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What The Health Care Bill Actually Says

Here is a long but we believe helpful analysis of HR 3200 from the site, Classical Ideals, by John David Lewis:

The Health Care Bill: What HR 3200, ‘‘America’s Affordable Health Choices Act of 2009,” Says

John David Lewis

August 6, 2009

What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.

This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws. I have only touched pieces of the bill here. For instance, I have not considered the establishment of (1) “Health Choices Commissio0ner” (Section 141); (2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity; (3) a Public Health Insurance Option (Section 221); and similar provisions. 

This is the evaluation of someone who is neither a physician nor a legal professional. I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore.

We may answer one question up front: How will the government will pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services—there are no other options.  We will all pay for this, enrolled in the government “option” or not.

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

WILL THE PLAN RATION MEDICAL CARE?

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

‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

and, under “Definitions”:

‘‘(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .

and:

‘‘(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

and:

‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .

‘‘(C) the measures of readmissions . . .

EVALUATION OF THE PASSAGES:

1.  This section amends the Social Security Act

2. The government has the power to determine what constitutes an “applicable [medical] condition.”

3. The government has the power to determine who is allowed readmission into a hospital.

4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.

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

6. There can be no judicial review of decisions made here. The Secretary is above the courts.

7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.

Will the plan punish Americans who try to opt out?

What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:

‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—

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

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

EVALUATION OF THE PASSAGE:

1. This section amends the Internal Revenue Code.

2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.

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

What constitutes “acceptable” coverage?

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

(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .

(b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services . . .

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services . . .

(9) Maternity care.

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

(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

(3) MINIMUM ACTUARIAL VALUE.—

(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

EVALUATION OF THE PASSAGES:

1. The bill defines “acceptable coverage” and leaves no room for choice in this regard.

2. By setting a minimum 70%  actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.

Will the PLAN destroy private health insurance?

Here is what it requires, for businesses with payrolls greater than $400,000 per year. (The bill uses “contribution” to refer to mandatory payments to the government plan.)  Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE

(a) IN GENERAL.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of  the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—

(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and

(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.

(The bill then includes a sliding scale of payments for business with less than $400,000 in annual payroll.)

The Bill also reserves, for the government, the power to determine an acceptable benefits plan: page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.

5 (a) IN GENERAL.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

EVALUATION OF THE PASSAGES:

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

2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”

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

4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.

5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.

6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.

Does the plan TAX successful Americans more THAN OTHERS?

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

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

‘‘(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—

‘‘(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,

‘‘(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and

‘‘(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

EVALUATION OF THE PASSAGE:

1. This bill amends the Internal Revenue Code.

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

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

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

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

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

(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.

(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.

EVALUATION OF THE PASSAGES:

  1. The government’s authority to set payments is basically unlimited.
  2. The official will decide what constitutes “excessive,” “deficient,” and “efficient” payments and services.

Will THE PLAN increase the power of government officials to SCRUTINIZE our private affairs?

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

‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—

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

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

‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),

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

‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and

‘‘(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.

And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:

(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.

EVALUATION OF THE PASSAGE:

1. This section amends the Internal Revenue Code

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

3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.

4. Employers are required to report whatever information the government says it needs to enforce the plan.

Does the plan automatically enroll Americans in the GOVERNMENT plan?

What it says, page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:

(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

And, page 145, section 312:

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

EVALUATION OF THE PASSAGES:

1.  Do nothing and you are in.

2. Employers are responsible for automatically enrolling people who still work.

Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?

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

(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

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

‘‘(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—

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

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

EVALUATION OF THE PASSAGES:

1. Sec. 1123 amends the Social Security Act, to allow the Secretary to identify areas of the country that underutilize the government’s plan “based on per capita spending.”

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

Mr. Lewis is a professor of classics at Duke University.

Which just goes to show that just about anyone can figure out what is in the healthcare bill, if they just take the time to read it.

In any case, Mr. Lewis represents the best of Americans being citizens – and, alas, citizen journalists.

This article was posted by Steve Gilbert on Wednesday, August 12th, 2009. Comments are currently closed.

15 Responses to “What The Health Care Bill Actually Says”

  1. Liberals Demise

    Okay ….. I read it until my eyes blurred and watered up. Then my blood pressure shot up.

    This (all 1017 pages) is a disaster from page 1 and should be sent to Cuba to help out with their toilet paper shortage. Plain and simple………

  2. catie

    I read this thing myself over the course of four days. I called my Rep and asked the phone answerer about certain provisions with the page numbers and the guy named Colin was clueless.

  3. artboyusa

    OBAMA SPEAKS! Or, more accurately, “Obama Reads!”, since he’s not really so, uh, good, at that whole, ummm, “unscripted” thing…

    “I want to thank you all for coming out tonight to this special town hall meeting” read President Obama, his narrow little head scanning the teleprompters in the now familiar left to right slow rotation. “Carefully scripted participation by selected citizens in a tightly controlled environment is a cornerstone of our democracy!”

    “Carefully scripted! Tightly controlled!” The crowd of handpicked “ordinary people”, their underpants soaked in Obama-generated love honey and their wallets stuffed with $50 each “expenses money”, howled their grateful enthusiasm back at the President of the World and he smiled that arrogant little smile of his.

    “Sure, we can have a national conversation about health care…its good to have a conversation” he continued, lapsing now into that preacher style speaking voice that had served him so well on the long road from Nairobi to Washington. “We know that…but… when we talk to each other…let’s remember… to keep it civil… to use our… Indoor Voice!”

    “Indoor Voice! Indoor Voice!” howled the crowd, waving their color coordinated posters and banners. “Indoor voice!”

    “Our Indoor Voice and not…our Angry Voice! Dissent is fine! Dissent is okay! But let’s remember that…dissent… has its limits! When dissent threatens to get… in the way of the untold benefits that a progressive agenda of hope and change can bring to our…frightened, exhausted and confused people… then it ceases to be… the highest form of patriotism, as it was under the regime of my…predecessor…and it just becomes…a big fat drag! Its time to say no… to dissent! Just say… no!”

    “No dissent! No dissent!”

    “Because dissent is fine but consensus is better! Its better to say Yes than to say No, isn’t it? Especially if it’s me doing the asking! You don’t want to…disappoint me, do you? You don’t want me to… feel bad; like you don’t… like me or something, do you?”

    “No! No! Never! We won’t let you down, Barack! Govern us, Barack!”

    “Sure, it’s easy to listen to those… voices of hate; the Lim Rushbaughs and the Han Seannittys and the… Artboys of this world but I know the American people are better than that; more… helpful and …compliant, more…tractable!”

    “Tractable! Tractable!” chanted the crowd, not knowing what the word meant but thinking that it sounded like something to do with farming, so it was probably okay.

    “My health care plan, whatever it actually is…and don’t try to pin me down too much on this one…isn’t about… health care. It’s about protection! Protection and security! Protection and security for whom? For the government, that’s who!”

    “Who? Whom? Huh?” wondered the crowd.

    “I knew you’d understand! Under my health plan thousands of new government jobs will be created, easing the burden on our nation’s unemployed and their families…”

    “Families! Families!” chanted the crowd, back on familiar ground now.

    “And offer security to our hard pressed administrators and middle managers. A whole new multi-tiered layer of government protection will be put in place, staffed mostly by…Americans…to help other ordinary American working parents… who do such a great job… to deal with the scrapes, boo boos and sniffles that take…such a toll…on our children!”

    “Children! Children!”

    “Because who knows best how to look after our kids? Not you, that’s for sure! If you did, they wouldn’t have turned out like they did, would they? And they’d phone more often too!”

    “Phone more often! Phone more often!”

    “And phone they will, under my plan! Once my health care plan, whatever it actually is…because who has time to read a bill in our high pressure modern world? …is in place you can be sure that…once you’re signed up…and I mean signed up or else… as you stand in the line, waiting for your…carefully rationed aspirin…and chemotherapy… and your assisted suicide…you can stand proud and look…Canada…in the eye!”

    “Canada! Canada!”

    “And Cuba! And the UK! And Romania! And you can say that in our time we set in place a system of carefully rationed health care for all Americans…living and dead…that will amplify the role of government in all our lives – and the lives of succeeding generations, out of all imagining!”

    “Amplify! Amplify!”

    “You can’t run your own lives – you know that! So let us do it for you! It’ll be better and easier and safer! I promise!”

    “Run our lives! Run our lives!”

    Hehehehe snickered Obama to himself. They’re falling for it again, the stupid bunch of adult babies…

    • texaspsue

      “Dissent is fine! Dissent is okay! But let’s remember that…dissent… has its limits!”

      This seems to be the Whitehouse/Liberal Congressmen’s message right now. As if they can determine the rules/guidelines for the protesters. In other words: “You can be angry but, not too angry. You can speak out but, we need to tell you how loudly you can speak and we will tell you, who/when. You can make protest signs but, they will be screened at the rally/townhall for appropriateness (any inappropriate signs will promptly be removed from the event). LOL He wishes that we were, “the stupid bunch of adult babies”.

      Great story & hi! artboy! You hit the nail on the head.

  4. proreason

    The scariest words in any language: “The government has the power to determine”

  5. Helena

    This is great, Steve. Thanks for finding this and posting it. Mr. Lewis has done a great job.

  6. texaspsue

    Great posting SG. It’s full of good info. :-)

    Have you noticed that most of the Teaparty/Townhall protesters are better informed than the Congressmen sponsoring the Townhall? They have shown to have more knowledge of what is in the House Bill.

  7. proreason

    There’s an email going around that says the Dept of Energy was formed 32 years ago with the purpose of lessening our dependence on Foreign Oil. The Department now has an annual budget of $24.2B per year, 16,000 employees and 100,000 contractors.

    I didn’t check the numbers, but it hardly matters. We know that Dept of Energy is useless, expensive, corrupt, and a drain on all of our lives.

    Even if Death Care is the greatest thing since sliced bread at the beginning, in a few short years it will be an octopus that will strangle all of our lives. When not killing us by rationing and Death Counseling, it will be strangling us with beaurocratic paper-work, and consuming hundreds of hours each year for each of us as we move from line to line to line to line to comply with the ever increasing rules preventing us from getting medical treatments.

    Daniel Hanning said the other day that UK Death Care is the 3rd largest employer IN THE WORLD. Behind the Red Army, and the Indian Railroad. And he also said that doesn’t count the doctors!! But Death Care will eclipse them within 5 years.

    The Death Care being rammed down our throats is a plague that will complete the destruction of the United States of America, and replace it with a socialist dictatorship that will be the plaything of a handful of Commissars (Pelosi, Obamy, Drooling Barney) who will live in splendor as they move their game pieces (us) merrily around their game boards.

  8. Nan Sequitur

    Apparently this particular article is going to be discussed on the Rush Limbaugh show in his monologue next hour.

  9. ExLib

    Please, Please, Please send this post to EVERYONE you know…right,left, up, down…everyone and Thank you Prof. Lewis!

  10. proreason

    Keen insight from and Ace Of Spades HQ post today:

    “Health care in the US is covered by three main systems– Medicare, medicaid, and private insurance.

    two of these systems are bankrupt, and will be unable to make payments beyond 2032 (insert correct date here, I don’t know).

    the third is solvent, and can make all of its payments for the foreseeable future.

    Barack Obama’s plan is to take the one system meeting its obligations and fold it into the two systems that are bankrupt.”

    http://ace.mu.nu/

  11. neocon mom

    “We know that Dept of Energy is useless, expensive, corrupt, and a drain on all of our lives.”

    Department of Education is usually the first one that comes to mind when I think of useless and expensive.

    Precisely, the sinister thing is that when Obamacare passes, people will be quite pleased with it at first. The destruction of innovation in healthcare will certainly not be felt right away. Even older Americans will probably not see things change much in their remaining years.

    It is for my children that I fear most, and myself, at 30 years of age. I am confident that a 70 year old alive right now with cancer will have a better outcome than I may have should I be diagnosed with cancer in 40-50 years. And my grandma had a hip replacement at 75, and was overweight (she was gaining weight partly because the knee problems slowed her down.) Wonder how the QALY would have worked out for her, considering she had heart valve replacement surgery prior to the double knee replacement as well as glaucoma and had been a smoker since age 11.

    The fact is that my children are likely going to live healthier lives than their great-grandma because they are being taught to make better choices. However they may not live any longer than she will (87 this month) because of socialized medicine.

  12. Liberals Demise

    I just found this and had my daughter show me how to grab and post this link because I’m a dunce when it comes to the puter but I’m learning’
    This is how much distain they have for us commoners.
    Just think, “TERM LIMITS”.
    http://specfriggintacular.word.....-question/

  13. Diane

    I felt this was too important to ignore, so I made a post on the “Organizing for America” blog, linking to the original document.

    Link

    My more cynical self doubts it will do any good, but I’m hoping at least a couple of those so very much in love with Mr. Obama and anything he does will actually read the bill and start to get a clue about what is in there. We’ll see.

    I do, by the way, fully expect to be reported to the snitch website for this as well. C’est la guerre, I suppose.

  14. proreason

    Larry Kudlow notices some big bets agains Death Care:

    “It’s still tough to know whether this behemoth government takeover of heath care will actually pass. But two key markets are betting against it. First, over at the Intrade pay-to-play online betting parlor, the bid for the U.S. government health-plan contract is only 38 cents. That’s down from 50 cents in late July. Second, the share prices of big private health insurers have rallied in recent weeks. UnitedHealthcare is up 13 percent, Humana is up 12.4 percent, and Aetna is up almost 10 percent. These firms will be decimated if the government insurance plan passes. But investors are now predicting it won’t.

    For the sake of economic freedom, liberty and fiscal sanity, let’s hope the markets are right. ”

    http://townhall.com/columnists.....ase?page=2




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