Alright, I get some conservative newsletters, including one from Human Events.com, who just sent me the following article, titled “I Read the Heath-Scare Bill & Obama Is Lying!”, apparently in turn from something called ‘AMERIPAC’, or American Political Action Committee. Oddly enough, I could only find the article posted on the internet here and here, although it was just sent out recently.
At any rate, they were decent enough to cite page sources, but unfortunately I also disagree with their interpretations of what the bill actually says, and since I am reading the bill myself as well, will post their comments and evaluate them for accuracy, or make my own observations about the bill’s truly negative elements.
It is imperative that any false claims about the bill be called out and debunked by conservatives, so that when the truth inevitably comes out about their falseness, people do not assume the valid claims (such as the bill’s pro-abortion agenda – see my earlier post, ‘Obama v. Obama on Abortion in Healthcare Bill‘) are false as well.
Unfortunately many of the claims being leveled by the conservative crowd against the bill have some basis for objection, but are clouded in exaggerative language that turns them into half-truths.
Follow me on a tour through this bill’s exact wording and the very real criticisms, and exaggerations, surrounding it.
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From the newsletter:
“1. Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory! He will control your living wills”
Status: Partially True.
What the Bill Actually Says:
‘‘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:
‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
‘‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
‘‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
‘‘(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—
‘‘(I) 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;
‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
‘‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—
‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
‘‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
‘‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—
‘‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
‘‘(III) provides training for health care professionals across the continuum of care
about the goals and use of orders for life sustaining treatment; and
‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
Analysis: Do you see what they did? The bill says,
“regarding advance care planning… Such consultation shall include the following… An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.”
From that they assumed that because living wills are being explained to you in a consultation the government will ‘control’ them. The government will ‘control’ them in that they are presenting you with the information every 5 years, and it is a bit concerning that government officials are presenting you with information about how to live the end of your life (gee – hopefully they don’t show too much bias in suggesting care for poor old people as opposed to rich ones).
However, it is a bit misleading to state that simply by presenting the information about living wills they are controlling the whole process.
From a simple reading of the bill’s language as I understand it, the aim is only to guide Americans in making informed decisions about end of life care and to help them have instructions in place, possibly to prevent another Terry Schiavo situation resulting from a lack of proper documentation about one’s end of life wishes. Whether the government having control of that is a good idea or even will work, is a whole other matter.
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From the newsletter:
“2. Pg 30 Sec 123 of HC bill – THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get (Unions are EXEMPTED)”
Status: Mostly True.
What the Bill Actually Says:
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.
(2) CHAIR.—The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.
(3) MEMBERSHIP.—The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:
(A) 9 members who are not Federal employees or officers and who are appointed by the President.
(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.
(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint. Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.
(4) TERMS.—Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.
(5) PARTICIPATION.—The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.
(b) DUTIES.—
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(2) DEADLINE.—The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) PUBLIC INPUT.—The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED.—In this subtitle, the term ‘‘benefit standards’’ means standards respecting—
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).
(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).
(c) OPERATIONS.—
(1) PER DIEM PAY.—Each member of the
Health Benefits Advisory Committee shall receive travel expenses, including per diem in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code, and shall otherwise serve without additional pay.
(2) MEMBERS NOT TREATED AS FEDERAL EMPLOYEES.—Members of the Health Benefits Advisory Committee shall not be considered employees of the Federal government solely by reason of any service on the Committee.
(3) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the Health Benefits Advisory Committee.
(d) PUBLICATION.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.
Analysis: Yes, there is a government committee. However, the key word in the bill’s language is ‘recommend’. It does not decide the benefits, but knowing government systems, it is quite possible that it could end up being looked to as authoritative so that government systems simply defer to accepting their opinion in almost all cases.
Nevertheless, it is misleading to say the Committee will decide the benefits. According to the bill’s language, they will only make recommendations… which as the bill states will then be publicized in the following manner: “The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.”
Look, does it disturb me that the president, an unabashedly pro-choice President who supports the most immoral form of abortion, murdering new-born children who survive late-term abortions, is supporting a bill that gives him the right to appoint 2/3 of a committee that in turn would carry major weight in determining medical plans, and the committee head, Kathleen Sebelius (head of the Department of Health and Human Services) was also appointed by him?
Yeah. You can bet your bottom dollar it bugs me. Knowing Obama, he’s probably letting Planned Parenthood submit their merry list of applicants and is just waiting to approve whatever names they send him, given his close companionship with their agency of death.
However, to be fair, this claim was a bit misleading.
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From the newsletter:
“3. Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You have no choice! Government, not you, will decide what health care you are allowed.”
Status: Somewhat True.
What the Bill Actually Says:
SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.
(a) DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
(b) PROMOTING ACCOUNTABILITY.—
(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 of such QHBP offering entities.
(c) DATA COLLECTION.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services.
(d) SANCTIONS AUTHORITY.—
(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
(2) REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—
(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act;
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;
(C) in the case of an Exchange-participating health benefits plan, suspension of payment to the entity under the Health Insurance Exchange for individuals enrolled in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur; or
(D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title.
(e) STANDARD DEFINITIONS OF INSURANCE AND MEDICAL TERMS.—The Commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.
(f) EFFICIENCY IN ADMINISTRATION.—The Commissioner shall issue regulations for the effective and efficient administration of the Health Insurance Exchange and affordability credits under subtitle C, including, with respect to the determination of eligibility for affordability credits, the use of personnel who are employed in accordance with the requirements of title 5, United States Code, to carry out the duties of the Commissioner or, in the case of sections 208 and 241(b)(2), the use of State personnel who are employed in accordance with standards prescribed by the Office of Personnel Management pursuant to section 208 of the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728).
Analysis: Does the bill really say you don’t get to pick your benefits? I am sure plans will still be available allowing you to mix and match benefits. However, it is true that the Commissioner would be able to ‘set the standards’, or in other words the essential requirements that all healthcare plans must have. In this sense, he is controlling the benefits you can have, which is why I label this claim ‘somewhat’ true.
And as Obama has already said, he considers abortion an ‘essential benefit’ or standard, and is very likely to appoint a commissioner who shares those and other radical views. If you’re prepared for a lot of ideological liberal agendas as part of a government system determining what medical benefits are available to you, by all means support Obama’s bill. I on the other hand will refrain from doing so.
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From the newsletter:
“4. PG 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise Obama wants illegal aliens covered, with YOU paying”
Status: False, with some concerns.
What the Bill Actually Says:
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.
(b) IMPLEMENTATION.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance
coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.
Analysis: Pretty straightforward. The authors of the conservative newsletter jumped to the conclusion that the phrasing about providing healthcare ‘without regard to personal characteristics’ was so inclusive as to include illegal immigrants.
However, the bill specifically states later in Sec. 246,
“SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”
So there goes that theory… Almost. Like I said though, there are still a few concerns. For a bill that goes out of its way to clarify the exact ways of enforcing things with the exact rules of how many members a committee should have, what their job duties are, and how to carry them out, it completely left out any kind of enforcement legislation here on HOW this is to be accomplished.
As Mariano Castillo of CNN in her article, “Health care bill has curious coverage for illegal immigrants“, points out about the findings of a recent federal study, “While the report found that federal subsidies to obtain health coverage would be restricted to U.S. citizens and legal residents, it also noted that the bill does not specify a citizenship verification system, something that critics say creates a loophole for undocumented immigrants to receive subsidies anyway.”
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From the newsletter:
“5. Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Only Americans will pay) Illegal aliens get health care FREE.”
Status: True about tax exemptions, false about free health care.
What the Bill Actually Says:
‘‘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.
‘‘(b) LIMITATIONS.—
‘‘(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.
‘‘(B) APPLICABLE NATIONAL AVERAGE PREMIUM.—
‘‘(i) IN GENERAL.—For purposes of subparagraph (A), the ‘applicable national average premium’ means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.
‘‘(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL.—In the case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting ‘family coverage’ for ‘self-only coverage’.
‘‘(2) PRORATION FOR PART YEAR FAILURES.— The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the 10amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as—
‘‘(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to
‘‘(B) the entire taxable year.
‘‘(c) EXCEPTIONS.—
‘‘(1) DEPENDENTS.—Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as 24
such taxable year.
‘‘(2) NONRESIDENT ALIENS.—Subsection (a) shall not apply to any individual who is a non-resident alien.
‘‘(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES.—Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.
‘‘(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES.—Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.
‘‘(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.
‘‘(d) ACCEPTABLE COVERAGE REQUIREMENT.—
‘‘(1) IN GENERAL.—The requirements of this subsection are met with respect to any individual for any period if such individual (and each qualifying child of such individual) is covered by acceptable coverage at all times during such period.
‘‘(2) ACCEPTABLE COVERAGE.—For purposes of this section, the term ‘acceptable coverage’ means any of the following:
‘‘(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan (as defined in section 100(c) of the America’s Affordable Health Choices Act of 2009).
‘‘(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER GRANDFATHERED EMPLOYMENT-BASED HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America’s Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).
‘‘(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
‘‘(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act.
‘‘(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).— Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
‘‘(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran’s Affairs and the Health Choices Commissioner, based on the individual’s priority for services as provided under section 1705(a) of such title.
‘‘(G) OTHER COVERAGE.—Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.
‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.—
‘‘(1) QUALIFYING CHILD.—For purposes of this section, the term ‘qualifying child’ has the meaning given such term by section 152(c).
‘‘(2) BASIC PLAN.—For purposes of this section, the term ‘basic plan’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009.
‘‘(3) HEALTH INSURANCE EXCHANGE.—For purposes of this section, the term ‘Health Insurance Exchange’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009, including any State-based health insurance exchange approved for operation under section 208 of such Act.
‘‘(4) FAMILY COVERAGE.—For purposes of this section, the term ‘family coverage’ means any coverage other than self-only coverage.
‘‘(5) MODIFIED ADJUSTED GROSS INCOME.— For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income—
‘‘(A) determined without regard to section 911, and
‘‘(B) increased by the amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.
‘‘(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 18
purposes of section 55.
‘‘(f) REGULATIONS.—The Secretary shall prescribe such regulations or other guidance as may be necessary or appropriate to carry out the purposes of this section, including regulations or other guidance (developed in coordination with the Health Choices Commissioner) which provide—
‘‘(1) exemption from the tax imposed under subsection (a) in cases of de minimis lapses of acceptable coverage, and
‘‘(2) a process for applying for a waiver of the application of subsection (a) in cases of hardship.’’.
(b) INFORMATION REPORTING.—
(1) IN GENERAL.—Subpart B of part III of subchapter A of chapter 61 of such Code is amended by inserting after section 6050W the following new section:
Analysis: Yes, the bill says no taxes on illegal immigrants. Obviously the assumption is that because they don’t get the healthcare, they can’t be taxed for it. As the previous point showed, they aren’t supposed to get affordability credits for the healthcare under this bill. However, the lack of provision in the bill for verifying their citizenship means some might be able to pass themselves off as citizens and then not pay taxes.
Logically you’d think they’d still get caught. And I don’t think Obama had any ulterior motive here for allowing this either. They just didn’t really care about stopping illegal immigrants from getting it and just made a half-hearted attempt to prevent it to silence future criticism, unless I miss my guess, and this potential loophole is the result. Logically, if Obama doesn’t care about unborn children, what possible affinity could he have for illegal immigrants? Unless of course you buy into the theory that he is one I suppose.
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From the newsletter:
“6. Pg 241 Line 6-8 HC Bill – Doctors, doesn’t matter what specialty you have, you’ll all be paid the same Government gets to set pay rates-this guarantees fewer specialized doctors, mandating a lower quality of care. “
Status: False about paying physicians the same, but is instead creating a new category to ensure payment of abortion doctors.
What the Bill Actually Says:
Subtitle B—Provisions Related to Part B
PART 1—PHYSICIANS’ SERVICES
SEC. 1121. SUSTAINABLE GROWTH RATE REFORM.
(a) TRANSITIONAL UPDATE FOR 2010.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) is amended by adding at the end the following new paragraph:
‘‘(10) UPDATE FOR 2010.—The update to the single conversion factor established in paragraph (1)(C) for 2010 shall be the percentage increase in the MEI (as defined in section 1842(i)(3)) for that year.’’.
(b) REBASING SGR USING 2009; LIMITATION ON CUMULATIVE ADJUSTMENT PERIOD.—Section 1848(d)(4) of such Act (42 U.S.C. 1395w–4(d)(4)) is amended—
(1) in subparagraph (B), by striking ‘‘subparagraph (D)’’ and inserting ‘‘subparagraphs (D) and (G)’’; and
(2) by adding at the end the following new subparagraph: ‘‘(G) REBASING USING 2009 FOR FUTURE UPDATE ADJUSTMENTS.—In determining the update adjustment factor under subparagraph (B) for 2011 and subsequent years—
‘‘(i) the allowed expenditures for 2009 shall be equal to the amount of the actual expenditures for physicians’ services during 2009; and
‘‘(ii) the reference in subparagraph (B)(ii)(I) to ‘April 1, 1996’ shall be treated as a reference to ‘January 1, 2009 (or, if later, the first day of the fifth year before the year involved)’.’’.
(c) LIMITATION ON PHYSICIANS’ SERVICES INCLUDED IN TARGET GROWTH RATE COMPUTATION TO SERVICES COVERED UNDER PHYSICIAN FEE SCHEDULE.—Effective for services furnished on or after January 1, 2009, section 1848(f)(4)(A) of such Act is amended striking ‘‘(such as clinical’’ and all that follows through ‘‘in a physician’s office’’ and inserting ‘‘for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services)’’.
(d) ESTABLISHMENT OF SEPARATE TARGET GROWTH RATES FOR CATEGORIES OF SERVICES.—
(1) ESTABLISHMENT OF SERVICE CATEGORIES.—Subsection (j) of section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended by adding at the end the following new paragraph:
‘‘(5) SERVICE CATEGORIES.—For services furnished on or after January 1, 2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’:
‘‘(A) Evaluation and management services that are procedure codes (for services covered under this title) for— ‘‘(i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009, and as subsequently modified by the Secretary); and ‘‘(ii) preventive services (as defined in section 1861(iii)) for which payment is made under this section.
‘‘(B) All other services not described in subparagraph (A).
Analysis: Tough to tell what’s really going on here, isn’t it? This will be tough to follow, as this gets into some serious legalese and mumbo jumbo; but I will try to break it down. First, some definitions:
-SGR, or Sustainable Growth Rate, according to Investopedia, means “The maximum growth rate that a firm can sustain without having to increase financial leverage.”
-MEI, or Medicare Economic Index, according to Medtronic, is defined as “Used to update Medicare payments, the MEI is a measure of general and medical inflation. Under the new system the MEI is used to update the conversion factors used to transform relative value units into dollar payment amounts. The increases are subject to limits imposed by the Medicare Volume Performance Standards which require payment cuts if service volume grows beyond a certain point.”
Now, why would they be talking about the MEI and Physician Fee Schedules? The CMS (Centers for Medicaid and Medicare Services) have an article on their website titled “EFFECT OF THE MEDICARE ECONOMIC INDEX (MEI) ON THE PHYSICIAN UPDATE” that helps those of us who aren’t medical professions understand the issue, and states:
“The Medicare Physician Fee Schedule (MPFS) is updated on an annual basis according to a formula specified by statute. The formula specifies that the update for a year is equal to the Medicare Economic Index (MEI) adjusted up or down depending on how actual expenditures compare to a target rate, called the sustainable growth rate, or SGR. The SGR in turn is calculated based on medical inflation, the projected growth in the domestic economy, projected growth in the number of beneficiaries in fee-for-service Medicare, and changes in law or regulation.
The MEI is a measure of inflation faced by physicians with respect to their practice costs and general wage levels. The MEI includes a bundle of inputs used in furnishing physicians’ services such as physician’s own time, non-physician employees’ compensation, rents, medical equipment, etc. The MEI measures year-to-year changes in prices for these various inputs based on appropriate price proxies.”
So it seems the bill is setting new categories indeed for how physicians can be paid. However, if you check (d)(1) in the above language, you’ll note the key word is ‘amended’. They are looking to change one specific part of a part of the U.S. Code and adding some language about making new categories for ‘Evaluation and Management’ and ‘preventive services’, and then what appears a catch-all for any other services of ‘all other services not described in subparagraph(A)’.
Here is the wording of that section from the U.S. Code mentioned in the bill, which you can read for yourself here (Hint: It’s about 3/4 down the page):
(j) Definitions.—In this section:
(1) Category.—For services furnished before January 1, 1998, the term “category” means, with respect to physicians’ services, surgical services (as defined by the Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)), and all other physicians’ services. The Secretary shall define surgical services and publish such definitions in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians.
(2) Fee schedule area.—The term “fee schedule area” means a locality used under section 1842(b) for purposes of computing payment amounts for physicians’ services.[250]
(3) Physicians’ services.—The term “physicians’ services” includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(oo)(2)), (2)(R) (with respect to services described in subparagraphs (B), (C), and (D) of section 1861(pp)(1)), (2)(S), (2)(W), 2(AA),[251] (3), (4), (13) (14) (with respect to services described in section 1861(nn)(2)), and (15) of section 1861(s) (other than clinical diagnostic laboratory tests and, except for purposes of subsections (a)(3), (g), and (h) such other items and services as the Secretary may specify).
(4) Practice expenses.—The term “practice expenses” includes all expenses for furnishing physicians’ services, excluding malpractice expenses, physician compensation, and other physician fringe benefits.
So, why would Obama be trying to add a new paragraph below this? Apparently it goes back to his abortion agenda. If the U.S. Code did not previously allow for those providing ‘preventive services’ or abortions to be paid with government money; or at least mandate it, Obama would want to change that, right?
And how will they be paid? They will be lumped in together with the salaries of “Evaluation and management” according to the bill above. Sneaky Obama, he really cares about his abortion services, doesn’t he? It appears Obama was worried that the U.S. Code’s language was being used to prevent payments to doctors performing abortions, or would be used, and took steps to change the law’s wording.
Then, just in case there was any way that still wasn’t enough, he threw in an ambiguous phrase at the end, ‘all other services’, to provide a basis for them to dispute any attempt not to pay them with government funds.
However, with regards to the original subject, this does not appear to be about paying all physicians the same, but rather creating a new payment category for those who perform abortions to be paid at the same rate of those in Evaluation or Management.
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From the newsletter:
“7. PG 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing! City of Hope and other cancer hospitals controlled by government–very young and elderly, due to other parts of Obamacare, will be forced to die since they will not be allowed health care.”
Status: Completely false.
What the Bill Actually Says:
SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
‘‘(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 under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.’’.
Analysis: The specified Section of the U.S. Code, 1833(t), which this bill wants to add a new paragraph to, is a very lengthy section called “(t) Prospective Payment System for Hospital Outpatient Department Services” that goes into detail about how hospitals are to be funded. It is about 60% of the way down the page as seen here.
The specified section of the U.S. Code, 1886(d)(1)(B)(v), which this bill wants to be looked at in the study, has the following text as seen here (about 25% of the way down the page):
(v)(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause[626], is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer,
(II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1814(b), that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before the date of the enactment of this subclause), that as of the date of the enactment of this subclause, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or
(III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998, that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1814(b), that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of the date of the enactment of this subclause, is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E);
However, unless I misread this, when the bill says “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 under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.” what it is actually saying is that cancer hospitals will be paid MORE if their costs are higher – not less.
There may be valid criticisms of the bill, but this certainly does not appear to be one.
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From the newsletter:
“8. They will teach you to die. PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens and end of life.”
Status: False.
What the Bill Actually Says:
‘‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
‘‘(I) 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;
‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
Analysis: I already addressed this in point 1, so I won’t belabor this. However, I disagree with the interpretation that a consultation about “life sustaining treatment… to make informed decisions… so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes” is the same thing as “They will teach you to die.”
Again, I think this may have been included with the Terry Schiavo case in mind, so that those who reach such a situation will already have expressed their views. I can only imagine the people who wrote this bill put such inflammatory and exaggerated statements because they secretly like the idea of willing euthanasia, and allowing anyone to refuse life-sustaining treatment, regardless of the circumstances.
Which is a whole other issue, whether physician-assisted suicide should be permitted. While government officials could give inappropriate advice, ideally you would think such instances would ensure government punishment. Simply from the bill’s wording, there is no reason to think this is anything but an attempt to have a person’s wishes expressed about end of life care.
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From the newsletter:
“9. They will stop assistance to special needs children. Pg 354 Sec 1177 – Government will RESTRICT enrollment of Special needs people!”
Status: Completely False.
What the Bill Actually Says:
SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT.
(a) IN GENERAL.—Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘January 1, 2011’’ and inserting ‘‘January 1, 2013 (or January 1, 2016, in the case of a plan described in section 1177(b)(1) of the America’s Affordable Health Choices Act of 2009)’’.
(b) GRANDFATHERING OF CERTAIN PLANS.—
(1) PLANS DESCRIBED.—For purposes of section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)), a plan described in this paragraph is a plan that had a contract with a State that had a State program to operate an integrated Medicaid-Medicare program that had been approved by the Centers for Medicare & Medicaid Services as of January 1, 2004.
(2) ANALYSIS; REPORT.—The Secretary of Health and Human Services shall provide, through a contract with an independent health services evaluation organization, for an analysis of the plans described in paragraph (1) with regard to the impact of such plans on cost, quality of care, patient satisfaction, and other subjects as specified by the Secretary. Not later than December 31, 2011, the Secretary shall submit to Congress a report on such analysis and shall include in such report such recommendations with regard to the treatment of such plans as the Secretary deems appropriate.
Analysis: As the title suggests, this is just the extension of an already-existent piece of legislation. The first part is clearly just changing the time period by a few more years for something about to expire in 2011 so that it lasts 2-5 more years.
Now, why there’s a restriction on enrollment I have no idea. It could’ve been legislated for good reasons or bad. Until some news piece can be found for why this legislation was introduced, it’s tough to say. However, this bill itself is just extending the legislation’s term of enforcement and requiring some report on the findings.
UPDATE: After some searching, I found this very thorough and understandable article on the website of the Department of Health and Human Services, “FEDERAL AUTHORITY FOR MEDICAID SPECIAL NEEDS PLANS AND THEIR RELATIONSHIP TO STATE MEDICAID PROGRAMS“.
As the article states,
“In response to concerns that many SNPs have not, in fact, been offering specialty models of care, federal legal authority has been amended twice recently, first in December 2007 as part of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007, and again by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 in July 2008.2 The Congressional actions of December 2007 and July 2008, coming less than a year apart, resulted in a one-year freeze in the program, but also extended the program’s authority from the original sunset date of December 31, 2008 to the current end date of December 31, 2010. When the Centers for Medicare and Medicaid Services (CMS) resumes accepting applications in 2009 for contract year 2010, new requirements will be in place, but unless federal authority is further extended, the revised program will have only one year to run. Figure 1 provides major points in the evolution of SNP authority.”
In other words, legislation created SNPs, or Special Needs Plans for the disabled, but due to some complications and difficulties with them, they were not going to be extended beyond 2010. For them to continue, federal authority would have to be extended so they could keep going.
In short, the bill does not appear to be removing funding for Special Needs Plans, but on the contrary to be extending the life of legislation that created them.
Political Reason 