walks in and hands them one. The damned thing just makes more work for everyone) and the Physician Quality Reporting Initiative (PQRI). Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods. CMS is proposing to simplify the reporting requirements for the electronic prescribing measure and to provide eligible professionals with more reporting options. CMS is also proposing a new process for group practices to be considered successful electronic prescribers. 

In addition, CMS is proposing to add more measures and more measures groups for eligible professionals to report under the PQRI, to provide a mechanism for participants to submit quality measure data from a qualified electronic health record and to create a process for group practices to use for reporting the quality measures.
CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.

(Just sayin': there's a lot more going on behind the scenes than the patient and the bureaucrat realizes)

I had a brilliant idea at the eleventh hour.  For the longest time I would not write to my Congressmen because I was unsure of what to say and how to go about it. Yesterday I decided that I would start posting my letters on Facebook so others could copy and paste or use them as a springboard for their own letters. 

I typed my letter in a Word document then copied it to the clipboard. I opened up the list of Senators and their emails (URL address is below) and just went down the list.

I've been faxing and emailing for quite awhile now and nobody appears to be listening, so this isn't the best example of a professional well-written letter.  My irritation and frustration is showing.  Nevertheless, I emailed this to every single Senator yesterday. Took me a little over two hours.  Once you get a rhythm going, you're set!

www.senate.gov/general/contact_information/senators_cfm.cfm

=======================================================================

Senator 

We were forwarned of the impending government seizure of our healthcare:

“Unless we put medical FREEDOM into the Constitution, the time will come when medicine will organize itself into an undercover dictatorship. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic.” – Benjamin Rush, Revolutionary war hero, physician, and signer of the Declaration of Independence.

I will not participate in any government run healthcare plan nor will I pay a fine, tax, or penalty for failure to comply. Your vote will affect the entire country, and I urge you to vote AGAINST passage of the healthcare “reform” so that life, health and death decisions justly remain in the hands of the patient and his physician. Otherwise, get my jail cell ready…there will be one less taxpayer contributing to the system and one more drawing FROM it.

Thank you.

 Disregarding this history www.americanthinker.com/2009/03/michelle_obamas_patientdumping_1.html, I was wondering why Michelle Obama was sent out to push the healthcare bill and why they've been trying to say it was so good for women. After being lied to over and over and over, I'm very suspect of anything they say now and trying my level best not to become a conspiracy theorist.

In reading just a tiny part of "Ecoscience: Population, Resources, Environment" co-authored by Ezekiel Emanuel in 1977, I found the reproductive version of Cap & Trade, whereby "some couples might be allowed to have a third child if they purchased "deci-child" units from the government or from other women who had decided not to have their full allotments of children..." I also read "a government might require only implantation of the contraceptive capsule...Certainly unwanted births and the problem of abortion would both be entirely avoided. The disadvantages...include the questionable desirability of keeping the entire female population on a continuous steroid dosage..." Also in the text was this: "...responsible parenthood ought to be encouraged and illegitimate childbearing could be strongly discouarged. One way to carry out this disapproval might be to insist that all illegitimate babies be put up for adoption--especially those born to minors..."

I found starting on page 1609, "Section 2588 Office of Women's Health" and wonder why there would be a special section dedicated to women in this bill. The government will establish within the Office of the Secretary, an Office on Women's Health, a Coordinating Committee loaded with more government employees which will establish short- and long-range goals and objectives, provide the Secretary advice and consultation concerning scientific, legal, ethical and policy issues; a National Women's Health Information Center; and they'll be issuing contracts and grants for what I don't know.

We already have the NIH for women's health issues so why add another bureaucratic mess? It's more government jobs, more government intrusion, and more tax dollars spent. Then on pg 1623 there was this:

RULE OF CONSTRUCTION.—Nothing in this section (or the amendments made by this section) shall be construed to limit the authority of the Secretary of Health and Human Services with respect to women’s health, or with respect to activities carried out through the Department of Health and Human Services on the date of enactment of this section.

I'm sure I'm reading more into this than I should be. I guess after the first 1,018 page healthcare bill that completely FAILED to hide its ultimate objective (control) and absolutely contradicted everything the federal government was telling us, then reading the same things in the first 700 pages of the current bill, my head is ready to explode.

I think I'm on overload. What more do I have to watch out for? Can't they just leave us the hell alone?

(if you delete this line and set your printer's margins at one-half inch top, bottom and sides, this should fit on 4 pages)

HR-3962 Excerpts - The Facts:  IT'S NOT FREE

Bolded for easier reading.  Italics are my comments.

Pg 4 - (4) HEALTH DELIVERY REFORM.—This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and Government. 

Pg 9 - (4) COST-SHARING.—The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges, but does not include premiums, balance billing amounts for non-network providers, or spending for non-covered services. (You still pay all of these)

Pg 16 - SEC. 101. NATIONAL HIGH-RISK POOL PROGRAM. 

Pg 18 - (d) MEDICALLY ELIGIBLE REQUIREMENTS.—For purposes of subsection (c)(1)(B)(ii), an individual described in this subsection is an individual—(1) who, during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section applied for individual health insurance coverage and— A) was denied such coverage because of a preexisting condition or health status; or (B) was offered such coverage— (i) under terms that limit the coverage for such a preexisting condition; or (ii) at a premium rate that is above the premium rate for high risk pool coverage under this section;

Pg 19 - the Secretary shall make adjustments to offset differences in premium rating that are attributable solely to differences in age rating.  ("High risk" people will still pay a higher rate under the new system - the only adjustments will be for age...older people will pay up to twice as much as younger ones. Age not yet specified in the bill)

Pg 22 - (g) COVERED BENEFITS, COST-SHARING, PREMIUMS, AND CONSUMER PROTECTIONS

(1) PREMIUM.—The monthly premium charged to eligible individuals for coverage under the program— (A) may vary by age so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1; (B) shall be set at a level that does not exceed 125 percent of the prevailing standard rate for comparable coverage in the individual market; and (C) shall be adjusted for geographic variation in costs.  

The Secretary shall establish standard rates in consultation with the National Association of Insurance Commissioners. 

(Just like private insurance now, older people pay higher premiums.  Rates will be determined by the same people who decide the rates for private insurance)

Pg 23 - (4) APPEALS.—The Secretary shall establish an appeals process for individuals to appeal a determination of the Secretary--(A) with respect to claims...B) with respect to eligibility determinations made by the Secretary (no outside  recourse) 

Pg 24 - 5) STATE CONTRIBUTION, MAINTENANCE OF EFFORT...the Secretary shall require the State make a maintenance of effort payment each year that the high-risk pool is in effect equal to an amount not less than the amount of all sources of funding for high-risk pool coverage... (Where will your state get the money for its payments?)

Pg 25 - (h) FUNDING; TERMINATION OF AUTHORITY.— (1) IN GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.   (2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists. 

Pg 26 - (3) TERMINATION OF AUTHORITY.— (A) IN GENERAL.—Except as provided in subparagraph (B), coverage of eligible individuals under a high-risk pool shall terminate as of the date on which the Health Insurance Exchange is established. (B) TRANSITION TO EXCHANGE.—The Secretary shall develop procedures to provide for the transition of eligible individuals who are enrolled in health insurance coverage offered through a high-risk pool established under this section to be enrolled in acceptable coverage.

Pg 31 - SEC. 104. SUNSHINE ON PRICE GOUGING BY HEALTH INSURANCE ISSUERS.  The Secretary of Health and Human Services, in conjunction with States, shall establish a process for the annual review of increases in premiums for health insurance coverage. Such process shall require health insurance issuers to submit a justification for any premium increases prior to implementation of the increase.  (Your rates will increase, just as they do now; only the government will decide if your insurer can raise rates and by how much- denials can mean less coverage)

Pg 54 - SEC. 717. PROTECTION AGAINST POSTRETIREMENT REDUCTION OF RETIREE HEALTH BENEFITS. (b) NO REDUCTION.—Notwithstanding that a group health plan may contain a provision reserving the general power to amend or terminate the plan or a provision specifically authorizing the plan to make post-retirement reductions in retiree health benefits...(If your health plan had a clause allowing amendments, reductions or terminations, this Section will still not ensure your coverage will remain unchanged.  If not, your employer can still apply for and be granted a hardship waiver.)

Pg 72 - SEC. 114. STATE HEALTH ACCESS PROGRAM GRANTS. (2) COMMUNITY COVERAGE PROGRAM.—Community coverage with shared responsibility between employers, governmental or nonprofit entity, and the individual. (NOT FREE)  (c) ELIGIBILITY AND ADMINISTRATION.— (1) IMPLEMENTATION OF KEY STATUTORY OR REGULATORY CHANGES.—In order to be awarded a grant under this section for a program, a State shall demonstrate that— (B) it will be able to sustain the program without Federal funding after the end of the period of the grant.  (That means the State has to get the money from somewhere...a state income tax? a higher sales tax? increase in property tax?)

Pg 75 - (B), no grant may be awarded to a State unless the State demonstrates the seriousness of its effort by matching at least 20 percent of the grant amount through non-Federal resources, which may be a combination of State, local, private dollars from insurers, providers, and other private organizations. 

Pg 77 - (2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS. (D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, on a specific date or range of dates,... (Your financial records are immediately accessible in order to determine if you are allowed certain services and if so when, where, and by which doctor.)

Pg 79 - (B) require paper versions of standardized transactions... (D) require timely and transparent claim and denial management processes

Pg 91 - SEC. 201. REQUIREMENTS REFORMING HEALTH INSUR17ANCE MARKETPLACE.SEC. 202. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. (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.  (You cannot buy private insurance after the government plan starts) (2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.  (With the exception of raising your premiums as allowed by the gov't, your insurance policy cannot change at all once the government plan starts; otherwise it is not considered "acceptable coverage")

Pg 92 - (b) GRACE PERIOD FOR CURRENT EMPLOYMENT-BASED HEALTH PLANS. (A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 201, including the essential benefit package requirement under section 221.  (After 5 years, private insurance must conform to the government’s required coverage)

Pg 94 - (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. (Again, if you don’t have private insurance when the government plan goes into effect, you cannot buy it - you must enroll in the government insurance.  Dental and vision  insurance are not included in your health plan - you must buy it separately)

Pg 96 - SEC. 213. INSURANCE RATING RULES.  a) IN GENERAL.—The premium rate charged for a qualified health benefits plan that is health insurance coverage may not vary except as follows:  (1) LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1. (2) BY AREA.

(c) STUDY AND REPORTS.— (A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.  (C) The financial solvency and capital reserve levels of employers that self-insure by employer size.  (2) REPORTS. (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and midsize employers to self-insure.

Pg 100 - SEC. 215. ENSURING ADEQUACY OF PROVIDER NETWORKS.  (b) INTERNET ACCESS TO INFORMATION.  The Commissioner shall also establish an on-line system whereby an individual may select by name any medical provider (as defined by the Commissioner) and be informed of the plan or plans with which that provider is contracting.  (Not all doctors will take all insurance plans - just like the current system)

Pg 104 - SEC. 222. ESSENTIAL BENEFITS PACKAGE DEFINED.  (1) Hospitalization. (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... (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... (11) Durable medical equipment, prosthetics, orthotics and related supplies. 

(1) NO COST-SHARING FOR PREVENTIVE SERVICES.—There shall be no cost-sharing under the essential benefits package for— #8 and #10 above only. (Cost sharing does not mean premiums or balance billing)

Pg 107 - (A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year...is not to exceed $5,000 for an individual and not to exceed $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year (Sounds just like private insurance, doesn't it? Only after this bill passes, you won't have the choice to pick the plan that is right for you)

Pg 110 -  (4) ABORTION SERVICES.— (A) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROHIBITED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved. (B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved. 

Pg 147 - (a) NO PREEMPTION OF STATE LAWS REGARDING ABORTION. (b) NO EFFECT ON FEDERAL LAWS REGARDING ABORTION.

Pg 110 -  SEC. 223. HEALTH BENEFITS ADVISORY COMMITTEE.  (a) ESTABLISHMENT.— (1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans. 

Pg 129 - SEC. 240. DISSEMINATION OF ADVANCE CARE PLANNING INFORMATION. (a) IN GENERAL.—The QHBP offering entity — (1) shall provide for the dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits plans offered through the Exchange

Pg 132 - SEC. 242. DUTIES AND AUTHORITY OF COMMISSIONER.  (2) COMPLIANCE EXAMINATION AND AUDITS.— (B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.  (Costs to your insurer are usually passed on to you. With new gov't interference, if costs rise but the company can't cover that with higher premiums they will likely end up out of business which forces you on to the govt plan)

Pg 167 - SEC. 303. BENEFITS PACKAGE LEVELS. b) LIMITATION ON HEALTH BENEFITS PLANS OFFERED BY OFFERING ENTITIES.—The Commissioner may not enter into a contract with a QHBP offering entity under section 304(c) for the offering of an Exchange-participating health benefits plan in a service area unless the following requirements are met: (1) REQUIRED OFFERING OF BASIC PLAN. (2) OPTIONAL OFFERING OF ENHANCED PLAN. (3) OPTIONAL OFFERING OF PREMIUM PLAN. (4) OPTIONAL OFFERING OF PREMIUM-PLUS PLANS

Pg 169 - ...plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner.

Pg 184 - (2) ENROLLMENT PERIODS.— (A) OPEN ENROLLMENT PERIOD. Such periods shall be during September through November of each year...

Pg 185 - 3) AUTOMATIC ENROLLMENT FOR NON-MEDICAID ELIGIBLE INDIVIDUALS.

Pg 195 - SEC. 307. HEALTH INSURANCE EXCHANGE TRUST FUND.  (a) ESTABLISHMENT OF HEALTH INSURANCE EXCHANGE TRUST FUND.  (c) TRANSFERS TO TRUST FUND.— (A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE. (B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE. (C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS. (2) APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS. (they're going to tax us all to death)

Pg 216 - regarding the “public option”: SEC. 323. PAYMENT RATES FOR ITEMS AND SERVICES.  (3) INNOVATIVE PAYMENT METHODS. (c) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 324.  SEC. 324. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM.  The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services (currently illegal in Florida), differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers. 

Pg 256 -SEC. 345. INCOME DETERMINATIONS. (2) INCOME VERIFICATION.— (i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application;  (tax returns; guidelines for reporting to the gov’t changes to your income)

Pg 283 - (b) ENFORCEMENT OF HEALTH COVERAGE PARTICIPATION REQUIREMENTS. (Monetary penalties charged to employers who “fail to satisfy the health coverage participation requirements” will not go into the healthcare fund to help offset expenses): (F) DEPOSIT OF PENALTY COLLECTED.— Any amount of penalty collected under this paragraph shall be deposited as miscellaneous receipts in the Treasury of the United States. (Don't you think those fines should go into the healthcare fund instead?)

Pg 298 - SEC. 501. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.  (1) TAX LIMITED TO AVERAGE PREMIUM.— (A) IN GENERAL.—The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year. 

Pg 304 - (6) NOT TREATED AS  TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—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. (You have to pay a penalty called a “tax” but can’t deduct it on your tax return for credit as a tax paid.)

Pg 305 - SEC. 6050X. RETURNS RELATING TO HEALTH INSURANCE COVERAGE. (a) REQUIREMENT OF REPORTING.—Every person who provides acceptable coverage (as defined in section 59B(d)) to any individual during any calendar year shall, at such time as the Secretary may prescribe, make the return described in subsection (b) with respect to such individual.  (Your employer is required to file a return with an as yet unnamed government dept containing your personal info and social security number or be penalized - undoubtedly that will cause some kind of reconciliation on our private returns, too)

Pg 313 - (c) EMPLOYERS ELECTING NOT TO PROVIDE HEALTH BENEFITS.— (1) IN GENERAL.—In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the wages... 

Pg 318 - SEC. 45R. SMALL BUSINESS EMPLOYEE HEALTH COVERAGE CREDIT. (1) IN GENERAL.—For purposes of this section, the applicable percentage is 50 percent. (2) PHASEOUT BASED ON AVERAGE COMPENSATION OF EMPLOYEES.—In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the percentage specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000.  (The small employer’s credit for paying your premiums is only 50% of his cost, which means less money for raises, improvements, new hires, etc and is further reduced or phased out the higher your salary is)

(2) CREDIT NOT ALLOWED WITH RESPECT TO CERTAIN HIGHLY COMPENSATED EMPLOYEES (making $80,000 or more) (3)CREDIT ALLOWED FOR ONLY 2 TAXABLE YEARS.

Pg 324 - PART 3—LIMITATIONS ON HEALTH CARE RELATED EXPENDITURES.  

SEC. 531. DISTRIBUTIONS FOR MEDICINE QUALIFIED ONLY IF FOR PRESCRIBED DRUG OR INSULIN. 

Pg 337 - SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.

Pg 339 - SEC. 552. EXCISE TAX ON MEDICAL DEVICES.  (a) IN GENERAL.—There is hereby imposed on the first taxable sale of any medical device a tax equal to 2.5 percent of the price for which so sold. (2) LEASE TREATED AS SALE. (3) USE TREATED AS SALE.  (Your doctors or hospitals will pay an EXTRA tax when they purchase devices and equipment to be used to treat you)

Pg 429 - D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS. III) ADDITIONAL REDUCED PAYMENT FOR MULTIPLE IMAGING PROCEDURES. (When you have more than one body part scanned on a visit, the facility discounts the second test by 50%; the gov’t will change that to 75%  and pay the facility even less) 

Pg 441-446 - SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS.  (1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital... (Penalizing hospitals, doctors, skilled nursing and rehab facilities, and home health agencies for additional if a patient has to be readmitted after being discharged - timeframe determined by the gov’t; and there is no challenge allowed.  Life happens - human beings aren’t machines!) (6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review..

If you would like a copy of the original bill in PDF format, or any other information, please contact me at

MissJaneQPublic@gmail.com

Feel free to forward this information – Knowledge is Power

This is what I put out for the first bill - I printed it on a bright neon blue paper.  I KNOW it made a difference in my area.  I've been passing these out every chance I get.  I still have people asking for this even though it's not the recent bill.  

 HR 3200 EXCERPTS

cover page - To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. 

pg 16 - SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. 

(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. 

1. LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1. 

pg 17 - (b) GRACE PERIOD FOR CURRENT EMPLOYMENT- BASED HEALTH PLANS.— 

(1) GRACE PERIOD.— (A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.  

pg 19

(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. 

pg 22 - SEC. 113. INSURANCE RATING RULES. 

(2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure...

pg 30 - SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE. 

(a) ESTABLISHMENT.— (1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(5) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS.— (A) ENHANCED PLAN.—The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).  (B) PREMIUM PLAN.—The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B). 

pg 43 - SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER. 

1. IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange. 

(2) COMPLIANCE EXAMINATION AND AUDITS.— (A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance. 

(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit...

pg 50

SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE. 

(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services. 

pg 58 - SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS. 

(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; 

pg 84 -SEC. 203. BENEFITS PACKAGE LEVELS. 

(a) IN GENERAL.—The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section. 

pg 110 - SEC. 207. HEALTH INSURANCE EXCHANGE TRUST FUND. 

(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).  (B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE. 

(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS.

pg 119 - SEC. 222. PREMIUMS AND FINANCING. 

(a) ESTABLISHMENT OF PREMIUMS.— (1) IN GENERAL.—The Secretary shall establish geographically-adjusted premium rates for the public health insurance option 

pg 120 - (2) START-UP FUNDING.— (A) IN GENERAL.—In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. (B) AMORTIZATION OF START-UP FUNDING.—The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1.

pg 121 -SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES.

1. RATES ESTABLISHED BY SECRETARY 1) IN GENERAL.—The Secretary shall establish payment rates for the public health insurance option for services and health care providers

pg 124 -(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. 

(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. 

pg 125 - SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM. 

(a) IN GENERAL.—For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services...  

pg 149 - SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE. 

(a) IN GENERAK.—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). 

pg 167 - SEC. 59B. 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.  pg 181 - (1) IN GENERAL.—In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee to whom such election applies, there is hereby imposed on each such failure with respect to each such employee a tax of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.  pg 183 - (c) EMPLOYERS ELECTING TO NOT PROVIDE HEALTH BENEFITS.— (1) IN GENERAL.—In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the wages (as defined in section 3121(a)) paid by him with respect to employment (as defined in section 3121(b)). 

pg 171

(5) RELIGIOUS CONSCIENCE EXEMPTION.— 

‘‘(A) IN GENERAL.—Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.   (B) EXEMPTION.—An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate. 

pg 198 - SEC. 441. 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. 

pg 272 - SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS. 

(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.— 

(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).   (B) AUTHORIZATION OF ADJUSTMENT.— Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment

pg 281 - SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS

(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR EXCESS READMISSIONS.— (1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital (**see actual bill for complex computations**)

pg 285 - (A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary among conditions and procedures

pg 288 - (6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review 

pg 297 - (d) PHYSICIANS.— (1) STUDY.—The Secretary of Health and Human Services shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians.   (C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission

pg 424 - SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. 

‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.  Such consultation shall include the following:  (E) 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. 

(F)(i) 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; 

pg 502 - SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED

pg 713 - SEC. 1633. REQUIRED INCLUSION OF PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.  (p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.—The Secretary shall establish a payment modifier under the fee schedule under this section for evaluation and management services (as specified in section 1842(b)(16)(B)(ii)) that result in the ordering of additional services (such as lab tests), the prescription of drugs, the furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for such additional services under this title, or the ordering, furnishing, or prescribing of other items and services determined by the Secretary to pose a high risk of waste, fraud, and abuse. 

pg 717 - SEC. 1636. MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS REDUCED TO NOT MORE THAN 12 MONTHS. 

pg - 757 - SEC. 1704. REDUCTION IN MEDICAID DSH.

pg 828 - (2) ALLOCATION FOR COMMISSION.—Not less than the following amounts in the CERTF for a fiscal year shall be available to carry out the activities of the Comparative Effectiveness Research Commission established under section 1181(b) of the Social Security Act for such fiscal year:  (A) For fiscal year 2010, $7,000,000.  (B) For fiscal year 2011, $9,000,000.  (C) For each fiscal year beginning with 2012, $10,000,000.   Nothing in this paragraph shall be construed as preventing additional amounts in the CERTF from being made available to the Comparative Effectiveness Research Commission for such activities.

pg 829 -‘Subchapter B—Insured and Self-Insured Health Plans  / SEC. 4375. HEALTH INSURANCE. 

(a) IMPOSITION OF FEE.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.  (b) LIABILITY FOR FEE.—The fee imposed by sub-section (a) shall be paid by the issuer of the policy.  (1) IN GENERAL.—Except as otherwise provided in this section, the term ‘specified health insurance policy’ means any accident or health insurance policy issued with respect to individuals residing in the United States. 

pg 831 - SEC. 4376. SELF-INSURED HEALTH PLANS. 

(a) IMPOSITION OF FEE.—In the case of any applicable self-insured health plan for each plan year, there is hereby imposed a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the plan.  (b) LIABILITY FOR FEE.— (1) IN GENERAL.—The fee imposed by subsection (a) shall be paid by the plan sponsor.   (2) PLAN SPONSOR.—For purposes of paragraph (1) the term ‘plan sponsor’ means— (A) the employer in the case of a plan established or maintained by a single employer,  (B) the employee organization in the case of a plan established or maintained by an employee organization... 

pg 836 - SEC. 1901. REPEAL OF TRIGGER PROVISION. 

Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted. 

If you would like a copy of the original bill emailed to you in PDF format, please contact me at MissJaneQPublic@gmail.com

============================================================

HR 3200 as interpreted by me.  I encourage you to read the actual text of the bill and draw your own conclusions.

Cover Page - The purpose of this bill is to reduce healthcare spending. The government will be paying your doctors, hospitals, pharmacies, and test facilities + reduced spending = rationing.

pg 16 - (1) (A): You can keep your private insurance if it began BEFORE the government plan started.  (2): Once the government plan goes into effect, your private insurance cannot change ANYTHING or you are automatically enrolled in the government plan.

pg 17 - After the government plan goes into effect, your private health insurance plan has 5 years to conform to the same standards and benefits as the government plan.

pg 19 - If you do not already have a private insurance plan by the time the government plan starts, you cannot buy it.  All new plans must be part of the government’s Health Exchange.

pg 22 - The Commissioner and Congress will work together to make sure the law does NOT provide incentives for small- or mid-size employers to offer private insurance.

pg 30 - A government committee will determine what benefits are covered under each of the 4 plans, and what your premiums, co-payments and out-of-pocket limitations (for Year 1: 5k for individuals; 10k for families, to be increased in subsequent years) will be.  (See also pg 84)

pg 43 - The Commissioner will audit government and private insurers and will charge your insurance for the costs of these examinations.

pg 50 - This provision does not exclude illegal aliens are included in government subsidized healthcare and related services, but they ARE excluded from the penalty tax...you are not (see pg 170)

pg 58 - The government will have immediate access to your finances and medical history/condition to determine if you are eligible a particular service with a particular doctor at particular facility (RATIONING).

pg 110 - If you or your employer to not purchase “acceptable coverage” you and/or your employer will be “taxed” a penalty.  See also pg 167 of the bill for the computations.

pg 119 - The Secretary of H&H (who currently has no medical or business background) will determine the premiums you pay for the government healthcare.  THIS GOVT INSURANCE IS NOT FREE.

pg 120 - Initial funding for nationwide government run healthcare is $2 billion to be paid back in 10 years. (Cash For Clunkers was given $1 billion and went bankrupt in less than a week.)  How do they expect that money to be paid back unless they “make a profit”...charging premiums and limiting care/medications (RATIONING).

pg 121 - The H&H Secretary will determine the payment rates for your doctors.

pg 124 - The H&H Secretary can decide and correct reimbursement for medical care if SHE determines it is excessive, and the government cannot be sued for this “price fixing.”

pg 125 - Bundling is currently illegal and insurance companies have been sued for this.  It is a way to pay your doctor less for services he gave you. *Underpaying doctors will force good doctors to quit practicing, bright students to avoid going into the medical field, and leave a poorer quality physician to take care of you.

pg 149 - If your employer does not offer health coverage, he is subject to a “contribution” (PENALTY) equal to 8% of the average wages he pays.  This goes into the Health Insurance Exchange Trust Fund.  Smaller employers pay between 2% and 6%.

pg 155 - If your employer fails to satisfy coverage requirements he will be charged $100 per day penalty.  This money goes into the US Treasury as “Miscellaneous Receipts” instead of to the Health Insurance Exchange Trust Fund.

pg 167 & 181 & 183 - The tax computations referenced on pg 110.

pg 171 - Certain religions will be exempt from tax penalties but only if the individual has filed an application and been granted exemption by the H&H Secretary.

pg 198 - Higher income people are charged additional penalties - the more you make, the higher the percentage rate goes.

pg 272 - The H&H Secretary will dock payment to cancer hospitals whose charges are more than others...that means better facilities with better treatments/physicians/testing will be paid less, which means your standard of care goes down.

pg 281 - If the H&H Secretary determines that you should not have been readmitted to a hospital, she will reduce the reimbursement to the hospital.  This puts your doctors in the difficult position of having to choose between readmitting you and being fined/penalized or not readmitting you at detriment to your health.  Or to not discharge you at all, leaving you to run up lengthy hospital stay charges.  The pg 285 - The H&H Secretary also decides what conditions are considered re-admittable.

pg 288 - You cannot challenge these decisions

pg 502 - Comparative Effectiveness Research as defined by Wikipedia:  “(CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances.”  This means YOU and your doctor do not get to decide.

pg 757 - Since 1981, federal law requires state Medicaid programs to “take into account” the circumstances of hospitals serving a “disproportionate number” of low-income patients when setting payment rates for inpatient hospital services. Over the past two decades this requirement has led to the emergence of the Medicaid disproportionate share hospital (DSH) programs in many states.  In many states, DSH payments are a critical revenue stream for children’s hospitals with high Medicaid patient volumes.  

pg 828 - The Comparative Effectiveness Research Commission will get at least $26 million for 3 years of expenses.

pg 836 - “[The Medicare warning trigger] requires the HHS Secretary to propose adjustments to fix this problem when two consecutive Medicare Trustee Reports indicate that general revenue is funding more than 45% of total Medicare outlays — i.e., the so-called trust funds are not covering enough of Medicare’s costs. It would be a shame if this provision went away. When I served at HHS, Secretary Leavitt took this provision seriously, and proposed significant Medicare funding adjustments to get us on more certain footing. Unfortunately, Congress was less interested in making such changes, and the situation continued to worsen. Taking this provision away gives the HHS Secretary one less tool for trying to fix the problem of Medicare’s impending bankruptcy.” Tevi Troy, deputy secretary of health and human services 2007-2009.

Note: **There is too much power in the hands of one person:  the Health & Human Services Secretary**

Entities involved/your tax $$ at work:  Health & Human Services Secretary; Health Choices Administration; Health Choices Commissioner (appointed by President); Health Insurance Exchange; Health Insurance Exchange Trust Fund; Secretary of Labor; Secretary of Treasury; State Insurance regulators; National Association of Insurance Commissioners;  State attorneys general; Qualified Health Benefits Plan Ombudsman; Retiree Reserve Trust Fund;  toll-free hotline and website for information; Office of Special Inspector General; Special Inspector General (appointed by President);  Medicare Payment Advisory Commission; Comptroller General of the United States/Government Accounting Office; Agency for Healthcare Research; Center for Comparative Effectiveness Research Commission - a Chairman, Vice Chairman, Executive Director and staff, Patient Ombudsman; Comparative Effectiveness Research Trust Fund; Institute of Medicine; National Academy of Sciences; Director of the Agency/Healthcare Research and Quality; Chief Medical Officer/Centers for Medicare & Medicaid Services; Quality Assurance and Improvement Program; Independent Monitor (of nursing homes); Assistant Secretary for Planning and Evaluation; Federal Hospital Insurance Trust Fund; Federal Supplementary Medical Insurance Trust Fund; Director of the Centers for Disease Control and Prevention; National Healthcare Safety Network; Office of the National Coordinator for Health Information Technology; Center for Quality Improvement; Healthcare Integrity and Protection Data Bank; National Practitioner Data Bank; Advisory Committee on Health Workforce Evaluation and Assessment; Medicare Prescription Drug Account; and I’m sure I’ve missed more...

If you would like a copy of the original bill in PDF format emailed to you, please contact me at MissJaneQPublic@gmail.com.

Also available are 4 pages of text of pertinent excerpts, 2 pages of the excerpts translated into plain English, and contact numbers for Mr Obama, Ms Pelosi, our Senators and Representatives.

Florida House of Representatives Majority Leader Adam Hasner (R-Delray Beach) made the following statement responding to Congressman Alan Grayson’s comments this afternoon comparing our country’s healthcare system to the Holocaust:

“Regardless of one’s position on the issue of healthcare reform, comparing the American healthcare system to the systematic murdering of over six million Jews is totally outrageous and unfit for someone holding public office. Congressman Grayson should apologize to the Jewish community and the families of those whose loved ones were brutally executed. I’d also encourage Mr. Grayson to take a walk tomorrow afternoon to the U.S. Holocaust Museum so he can witness for himself just how offensive and inappropriate his statement is.

“While his comments should offend every reasonable American, I also call on my Jewish colleagues in the Florida Legislature and Florida's Congressional delegation to condemn his remarks and demand an apology.


“Congressman Grayson should realize that one does not apologize for an inarticulate statement with another even more hateful. He would be wise to adhere to the advice that when you are in a hole, stop digging.”

Yesterday on the floor of the U.S. House of Representatives, Congressman Alan Grayson (D-Orlando) said that the Republican Health Care Plan was: Don't get sick — if you do, die quickly. In face of a resolution of disapproval this afternoon, Grayson took to the House floor again to “apologize,” where in fact he refused to apologize to his colleagues and instead compared the American healthcare and insurance system to the Holocaust.

 

Ok, I have HAD it.  I can't even begin to tell you what I've had it with since there is so much this government has done and is doing.  I listened to Glenn today and he has really inspired me to forge ahead with the "Refounders" movement and locating the 56.  I am therefore halfway through writing a document similar to the Declaration that I will send to every member of my local, state, and federal government that will let them know they are "on notice."  I'm so mad right now that the many thoughts churning around in my head are making it a little difficult to see straight, let alone write a concise and coherent letter.  

So I am asking all of you:  please send me a list of things that bother you - I do not want to miss anything in this letter.   I will be happy to post it once I am finished so that you all may tweak it and send it on, take it as is, or use it to inspire your own letters...

The fight is on!

I am on a mission.

 I really see the similarities between Kaa and Obama:

From the Review Journal - http://www.lvrj.com/opinion/56171937.html

SHERMAN FREDERICK: Enough is enough, Harry

Stop the childish bullying
SHERMAN FREDERICK
MORE COLUMNS

We're still here doing what we do for the people of Las Vegas and Nevada. So, let me assure you, if we weathered all of that, we can damn sure outlast the bully threats of Sen. Harry Reid.

This is purely for entertainment purposes.  

It is a sad day when long-time ties are broken for whatever reason, but in this case it is obviously for the better. As the saying goes, "When God closes a door, he opens a window" and I realize that this change is part of my spiritual evolution.

 http://www.youtube.com/watch?v=LO2eh6f5Go0

This seems to be a very well-informed crowd here on Freedom Torch.  However, I am providing here excerpts of text from the original proposed healthcare bill in case you know anyone who needs to be confronted by facts.  I have not altered any of the wording - this was cut straight out of the bill itself...they even made a typo!  The only thing I did was bold certain words to make it easier to understand the sentence.  Feel free to pass this along and along and along...  (I don't understand why the typeface changes sizes here but I can also send it to anyone via regular email)

Knowledge is power - fight on!

 HR 3200 EXCERPTS

cover page - To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. 

pg 16 - SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. 

(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. 

1. LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1. 

pg 17 - (b) GRACE PERIOD FOR CURRENT EMPLOYMENT- BASED HEALTH PLANS.— 

(1) GRACE PERIOD.— (A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.  

pg 19

(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. 

pg 22 - SEC. 113. INSURANCE RATING RULES. 

(2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure...

pg 30 - SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE. 

(a) ESTABLISHMENT.— (1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(5) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS.— (A) ENHANCED PLAN.—The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).  (B) PREMIUM PLAN.—The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B). 

pg 43 - SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER. 

1. IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange. 

(2) COMPLIANCE EXAMINATION AND AUDITS.— (A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance. 

(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit...

pg 50

SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE. 

(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services. 

pg 58 - SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS. 

(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; 

pg 84 -SEC. 203. BENEFITS PACKAGE LEVELS. 

(a) IN GENERAL.—The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section. 

pg 110 - SEC. 207. HEALTH INSURANCE EXCHANGE TRUST FUND. 

(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).  (B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE. 

(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS.

pg 119 - SEC. 222. PREMIUMS AND FINANCING. 

(a) ESTABLISHMENT OF PREMIUMS.— (1) IN GENERAL.—The Secretary shall establish geographically-adjusted premium rates for the public health insurance option 

pg 120 - (2) START-UP FUNDING.— (A) IN GENERAL.—In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. (B) AMORTIZATION OF START-UP FUNDING.—The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1.

pg 121 -SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES.

1. RATES ESTABLISHED BY SECRETARY 1) IN GENERAL.—The Secretary shall establish payment rates for the public health insurance option for services and health care providers

pg 124 -(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. 

(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. 

pg 125 - SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM. 

(a) IN GENERAL.—For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services...  

pg 149 - SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE. 

(a) IN GENERAK.—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). 

pg 167 - SEC. 59B. 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.  pg 181 - (1) IN GENERAL.—In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee to whom such election applies, there is hereby imposed on each such failure with respect to each such employee a tax of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.  pg 183 - (c) EMPLOYERS ELECTING TO NOT PROVIDE HEALTH BENEFITS.— (1) IN GENERAL.—In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the wages (as defined in section 3121(a)) paid by him with respect to employment (as defined in section 3121(b)). 

pg 171

(5) RELIGIOUS CONSCIENCE EXEMPTION.— 

‘‘(A) IN GENERAL.—Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.   (B) EXEMPTION.—An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate. 

pg 198 - SEC. 441. 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. 

pg 272 - SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS. 

(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.— 

(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).   (B) AUTHORIZATION OF ADJUSTMENT.— Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment

pg 281 - SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS

(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR EXCESS READMISSIONS.— (1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital (**see actual bill for complex computations**)

pg 285 - (A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary among conditions and procedures

pg 288 - (6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review 

pg 297 - (d) PHYSICIANS.— (1) STUDY.—The Secretary of Health and Human Services shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians.   (C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission

pg 424 - SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. 

‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.  Such consultation shall include the following:  (E) 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. 

(F)(i) 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; 

pg 502 - SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED

pg 713 - SEC. 1633. REQUIRED INCLUSION OF PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.  (p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.—The Secretary shall establish a payment modifier under the fee schedule under this section for evaluation and management services (as specified in section 1842(b)(16)(B)(ii)) that result in the ordering of additional services (such as lab tests), the prescription of drugs, the furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for such additional services under this title, or the ordering, furnishing, or prescribing of other items and services determined by the Secretary to pose a high risk of waste, fraud, and abuse. 

pg 717 - SEC. 1636. MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS REDUCED TO NOT MORE THAN 12 MONTHS. 

pg - 757 - SEC. 1704. REDUCTION IN MEDICAID DSH.

pg 828 - (2) ALLOCATION FOR COMMISSION.—Not less than the following amounts in the CERTF for a fiscal year shall be available to carry out the activities of the Comparative Effectiveness Research Commission established under section 1181(b) of the Social Security Act for such fiscal year:  (A) For fiscal year 2010, $7,000,000.  (B) For fiscal year 2011, $9,000,000.  (C) For each fiscal year beginning with 2012, $10,000,000.   Nothing in this paragraph shall be construed as preventing additional amounts in the CERTF from being made available to the Comparative Effectiveness Research Commission for such activities.

pg 829 -‘Subchapter B—Insured and Self-Insured Health Plans  / SEC. 4375. HEALTH INSURANCE. 

(a) IMPOSITION OF FEE.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.  (b) LIABILITY FOR FEE.—The fee imposed by sub-section (a) shall be paid by the issuer of the policy.  (1) IN GENERAL.—Except as otherwise provided in this section, the term ‘specified health insurance policy’ means any accident or health insurance policy issued with respect to individuals residing in the United States. 

pg 831 - SEC. 4376. SELF-INSURED HEALTH PLANS. 

(a) IMPOSITION OF FEE.—In the case of any applicable self-insured health plan for each plan year, there is hereby imposed a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the plan.  (b) LIABILITY FOR FEE.— (1) IN GENERAL.—The fee imposed by subsection (a) shall be paid by the plan sponsor.   (2) PLAN SPONSOR.—For purposes of paragraph (1) the term ‘plan sponsor’ means— (A) the employer in the case of a plan established or maintained by a single employer,  (B) the employee organization in the case of a plan established or maintained by an employee organization... 

pg 836 - SEC. 1901. REPEAL OF TRIGGER PROVISION. 

Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted. 

If you would like a copy of the original bill emailed to you in PDF format, please contact me at MsJaneQPublic@gmail.com