Below is a link to the Pelosi Health Care bill released this morning. I received the Reading Guide on Face Book and wanted to share it with you. I will forward additional information as I receive it. If you don't like what is in this bill, I strongly recommend you contact your representatives. Don't sit back and think someone else will speak up for you. They are TRANSFORMING AMERICA! If you don't get off your ass today and do something WE WILL LOSE OUR FREEDOM!

 

 

http://docs.house.gov/rules/health/111_ahcaa.pdf

 

Reading Guide to the Pelosi Health Care Reform Bill

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 Today at 6:35pm

Please read and forward the link to this note ( http://bit.ly/1rGrpW ) to your friends and family. This reading guide includes what we have uncovered in our initial reading of the Pelosi health “reform” legislation (H.R. 3962) introduced by House Democrats.

Page 94—Section 202(c) prohibits the sale of private individual health insurance policies, beginning in 2013, forcing individuals to purchase coverage through the federal government

Page 110—Section 222(e) requires the use of federal dollars to fund abortions through the government-run health plan—and, if the Hyde Amendment were ever not renewed, would require the plan to fund elective abortions

Page 111—Section 223 establishes a new board of federal bureaucrats (the “Health Benefits Advisory Committee”) to dictate the health plans that all individuals must purchase —and would likely require all Americans to subsidize and purchase plans that cover any abortion

Page 211—Section 321 establishes a new government-run health plan that, according to non-partisan actuaries at the Lewin Group, would cause as many as 114 million Americans to lose their existing coverage

Page 225—Section 330 permits—but does not require—Members of Congress to enroll in government-run health care

Page 255—Section 345 includes language requiring verification of income for individuals wishing to receive federal health care subsidies under the bill—while the bill includes a requirement for applicants to verify their citizenship, it does not include a similar requirement to verify applicants’ identity, thus encouraging identity fraud for undocumented immigrants and others wishing to receive taxpayer-subsidized health benefits

Page 297—Section 501 imposes a 2.5 percent tax on all individuals who do not purchase “bureaucrat-approved” health insurance— the tax would apply on individuals with incomes under $250,000, thus breaking a central promise of then-Senator Obama’s presidential campaign

Page 313—Section 512 imposes an 8 percent “tax on jobs” for firms that cannot afford to purchase “bureaucrat-approved” health coverage ; according to an analysis by Harvard Professor Kate Baicker, such a tax would place millions “at substantial risk of unemployment”—with minority workers losing their jobs at twice the rate of their white counterparts

Page 336—Section 551 imposes additional job-killing taxes, in the form of a half-trillion dollar “surcharge,” more than half of which will hit small businesses ; according to a model developed by President Obama’s senior economic advisor, such taxes could cost up to 5.5 million jobs

Page 520—Section 1161 cuts more than $150 billion from Medicare Advantage plans, potentially jeopardizing millions of seniors’ existing coverage

Page 733—Section 1401 establishes a new Center for Comparative Effectiveness Research; the bill includes no provisions preventing the government-run health plan from using such research to deny access to life-saving treatments on cost grounds, similar to Britain’s National Health Service, which denies patient treatments costing more than $35,000

Page 1174—Section 1802(b) includes provisions entitled “TAXES ON CERTAIN INSURANCE POLICIES” to fund comparative effectiveness research, breaking Speaker Pelosi’s promise that “We will not be taxing [health] benefits in any bill that passes the House,” and the President’s promise not to raise taxes on families with incomes under $250,000

If you would like to read the entire 1,990 pages yourself, you can find the legislation here: http://docs.house.gov/rules/health/111_ahcaa.pdf

 

 

The following comment is from Michael Connelly of Carrollton, Texas, a retired attorney and constitutional law instructor who states he has read the entire health care bill (HR 3200) and has some comments, not about the bill, but about the impact upon our Constitution.  It's a broader picture than just health care reform.

Looks like something to sit up and pay attention to; once this sort of thing happens, it will be irreversible.




THE TRUTH ABOUT THE HEALTHCARE BILLS?
                           
   Well, I have done it! I have read the entire text of proposed House Bill 3200: The Affordable Health Care Choices Act of 2009.  I studied it with particular emphasis from my area of expertise, constitutional law. I was frankly concerned that parts of the proposed law that were being discussed might be unconstitutional. What I found was far worse than what I had heard or expected.
                           
   To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, free health care for illegal immigrants, free abortion services, and probably forced participation in abortions by members of the medical profession.
                           
   The Bill will also eventually force private insurance companies out of business and put everyone into a government run system.  All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals.  Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.
                           
   However, as scary as all of that it, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.
                           
   The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn't have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.

   This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures.  You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.
                         
   If you decide not to have healthcare insurance or if you have private insurance that is not deemed "acceptable" to the “Choices Administrator" appointed by Obama there will be a tax imposed on you.  It is called a "tax" instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment.  However, that doesn't work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the "due process of law.
                           
   So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn't stop there though. The 9th Amendment that provides: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people;" The 10^th Amendment states: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people." Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control.
                           
   I could write many more pages about this legislation, but I think you get the idea. This is not about health care; it is about seizing power and limiting rights. Article 6 of the Constitution requires the members of both houses of Congress to "be bound by oath or affirmation" to support the Constitution. If I was a member of Congress I would not be able to vote for this legislation or anything like it without feeling I was violating that sacred oath or affirmation. If I voted for it anyway I would hope the American people would hold me accountable.
                           
   For those who might doubt the nature of this threat I suggest they consult the source. Here is a link to the Constitution:

http://www.archives.gov/exhibits/charters/constitution_transcript.html

Be advised this link has changed three times in the days since Mr. Connelly wrote this review. If you find it has again been moved simply type US Constitution Transcript in the search box.

   There you can see exactly what we are about to have taken from us.

   Michael Connelly
   Retired attorney,
   Constitutional Law Instructor
   Carrollton, Texas

For the credentials of Michael Connelly see the following web site:
http://www.freerepublic.com/focus/news/2339355/posts?page=6

Here is a link to active legislation at www.senate.gov

http://www.senate.gov/pagelayout/legislative/b_three_sections_with_teasers/active_leg_page.htm

TS Health Care Bill Review Board

Comprehensive Review

H.R. 3962:  Affordable Health Care for America Act of 2009

Report Submitted: 10/29/09

 

H.R. 3962

Affordable Health Care for America Act of 2009

Sponsor: John Dingell (D-MI)

http://docs.house.gov/rules/health/111_ahcaa.pdf

1,990 pages

 

 

SECTION I:  Detailed Review of Legislation by Topic

 

A. Topic Index

Abortion                                                                                                          1-3

Bureaucracy:  111 Newly-Created Bureaucracies                                          3-6

“Cadillac” Insurance Plans                                                                             6

Community Organizations                                                                              7

Discrimination , Immigration, and Health Disparities                                     7                     

End of Life Care and In-Facility Care                                                           7-9                  

Government Regulation of Health Research, Industry and Practices                        9-10    

Government Regulation of Non-Health Industry                                          11

Health Czar and Health Bureaucracy                                                             11-12              

Health Insurance Exchange                                                                            12-14              

Hospital Limitations and Loss of Autonomy                                                 14

Immediate Reforms                                                                                        15                   

Indian Health Services (IHS)                                                                                     15-16              

Medical Reimbursement                                                                                 16-17              

National Health Service Corps                                                                       17                   

Prescription Drugs                                                                                          17

Rationing                                                                                                        17                   

Requirements for “Qualified Health Benefit Plans”                                      18                   

Standardized Electronic Administrative Transaction                                     18                   

Taxes                                                                                                               18-20                          

                       

ABORTION

 

Abortion Coverage (Page 110): “Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A)”.  Paragraph (4)(A) Abortion Services – Abortions for which public funding is prohibited.  Paragraph (4)(B) “The services described in this subparagraph are for abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted.”

 

SEC. 258 (a) Presumably, the Act does not appear to preempt any state laws regarding abortion. This means that if there is a state law that disallows state funding (but not Federal) of abortion, it can presumably keep that restriction in place.

 

Abortion Providers (Page 182) Lines 18- 23 – States that “no Exchange participating health benefits plan may discriminate against an individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of or refer for abortions”.  The concern, of course, is that this means that no plan has the option NOT to participate with Planned Parenthood, otherwise they would be guilty of discrimination.

 

Family Planning (Page 1010) - Cites coverage under Medicaid – tobacco cessation and “family planning”. Family planning undefined in this section.

 

Federal Funding of Abortion (Page 147) Lines 14-(1) IN GENERAL.—“Nothing in this Act shall be construed to have any effect on Federal laws regarding – (A) conscience protection; (B) willingness or refusal to provide abortion; (C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion”. The concern regards lines 20-23 (C) as it is viewed as a potential open door for funding of organizations such as Planned Parenthood.  The document affirms that this bill has no effect on current law where discrimination based on either willingness or refusal to participate in abortion services, and thus, provides no additional protect against the use of Federal funds allocated for abortion services.  As, additionally, the Hyde Amendment is in no way incorporated into this piece of legislation and because no additional explicit protections exist in this document, this piece of legislation will, indeed, authorize federal funding of abortion under the public option.

 

Lack of HIS Abortion Funding Ban (Division D) This essentially reauthorizes the Indian Health Service, though without a specified ban on abortion funding and without any language, reference, or protection against such funding as was previously provided under the Vitter Amendment.   Thus, due to the lack of an outright ban on abortion funding, there exist no protections against or prohibition of federal funding for abortion. As, additionally, the Hyde Amendment is in no way incorporated into this piece of legislation, no such protections exist.

 

Mandated School-Based Health Clinics (Page 1354) Lines 9-21 states, “(c) Use of Funds – Funds awarded under a grant under this section …(2) may not be used to provide abortions. However, there is no specific language prohibiting either abortion referrals or the distribution of information materials regarding access to abortion.

 

National Teen Pregnancy Prevention Resource Center SEC. 2526 (Page 1399) – State funding for “evidence-based education programs”.

(Page 1401) (g) Lines 9- - Sec. will develop list within 180 days of enactment and states that it will be public.

(Page 1402) (i) “Definition. – In this section, the term ‘evidence-based’ means based on a model that has been found, in methodologically sound research – (1) to delay initiation of sex; (2) to decrease number of partners; (3) to reduce teen pregnancy; (4) to reduce sexually transmitted infection rates; or (5) to improve rates of contraceptive use.”

(Page 1402) - Authorizes $50,000,000 for each of fiscal years 2011 – 2015.

The concern, of course, is that Planned Parenthood could not only stand to benefit significantly in a financial manner, but also become a distinct part of government bureaucracy.

 

Secretary Determines Providers (Page 1451) Lines – “Any other type of provider specified by the Secretary, which has a desire to serve low-income and uninsured patients”.  The concern is that this language is grossly open-ended and provides for organizations such as Planned Parenthood that provide abortion services.

 

BUREAUCRACY:

 111 NEWLY-CREATED BUREAUCRACIES

 

1. Retiree Reserve Trust Fund SEC. 111 (Page 61)

2. Grant program for wellness programs to small employers SEC.112 (Page 62)

3. Grant program for State health access programs SEC. 114 (Page 72)  

4. Program of administrative simplification SEC. 155 (Page 76)

5. Health Benefits Advisory Committee SEC. 223 (Page 111)

6. Health Choices Administration SEC. 241 (Page 131)

7. Qualified Health Benefits Plan Ombudsman SEC. 244 (Page 138)

8. Health Insurance Exchange SEC. 201 (Page 155)

9. Program for technical assistance to employees of small businesses buying Exchange coverage SEC. 305 (Page 191)

10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner SEC. 306 (Page 194)

11. Health Insurance Exchange Trust Fund SEC. 307 (Page 195)

12. State-based Health Insurance Exchanges SEC. 308 (Page 197)

13. Grant program for health insurance cooperatives SEC. 309 (Page  206)

14. "Public Health Insurance Option" SEC. 321 (Page 211)

15. Ombudsman for "Public Health Insurance Option" SEC. 321 (Page 213)

16. Account for receipts and disbursements for "Public Health Insurance Option" SEC. 322 (Page 215)

17. Telehealth Advisory Committee SEC. 1191 (Page 589)

18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" SEC. 1222 (Page 617)

19. Demonstration program for shared decision making using patient decision aids SEC. 1236 (Page 648)

20. Accountable Care Organization pilot program under Medicare SEC. 1301 (Page 653) 21. Independent patient-centered medical home pilot program under Medicare SEC. 1302 (Page 672)

22. Community-based medical home pilot program under Medicare SEC.1302 (Page 681)

23. Independence at home demonstration program SEC. 1312 (Page 718)

24. Center for Comparative Effectiveness Research SEC. 401(Page 734)

25. Comparative Effectiveness Research Commission SEC. 1401 (Page 738)

26. Patient ombudsman for comparative effectiveness research SEC. 401 (Page 753)

27. Quality assurance and performance improvement program for skilled nursing facilities SEC. 1412 (Page 784)

28. Quality assurance and performance improvement program for nursing facilities SEC. 1412 (Page 786)

29. Special focus facility program for skilled nursing facilities SEC. 1413 (Page 796)

30. Special focus facility program for nursing facilities SEC. 1413 (Page 804)

31. National independent monitor pilot program for skilled nursing facilities and nursing facilities SEC. 1422 (Page 859)

32. Demonstration program for approved teaching health centers with respect to Medicare GME SEC. 1502 (Page 933)

33. Pilot program to develop anti-fraud compliance systems for Medicare providers SEC. 1635 (Page 978)

34. Special Inspector General for the Health Insurance Exchange SEC. 1647 (Page 1000) 35. Medical home pilot program under Medicaid SEC. 1722 (Page 1058)

36. Accountable Care Organization pilot program under Medicaid SEC. 1730 (Page 1073)

37. Nursing facility supplemental payment program SEC. 1745 (Page 1106)

38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases SEC. 1787 (Page 1149)

39. Comparative Effectiveness Research Trust Fund SEC. 1802 (Page 1162)

40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid" SEC. 1905 (Page 1191)

41. Center for Medicare and Medicaid Innovation SEC. 1907 (Page 1198)

42. Public Health Investment Fund SEC. 2002 (Page 1214)

43. Scholarships for service in health professional needs areas SEC. 2211 (Page 1224)

44. Program for training medical residents in community-based settings SEC. 2214 (Page 1236)

45. Grant program for training in dentistry programs SEC. 2215  (Page 1240)

46. Public Health Workforce Corps SEC. 2231 (Page 1253)

47. Public health workforce scholarship program SEC. 2231 (Page 1254)

48. Public health workforce loan forgiveness program SEC. 2231 (Page 1258)

49. Grant program for innovations in interdisciplinary care SEC. 2252 (Page 1272)

50. Advisory Committee on Health Workforce Evaluation and Assessment SEC. 2261 (Page 1275)

51. Prevention and Wellness Trust SEC. 2301 (Page 1286)

52. Clinical Prevention Stakeholders Board SEC. 2301 (Page 1295)

53. Community Prevention Stakeholders Board SEC. 2301 (Page 1301)

54. Grant program for community prevention and wellness research SEC. 2301 (Page 1305)

55. Grant program for research and demonstration projects related to wellness incentives SEC. 2301  (Page 1305)

56. Grant program for community prevention and wellness services SEC. 2301 (Page 1308)

57. Grant program for public health infrastructure SEC. 2301 (Page 1313)

58. Center for Quality Improvement SEC. 2401 (Page 1322)

59. Assistant Secretary for Health Information SEC. 2402 (Page 1330)

60. Grant program to support the operation of school- based health clinics SEC. 2511 (Page 1352)

61. Grant program for nurse-managed health centers SEC. 2512 (Page 1361)

62. Grants for labor-management programs for nursing training SEC.  2521 (Page 1372) 63. Grant program for interdisciplinary mental and behavioral health training SEC. 2522 (Page. 1382)

64. "No Child Left Unimmunized Against Influenza" demonstration grant program SEC. (Page 1391)

65. Healthy Teen Initiative grant program regarding teen pregnancy SEC. 2526 (Page 1398)

66. Grant program for interdisciplinary training, education, and services for individuals with autism SEC. 2527 (Page 1402)

67. University centers for excellence in developmental disabilities education SEC. 2527 (Page 1410)

68. Grant program to implement medication therapy management services SEC. 2528 (Page 1412)

69. Grant program to promote positive health behaviors in underserved communities SEC. 2530 (Page 1422)

70. Grant program for State alternative medical liability laws SEC. 2531 (Page 1431)

71. Grant program to develop infant mortality programs SEC. 2532 (Page 1433)

72. Grant program to prepare secondary school students for careers in health professions SEC. 2533 (Page 1437)

73. Grant program for community-based collaborative care SEC. 2534 (Page 1440)

74. Grant program for community-based overweight and obesity prevention SEC. 2535 (Page 1457)

75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools SEC. 2536 (Page 1462)

76. Demonstration project of grants to medical-legal partnerships SEC. 2537 (Page 1464) 77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response SEC. 2552 (Page 1478)

78. Council for Emergency Care SEC. 2552 (Page 1479)

79. Grant program to support demonstration programs that design and implement regionalized emergency care systems SEC. 2553 (Page 1480)

80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge SEC. 2554 (Page 1487)

 81. Interagency Pain Research Coordinating Committee SEC. 2562 (Page 1494)

82. National Medical Device Registry SEC. 2571 (Page 1501)

83. CLASS Independence Fund SEC. 2581 (Page 1597)

84. CLASS Independence Fund Board of Trustees SEC. 2581 (Page 1598)

85. CLASS Independence Advisory Council SEC. 2581 (Page 1602)

86. Health and Human Services Coordinating Committee on Women's Health SEC. 2588 (Page 1610)

87. National Women's Health Information Center SEC. 2588 (Page 1611)

88. Centers for Disease Control Office of Women's Health SEC. 2588 (Page 1614)

89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research SEC. 2588 (Page 1617)

90. Health Resources and Services Administration Office of Women's Health SEC. 2588 (Page 1618)

91. Food and Drug Administration Office of Women's Health SEC. 2588 (Page 1621)

92. Personal Care Attendant Workforce Advisory Panel SEC. 2589 (Page 1624)

93. Grant program for national health workforce online training SEC. 2591 (Page 1629) 94. Grant program to disseminate best practices on implementing health workforce investment programs SEC. 2591 (Page 1632)

95. Demonstration program for chronic shortages of health professionals SEC. 3101 (Page 1717)

96. Demonstration program for substance abuse counselor educational curricula SEC. 3101 (Page 1719)

97. Program of Indian community education on mental illness SEC. 3101 (Page 1722)

98. Intergovernmental Task Force on Indian environmental and nuclear hazards SEC. 3101 (Page 1754)

99. Office of Indian Men's Health SEC. 3101 (Page 1765)

100. Indian Health facilities appropriation advisory board SEC. 3101 (Page 1774)

101. Indian Health facilities needs assessment workgroup SEC. 3101 (Page 1775)

102. Indian Health Service tribal facilities joint venture demonstration projects SEC. 3101 (Page 1809)

103. Urban youth treatment center demonstration project SEC. 3101 (Page 1873)

104. Grants to Urban Indian Organizations for diabetes prevention SEC. 3101 (Page 1874)

105. Grants to Urban Indian Organizations for health IT adoption SEC. 3101 (Page 1877) 106. Mental health technician training program SEC. 3101 (Page 1898)

107. Indian youth telemental health demonstration project SEC. 3101 (Page 1909)

108. Program for treatment of child sexual abuse victims and perpetrators SEC. 3101 (Page 1925)

109. Program for treatment of domestic violence and sexual abuse SEC. 3101 Page 1927)

110. Native American Health and Wellness Foundation SEC. 3103 (Page 1966)

111. Committee for the Establishment of the Native American Health and Wellness Foundation SEC. 3103 (Page 1968)

 

 

“CADILLAC” INSURANCE PLANS

 

Credit vs. Points (Pages 318-320) This portion gives the appearance of providing a temporary two-year credit while at the same time deducting “points” if the Secretary deems that the employer is too generous with its health care benefit package.  Ex. p. 319, lines 11-18: “Credit not allowed with respect to certain highly compensated employees. No credit shall be determined under subsection (a) with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid by the employer to such employee during such taxable year exceeds $80,000”.

 

 

COMMUNITY ORGANIZATIONS

 

Community-Based Organizations (Page 1374) Line 10  -  3) a State training partnership program that consists of nonprofit organizations that include equal participation from industry, including public or private employers, and labor organizations including  joint labor-management training programs, and  which may include representatives from local governments, worker investment agency one-stop career centers, community-based organizations, community colleges, and accredited schools of nursing”.  The concern is that this opens the door for organizations such as ACORN.

 

 

DISCRIMINATION, IMMIGRATION, AND HEALTH DISPARITIES

 

Medicaid Coverage of “Qualified Aliens” (Page 1082) This item provides benefits (federal only) to legal aliens (possibly just from freely associated states like marshall islands.   The concern is that this could establish ground for a future amnesty bill which will make all those who have come here illegally, made eligible for our tax dollar paid benefits.  

 

Terminology Related to Access (Page 1318) Line 4 – “(3) The term ‘health disparities’ includes health and health care disparities and means population-specific differences in the presence of disease, health outcomes, or access to health care.  For purposes of the preceding sentence, a population may be delineated by race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socio-economic status, or rural, urban, or other geographic setting and any other population or subpopulation determined by the Secretary to experience significant gaps in disease, health outcomes, or access to health care.”

 

END OF LIFE CARE AND IN-FACILITY CARE

 

Assisted Suicide (Pages 129-131) (Section 240) While page 129, lines 21-26 state, “(b) Construction – Nothing in this section shall be construed – (1) to require an individual to complete and advance directive or a physician’s order for life sustaining treatment or other end of life planning document”, this section DOES require insurance companies to provide information related to "end-of-life planning" to individuals seeking enrollment in insurance offered on the health insurance exchange.  Additionally, there is concern that because key terminology is not provided and because broader protective language adopted earlier in the Energy and Commerce Committee version no longer exists in this version of legislation, that awareness of current law in the states of Oregon and Washington regarding assisted suicide may become cause for information purposes for patients.

 

*Government Panel for Senior Care Decisions (Pages 649-661): The Secretary has the right to waive requirements of the Social Security Act Titles XI & XVIII.  These providers will put together patient decisions aids and share in seniors’ decisions regarding their health care.  Seniors will attend counseling provided by said panel.  Compensation will be granted to providers who generate less cost for care with regards to Parts A and B of Medicare.

 

Government Regulation of Staffing in Nursing Facilities (Pages 822-826): In a specific motion to alter state authority of nursing facilities and to provide the Secretary and consumer advocacy groups with overreaching authority, this section of the bill calls for an amendment to the Social Security Act "(C) Submission of Staffing Information Based on Payroll Data in a Uniform Format."  The Secretary of Health and Human Services shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing information including agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format as established by the Secretary in consultation with among others, consumer advocacy groups.  

 

Government Authority in Determining Medical Home Models (Pages 680-690):  Secretary is provided wide latitude to fund and create both independent and community-based medical home models in order to reward physicians and others to coordinate treatment for chronically ill patients in underserved (rural) areas.  Patient need not designate a doctor as their caregiver.

Medical Home Pilot Program (Pages 733-761) The cost of the pilot program is high, equating to $120,000,000.00 for five years.  The concern is that there are state run programs in place that the HHC can achieve great results in implementing from already successful programs, without a five year costly pilot program.  The Medical Home Services concept has been around for 20 some years, but only in the last 5 years or so has begun to gather momentum with doctors embedded in the Medicare and Medicaid programs. Essentially, it is a group of dedicated specialists led by a Primary Care Physician who have all the records of a certain patient, and who work together to tend to the health concerns of that person. The patient cannot decide who is in the MHS, that is, she cannot go independently to another doctor or specialist outside her MHS for a second opinion. The whole MHS recieves a single payment from the insurer (Medicare, Medicaid, or private insurer), then they distribute among themselves. The patient cannot direct her insurer to pay someone outside the MHS.

Nursing Home Oversight SEC. 1413 (Page 789) Line 8 - The Nursing Home Compare Medicare website addition is a substantial data-gathering project that appears to attempt to provide a path for government to usurp virtually all nursing home oversight from the states. The concern is that, while presented under the guise of “consumer protection”, it vastly expands requirements for what and how often nursing homes must report data to the government.  Additionally, there is no language to indicate the cost to maintain the site project.

 

Regulation of Services (Page 383) Lines 11-16 allot for using appropriate indicators for non-therapy ancillary services classification, which may include age, physical and mental status, ability to perform activities of daily living, etc.  The concern is over the method of deciding care delivery, placing key decision-making elements in the hands of politicians and other non-medical staff as opposed to the hands of patients’ doctors and families.

 

Regulation on Patient Stay (Page 385) Establishes payment based on total costs during stay in a skilled nursing facility as opposed to the number of days in such stay.

 

“CLASS” Program for Assisted Living – National Voluntary Insurance Program

 

SEC. 3204 .  Enrollment and Disenrollment Requirements

Automatic Enrollment (Page 1575) Line 3 – Individuals are automatically enrolled by their employer if they meet the following description in subsection (c) (Page 1568) - unable to perform 2-3 daily living activities, pose a threat due to cognitive impairment, or have a functional limitation “as determined under regulations prescribed by the Secretary”.

Opt-Out Option (Page 1576) – Individuals may waive enrollment “in such form and manger as the Secretary shall prescribe”.

Inability to Disenroll (Page 1579) Line 16 –Individuals may only be permitted to disenroll during an annual disenrollment period established by the Secretary.

Life Independence Account (Page 1583) Line 20 – Account established by Secretary on behalf of each eligible beneficiary for nonmedical services and supports.  (Page 1584) Line 9 – “Nothing in the preceding sentence shall prevent an eligible beneficiary from using cash benefits from the (LIA) for obtaining assistance with decision-making concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives….living will”. 

Access to Cash Benefits (Page 1589) Lines 15-19 – Secretary will allow authorized persons to receive the beneficiary’s cash benefits if the individual is considered an “institutionalized beneficiary under clause (i)”.

SEC. 3207.  “CLASS Indpendence Advisory Council – Council established to advise the Secretary.

Government Long-Term Care Plan (Page 332) SEC. “CLASS” Program Treated in Same Manner at Long-Term Care Insurance. – Lines 12-18 -  This specifically strikes “State long-term care plan” from IRS Code of 1986 and replaces it with, “government long-term care plan.”

 

 

GOVERNMENT REGULATION OF HEALTH RESEARCH, INDUSTRY AND PRACTICES – IN ADDITION TO HIE

 

Authority to Effect Price Ceilings (Pages 1341-1342) Lines 23-1 – “(i) The establishment of a process to enable the Secretary to verify the accuracy of ceiling prices calculated by manufacturers under subsection (a)(1) and charged to covered entities..”.   Concern exists over lack of oversight.

 

Grant-Based Obesity Prevention Program (Page 1457)  Lines 11-20 – “(a) Program. – The Secretary shall establish a community-based overweight and obesity prevention program consisting of awarding grants and contracts under subsection (b). (b) Grants. – The Secretary shall award grants to, or enter into contracts with, eligible entities – (1) to plan evidence-based programs for the prevention of overweight and obesity among children and their families through improved nutrition and increased physical activity; or…..(Page 1458, lines 15-17)…representatives of public and private entities that have a history of working within and serving the community”.

 

Government Legislation of Pain Research (Pages 1493-1501):  Page 1496 describes the attributes of committee members (6 members are scientists, physicians, other health professionals while another 6 members are from general public representatives from leading in research, advocacy and service organizations for individuals with pain-related conditions).  This committee will coordinate all efforts within the Department of Health and Human Services and other Federal agencies that relate to pain research. Appears to be a decision making board on treatment protocols, create a public awareness campaign on pain.  Ramifications include overly regulated treatment protocols for chronic pain and the possible end result of rationing.  (Page 1501): Lines 15-18 establish the authorization of appropriations – “For purposes of carrying out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2011 and $4,000,000 for each of fiscal years 2012 and 2015”.

 

Government Regulation of Group Purchasing (Page 1340-1341) Lines 23-4 – “(C) Prohibits the use of group purchasing arrangements. – A hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of paragraph (4) shall not obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement”.  Concern exists over lack of oversight.

 

Required Reporting Regarding Infections Sec. 1138A – Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections.-  Page 915 – States, “infections are to be publicly posted and compared by demographic information.” Page 916 – States “infections are being studied in such detail in order to reduce costs, not because of quality of care concerns”. The concern stems from both the ambiguity that exists in the statement referenced on page 915 as well as the lack of concern over quality of care in regards to infection.

 

Required Reporting Trumps State Laws Sec. 1128H – Financial reports on physicians’ financial relationships with manufacturers and distributors of covered drugs, devices, biologicals or medical supplies under Medicare, Medicaid, or CHIP and with entities that bill for services under Medicare. Page 910 – Concerns is that language pre-empts state laws requiring manufacturers to report their relationships to physicians.  Page 912 – Establishes that “Comptroller General” is to file a report establishing that no loopholes exist in said section.

 

Vernacular Change Regarding Mental Health Centers (Page 1370) – This area redefines Community Mental Health Services as “Federally Qualified Behavioral Health Centers”.

 

 

GOVERNMENT REGULATION OF NON-HEALTH INDUSTRY

 

Regulation of Disclosure of Nutrient Content/Menu Variability (Page 1514) Lines 5-14 – “The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children’s combination meals, through means determined by the Secretary, including ranges, averages, or other methods”. Rules extend to maintaining the calculation of combo meals an addition cost to restaurants.

 

Regulation of Vending Machine Owners/Suppliers (Page 1516) Lines 4-8 – Pertaining to businesses that own or operation 20 or more vending machines, “the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that included a clear and conspicuous statement disclosing the number of calories contained in the article”.

 

Regulation of Food Preparation/Presentation (Page 1517) Lines 14-22 - “The Secretary shall (aa) consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines”.

 

*HEALTH CZAR* AND HEALTH BUREAUCRACY

 

Authorizes Investigation of Personal Records (Page 1006) - Federal agencies have authority to pull records relating to fraud and waste. The concern is that, under the auspices of fraud and waste, this may seem benign if not balanced against an understanding that this person would wield a tremendous amount of power over all people who give and receive health care.

 

Database Change (Page 1007) -  Health Care Integrity Data Base (HIPDB) & National Practitioner Data Base (HPDB) – Ceases continuation of the HIPDB. Transition carried out under Social Security act without fiscal year limitation

 

Family Planning (Page 1010) - Cites coverage under Medicaid – tobacco cessation and “family planning”. Family planning undefined in this section. (Also see Abortion section).

 

Government Control of Physician Training (Pages 944-945) Lines 1-25: 1-5 - The government will now spend money to determine if the residency programs are meeting the goals of the government and recommend how physicians are to be trained to meet these goals, including "developing curriculum requirements."

Government Override of Social Security Act (Page 1004) - No provision of the Social security act can supersede the authority of the health inspector or by extension his/her staff to carry out investigations.

Health Czar (Page 133): Establishes Health Czar and bureaucracy, i.e. “Health Choices Commissioner” and “Health Choices Administration”.  Essentially, this area lends the Health Commissioner and Health Choices Administration power over health insurance plans both inside and outside of the Health Insurance Exchange.  The concern is that the provision invites overreaching authority and oversight of plans specifically set up to provide timely and needed care not readily available through the government exchange-controlled plans.

 

Health Inspector General (Czar) (Page 1000-1010) – Establishes a Health Inspector General whose jurisdiction includes oversight of fraud, waste, abuse and misconduct, as well as oversight of private care.  This person will be appointed by the President.

 

Health Czar Health Plan Audits (Page 133-134) Provides “Health Commissioner”/Czar with wide discretion to audit “qualified health benefits plans” and then bill the plan for the cost of the audit, regardless of grounds for the audit and regardless of whether or not the plan was found to have violated any regulation.  The concern is the overreaching of authority and power over private health plans and the conjecture is that this will force private insurance companies out of business, thus significantly limiting consumer choice.  As written, no protection from abuse of power in this regard is apparent.

 

 

HEALTH INSURANCE EXCHANGE

Health Insurance Exchange (Pgs. 155-211)

Public Health Insurance Option (Pgs. 211-225)

Individual Affordability Credits (Pgs. 225-267)

 

 

Abortion Providers (Page 182) Lines 18- 23 – States that “no Exchange participating health benefits plan may discriminate against an individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of or refer for abortions”.  The concern, of course, is that this means that no plan has the option NOT to participate with Planned Parenthood, otherwise they would be guilty of discrimination. (Also see Abortion section).

 

**Authority Related to Improper Steering SEC. 414 (Page 277) This section addresses  government authority to penalize employers and insurers if they encourage or coerce employees to join the Health Insurance Exchange (HIE) and affect the risk pool of the HIE.  Essentially, the government will set rules which are yet to be written as to whether employers and insurers are or are not "undertaking any actions to affect the risk pool". The risk pool refers to the health of people in the population of those enrolled in the insurance plan. The government plan will want only healthy people, same as insurers. The concern is that the goal is to make sure that private insurance companies and employers don't dump their costly patients into the government run system, yet the government will find ways to ensure that it IS able to dump sick patients into the private industry and decrease the industry’s viability. 

 

Automatic Enrollment for Employer Sponsored Health Benefits (Page 273) The employer automatically enrolls employees into the employment-based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium.

 

Assistance for Small Employers (Page 191)

 

Benefits Package Levels (Page 167)

 

Enforcement (Page 180) – Gives Commissioner authority to terminate a contract with an entity within the exchange

 

Essential Community Providers (Page 175) “Entity shall include those essential community providers, where available, that serve predominantly low-income, medically-underserved individuals, such as health care providers defined in section 340B(a)(4) of the Public Health Service Act…” – Yet another opportunity for Planned Parenthood to benefit?

 

Establishment of a Provider Network SEC. 323 (Page 217) Lines 14-17 -  All current health care providers participating in Medicare are considered providers unless they "opt-out" The process for doing so would be established by the government.

Health Insurance Exchange Trust Fund SEC. 307 (Page 195)

 

Limitations After 2013 (Page 160) – After 2013, any health insurer not in the Exchange will no longer be able to adjust premiums, coverage or enroll new clients.

 

National Teen Pregnancy Prevention Resource Center SEC. 2526 (Page 1399) – State funding for “evidence-based education programs”.

(Page 1401) (g) Lines 9- - Sec. will develop list within 180 days of enactment and states that it will be public.

(Page 1402) (i) “Definition. – In this section, the term ‘evidence-based’ means based on a model that has been found, in methodologically sound research – (1) to delay initiation of sex; (2) to decrease number of partners; (3) to reduce teen pregnancy; (4) to reduce sexually transmitted infection rates; or (5) to improve rates of contraceptive use.”

(Page 1402) - Authorizes $50,000,000 for each of fiscal years 2011 – 2015.

The concern, of course, is that Planned Parenthood could not only stand to benefit significantly in a financial manner, but also become a distinct part of government bureaucracy. (Also see Abortion section).

 

Opt-Out (Page 274) In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt-out of such plan.  A 30 day period must be provided to make such an affirmative election before the employer may automatically enroll the employee in such a plan.

 

Oversight and Enforcement Responsibilities (Page 179)

 

Promotion of Delivery System (Page 220) Lines 14-19 – States that the Secretary can delay providing a public option in geographic areas where the public option would be at a competitive disadvantage. 

Public Insurance Option Competitive Edge (Page 212) Lines 8-12 - This section provides for three levels of insurance, as well as possible "premium coverage". The government, in providing these different levels of coverage, will be able to compete with private insurers at every level. The concern, of course, is that they are also creating all the rules for private and public.

Small Employer Defined (Pages 193)

 

Special Situation Authority (Page 165)

 

Taxes on Individuals and Employers (see Taxes section).

 

Termination of State-Based Health Insurance Exchanges (Pages 200-201) –Establishes the authority of the Commissioner to not only terminate, but to assume the authority of a State-Based Health Insurance Exchange.

 

HOSPITAL LIMITATIONS AND LOSS OF AUTONOMY

 

Government Establishes Regulations for Hospital Expansions (Page 490) With regard to hospital expansion, a “hospital may apply for an exception” for expansion.  Lines 24-25 – “The Secretary shall promulgate regulations”, or create the laws to manage the expansion process.  Page 491, lines 5-6 lists exceptions “up to once every 2 years”.

(Page 491) Lines 9-22 limit the size and facilities of the hospital; cannot double the size, baseline being “as of date of enactment of this subsection.”

(Page 493) Lines 12-18 appear to limit choice of hospital by limited expansion exceptions based on “average percent with respect to such admissions for all hospital located in the county in which the hospital is located”.

(Page 494) Lines 3-8 cite that expansion is also based on “average bed occupancy rate in the state.”

 

Mental Health “Project” and Emergency Care SEC. 1787 (Page 1149-1150) Establishes a demonstration project regarding mental health stabilization under emergency situations.  As presented, it appears as a test to determine cost effectiveness of emergency mental health care; whether provided by mental health institutions or general hospital emergency rooms not devoted to mental health. The concern is that medical protocol already contains adequate provisions.

 

Redistribution of Residency Slots (Pages 939-940) Lines 13-25; 1-6 – (vi) Authorizes Secretary to redistribute residency slots after a hospital closes to “approved” hospitals.

 

 

 

IMMEDIATE REFORMS

 

Fed & State Oversight of Insurance Premiums SEC. 104, (Page 31) – The Secretary of HHS, with states, will review an increase in insurance premiums & require companies to submit justification for any increases.

 

Elimination of Lifetime Limits SEC. 716 (Page 50) Lines 5-9 – Insurance providers “may not impose a aggregate dollar lifetime limit with respect to benefits payable under the plan or coverage”; effective Jan.1, 2010.

 

Reinsurance for Retirees SEC. 111 – (Page 56) Lines 6-14 – Government will establish reinsurance program to reimburse employment-based plans for coverage of retirees and their spouses, dependents. Reinsurance Audits (Page 61) – Government will audit plans to ensure their compliance with requirements. Limitations (Page 62) – Government has authority to refuse entities from participating in Reinsurance program if funds are limited.

 

Rules and Guide Established by Unnamed Entity (Page 83-85) - A “nonprofit entity” will be consulted with regarding the development of the Companion Guide and Operating Rules.  It does not define the entity, but it gives the entity, under the Health and Human Services Secretary, substantial power to make all the rules regarding eligible health plan and health claim transactions.

 

 

INDIAN HEALTH SERVICES

 

Government Oversight of Tribal Contracts (Pages 1850 – 1860) HEALTH SERVICES FOR URBAN INDIANS – Essentially states that the Secretary now controls and approves any and all grants and/or contracts entered into or referred by an Indian Tribe, Urban Indians or Tribal Organizations, including but not limited to healthcare needs, education of any kind, decease prevention, wild life preservation, land preservation or land purchases, and anything else covered under the 1921 Snyder Act.  

(Page 1860) Lines 14-23 – “The purpose of a contract or grant...shall be the determination... in order to assist the Secretary in assessing the health status and health care needs of Urban Indians in the Urban Center involved and determining whether the Secretary should enter into a contract or make a grant....”.

 

**IHS Delivery Demonstration Project (Page 1801) SEC. 306. – “The Secretary, acting through the Service, is authorized to make grants to, and enter into construction contracts or construction project agreements with, Indian Tribes or Tribal Organizations....for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering  health care and services to Indians through facilities.  (Page 1802) Line 14 – Secretary may “permit the use of funds or property donated from any source for project purpose” and Line 18 – “permit the use of Service funds to match other funds, including Federal funds”. The concern, of course, that this allows for use of taxpayer money to fund ANY entity.

 

IHS Penalties Sec. 311 (d) Breach of Agreement.  The concern is that there is a lack of sufficient language to determine what constitutes a breach.  However, it does explain that the tribe will be liable for monies paid to them and they will seize tangible property to repay the government for what was paid out.

 

Indian Self-Determination Law – Link to additional information: http://www.teamsarah.org/group/healthcarebillreviewboard/forum/topics/indian-selfdetermination-law

 

Lack of HIS Abortion Funding Ban (Division D) This essentially reauthorizes the Indian Health Service, though without a specified ban on abortion funding and without any language, reference or protection against such funding as was previously provided under the Vitter Amendment.   Thus, due to the lack of an outright ban on abortion funding, there exist no protections against or prohibition of federal funding for abortion. As, additionally, the Hyde Amendment is in no way incorporated into this piece of legislation, no such protections exist (Also see Abortion section).

 

Land Transfer (Page 1805) SEC. 307 – Lines 12-18 – Authorizes Bureau of Indian Affairs and all other agencies and departments of the U.S. to transfer land to the IHS for health care services (at no cost).

 

Mental Illness Decided by Government (Page 1884) – Directs terms for considering what constitutes mental illness; (Page 1892) – Authorizes government to convert existing hospital beds into psychiatric units if needed.

 

Separate but Equal? (Pages 1934) Health Services are to be "at a minimum...at parity...with health services available to and health status of general population."

 

Septic System Regulations (Pages 1780-1790) Congress reaffirms primary responsibility and authority of the government to provide sanitation facilities and services.  Government establishes  standards for such systems.  It is posited that this item is a necessary item for the bill as septic-related issues directly affect health issues for the Indian Community.  However, it is a concern that this is transition of power overrides local standards for the Indian Community and usurps local authority over key community infrastructure and systems.  It is worthy to note, as well, that sanitation needs include a clean water source which involves a myriad of issues related to clean water and environmental concerns.

 

MEDICAL REIMBURSEMENT

 

Uncompensated Care Increase (Page 389-390) Page 389, lines 14-19 detail a “significant” decrease in uninsurance will be triggered by only 8% decrease – “There is a “significant” decrease in the national rate of uninsurance as the result of this Act” if there is a decrease in the national rate of uninsurance from 2012 to 2014 that exceeds 8 percentage points.”   Page 390, lines 4-9 detail the increase in uncompensated care – “For each fiscal year (beginning with 2017) , the Secretary shall estimate the aggregate reduction in the amount of Medicare DSH payment that would be expected to result from the adjustment under paragraph (1)(A)”. This, in turn, will lower payments to hospitals in reimbursement rates.

 

NATIONAL HEALTH SERVICE CORPS

Sec. 2201

 

Obligated Service Requirement (Page 1220): “The entity and the Corps member agree in writing that the Corps member will perform half-time clinical practice”.  Essentially, this details “those individuals who have entered into a contract for obligated service under the Scholarship Program or Loan Repayment Program un which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice”.  Essentially these individuals are obliged to work off debt in this capacity. 

 

 

PRESCRIPTION DRUGS

 

Rationing (Page 1350) – Lines 1-18 - Essentially, the Secretary will decide who receives the drugs and if the manufacturer does not agree with the Secretary’s decision, they are no longer in the program.

 

Drug Pricing (Page 1350-1352) This section requires detailed reports on how companies determine pricing and the maximum amount that may permissibly be required to pay for said drug. It also requests information on any rebates or discounts a manufacturer provides to purchasers before the sale of the drug to covered entities. The concern is that this will result in such government oversight that the government itself will essentially set drug pricing.

 

RATIONING

 

Rationing (Pages 25-26) Lines 22-25; 1-4 - “(2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists”.

 

Rationing Board? (Page 111-112) SEC. 223 0 Lines 9-25; 1-10 -  Establishes “Health Benefits Advisory Committee” to oversee benefits and plans.  The Surgeon General will serve as Chair, along with nine Presidential appointees, nine appointees of the Comptroller General, and as many as eight Federal employees/officers.

 

Rationing (Page 589-590) SEC. 1191. – Sec. shall appoint Telehealth Advisory Committee to make recommendations, including deletion of services as they related to rural access protections for Medicare.

 

 

REQUIREMENTS FOR “QUALIFIED HEALTH BENEFIT PLANS”

 

**Grandfather Clause SEC. 202 (Page 91) – Set up to protect choice to keep current plan coverage, this is subject to succeeding provisions.  The insurer is not allowed to change terms, conditions, benefits or cost-sharing (except what is required by law) once the insurance exchange is established – the “catch” so to speak. There are few exceptions.  The concern here is that if insurers are NOT allowed to adjust the above items to meet their viability needs, that they will be unable to remain viable.

 

**Grandfathered Plan Grace Period (Page 92) – After five years, government will require employment-based health plans to meet requirements of “Qualified Health Benefits Plan”.

 

Rationing (see Rationing section).

Requirements SEC. 201 (Pages 89-91) Plans will not be qualified unless they meet requirement established.

 

STANDARDIZED ELECTRONIC ADMINISTRATIVE TRANSACTION

 

Enforcement Process (Page 81) – Establishes an enforcement process that will include investigations of complaints, random audits, and annual audit and certification process.  Provide civil monetary penalties for non-compliance.  All health plans must comply with the standards.

 

Goals/Logistics SEC. 1173A (Page 77) – Lines 4+ - Among other things, will “enable real-time determination of an individual’s financial responsibility at point of service” and will require strict adherence to uniform value codes and data elements.  Effective period is two years after enactment of section; but not later than 5 years. 

 

Standards (Page 81) – The concern is that this allows unequal treatment of health care providers by providing incentives and lessening the burden of implementation.  Rural or underserved areas are mentioned without defining, but it does not rule out any group to which they would provide these incentives.

 

TAXES

 

Employer FINE Under Mandated Excise Tax (Page 310):  A $100 per day excise tax imposed on employers for each employee for whom employer fails to “satisfy the health coverage participation requirements”.  Excise tax will not apply if Secretary determines even after “exercising reasonable diligence” employer was unaware of employee’s lack of participation in health coverage.

 

Employer Excise Tax (Pages 313-317): If an employer chooses not to provide health insurance to employees, an excise tax on the total wages paid is imposed on the employer. The excise tax percentage ranges from 2% of total payroll of $500,000 to 8% of payroll of $750,000 or more. If an employer has less than $500,000 annual payroll, he pays no excise tax.

 

Employer Health Coverage Tax Credit (Pages 317-319): Small business owners receive a tax credit of 50% of health insurance paid for employees whose wages are $20,000 or less per year when the employer has 10 or fewer employees. The tax credit is prorated as the amount of wages increases, leaving no tax credit for the employer when such employee's wages total $80,000 or more per year.

For employers with more than 10 employees, the tax credit calculated by the proratio shall be reduced by an amount in the ratio of 10 to total number of employees.

 

These items are in addition to the following:

 

Comprehensive List of Taxes in House Democrat Health Bill provided by Americans for Tax Reform (ATR)

 

http://www.atr.org/userfiles/102909pr-housetaxhikes.pdf

Employer Mandate Excise Tax (Page 275): If an employer does not pay 72.5 percent of a single employee’s health premium (65 percent of a family employee), the employer must pay an excise tax equal to 8 percent of average wages.  Small employers (measured by payroll size) have smaller payroll tax rates of 0 percent (<$500,000), 2 percent ($500,000-$585,000), 4 percent ($585,000-$670,000), and 6 percent ($670,000-$750,000).

Individual Mandate Surtax (Page 296): If an individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of 2.5 percent of modified adjusted gross income (MAGI) or the average premium.  MAGI adds back in the foreign earned income exclusion and municipal bond interest.

Medicine Cabinet Tax (Page 324): Non-prescription medications would no longer be able to be purchased from health savings accounts (HSAs), flexible spending accounts (FSAs), or health reimbursement arrangements (HRAs).  Insulin excepted.

Cap on FSAs (Page 325): FSAs would face an annual cap of $2500 (currently uncapped). 

Increased Additional Tax on Non-Qualified HSA Distributions (Page 326): Non-qualified distributions from HSAs would face an additional tax of 20 percent (current law is 10 percent).  This disadvantages HSAs relative to other tax-free accounts (e.g. IRAs, 401(k)s, 529 plans, etc.)

Denial of Tax Deduction for Employer Health Plans Coordinating with Medicare Part D (Page 327): This would further erode private sector participation in delivery of Medicare services.

Surtax on Individuals and Small Businesses (Page 336): Imposes an income surtax of 5.4 percent on MAGI over $500,000 ($1 million married filing jointly).  MAGI adds back in the itemized deduction for margin loan interest.  This would raise the top marginal tax rate in 2011 from 39.6 percent under current law to 45 percent—a new effective top rate.

Excise Tax on Medical Devices (Page 339): Imposes a new excise tax on medical device manufacturers equal to 2.5 percent of the wholesale price.  It excludes retail sales and unspecified medical devices sold to the general public.

Corporate 1099-MISC Information Reporting (Page 344): Requires that 1099-MISC forms be issued to corporations as well as persons for trade or business payments.  Current law limits to just persons for small business compliance complexity reasons.  Also expands reporting to exchanges of property.

Delay in Worldwide Allocation of Interest (Page 345): Delays for nine years the worldwide allocation of interest, a corporate tax relief provision from the American Jobs Creation Act

Limitation on Tax Treaty Benefits for Certain Payments (Page 346): Increases taxes on U.S. employers with overseas operations looking to avoid double taxation of earnings.

Codification of the “Economic Substance Doctrine” (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.

Application of “More Likely Than Not” Rule (Page 357): Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties.  If there is a tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability.