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.
- 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.
- 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.
- 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
