Monday, August 17, 2009

More on the House version of Health Care bill

I'm slowly making my way through this Bill… I wonder how much of it our representatives and their staff have read at this point!?!

Page 125 continues with information on the "Modernized Payment Initiatives and Delivery System Reform: (a) The Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option."
(That part doesn't sound so bad, right, but later on the page it continues…) (b) …The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that (1) seeks to improve health outcomes; reduce health disparities (including radical, ethnic, and other disparities); provide efficient and affordable care; address geographic variation in the provision of health services; prevent or manage chronic illness.
(How are they going to accomplish all of that?)

On page 130 the bill makes an interesting comment: "..the Commissioner shall establish effective methods that ensure that individuals with limited English proficiency are able to apply for affordability credits."
I have numerous relatives who immigrated to this country legally from Mexico – they took the responsibility to learn English very seriously. Why does the government need to take that away from them?

Then we get into State Medicaid Agencies: "If the Commissioner determines that a State Medicaid agency has the capacity to make a determination of eligibility…"
So, the Commissioner working for the Federal Government will be determining if State agencies have certain abilities? Does anyone else see a 10th amendment issue here?

On page 132 we get to another interesting part: "Access to Data-In carrying out this subtitle the Commissioner shall request from the Secretary of the Treasury consistent with section 6103 of the Internal Revenue Code of 1986 such information as may be required to carry out this subtitle."
So they'll have access to our financial information? Certainly sounds like it to me.

Section 246, Page 143 clearly spells out that "No Federal Payment for Undocumented Aliens: Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."
At first I thought this meant that none of the Health Care bill provisions would be going to pay for illegals, and that may still be true, but the 10 pages or so leading up to this have specifically been dealing with "Individual Affordability Credits" (starting on page 128) Those pages are dealing with what income levels people will be getting help with paying for their health care insurance – so that is more likely to be the only portion they are clearly saying here does not apply to illegals.

On page 143, we get started on the Employer's Responsibility. On pages 144 and 145 the details begin: An employer meets the requirements of this section if (1) Offering of coverage… (2) Employer Required Contributions… (3) Provisions of Information… (4) Autoenrollment of Employees… On page 146 the Government informs employers that they will be required to cover at least 72.5% of the premiums for their full time employees and no less than 65% of their spouse and children. My question here is what about employers who cannot afford to pay those amounts, or to employees who cannot afford to pay the remaining amounts? There is an opt-out option for the employee mentioned on
page 148. It looks like employees will have 30-days to opt out of the insurance being offered by their employers…

So what happens to those employers who cannot afford to provide insurance? We start to get the answer on pages 149 and 150, where we see that an employer of a "large" company will have to pay an 8% "contribution" if they are not providing acceptable insurance to all of their full-time employees. Companies with payrolls under $250,000 will not have to pay the "contribution, and it slides up to 2% for up to $300,000 in payrolls, to 4% for up to $350,000 and 6% for up to $400,000.

Page 162 lets us know how serious the government is about this: "The Secretary may assess a civil penalty against the employer of $100 for each day…beginning on the date such failure first occurs and ending on the date such failure is corrected." Now, to be fair, they do go on on pages 163 and 164 to say that "No penalty shall be assessed…if such failure was due to reasonable cause and not to willful neglect and such failure is corrected during the 30 day period… But they go on to say: "In the case of failures which are due to reasonable cause and not to willful neglect, the penalty assessed…during any failures during any 1-year period shall not exceed the amount equal to the lower of 10% of the aggregate amount paid or incurred by the employer during the preceding taxable year for group health plans or $500,000."

And on page 167 we get to "Tax on Individuals Without Acceptable Health Care Coverage" In the case of any individual who does not meet the requirements…during the taxable year, there is hereby imposed a tax equal to 2.5% of the excess of the the taxpayer's modified adjusted gross income for the taxable year, over the amount of gross income specified in section…"

On Pages 171 - 173 we get the Government's definition of "Acceptable Coverage": "(A) Qualified Health Benefits Plan Coverage… (B) Grandfathered Health Insurance Coverage; Coverage Under Grandfathered Employment-Based Health Plan… (C) Medicare…; (D) Medicaid…; (E) Members of the Armed Forces and Dependents (including Tricare); (F) VA… (G) Other coverage – Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner…"

We start seeing more about how they plan to pay for this starting on page 197, "Surcharge on High Income Individuals: 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% of so much of the modified adjusted gross income of the taxpayer as exceeds 350,000 but does not exceed $500,000, 1.5% of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and 5.4% of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000." (Remember, this is on top of all the other taxes these folks are already paying!)

On page 215 the section on Medicare and Medicaid Improvements begins. This is an oft-touted section for "saving money" in this overall bill, but if it's so easy to safe money in Medicare and Medicaid, without disrupting the benefits, why are they waiting until this 1000 page bill passes to do it? Details that interested me didn't start until pages 228 and 229 when they start discussing Payments to Skilled Nursing Facilities. There is talk of "Change in Payment for non-therapy ancillary (NTA) Services and Therapy Services." Congress has decided that it its necessary to "increase payment by 10% for non-therapy ancillary services" and to "decrease
payment for the therapy case mix component of such rates by 5.5%." I looked up what non-therapy ancillary services include – drugs, medical supplies, oxygen, and those types of things…As a non-medical person, I read these types of things and wonder how we can just arbitrarily make these types of decisions…Are non-therapy services being underpaid? If so, who decided a mere 10% would correct that? Are we paying too much for the therapy portions? Somehow I doubt it! Aren't these the types of legislative decisions that will result in the closings of more Skilled Nursing Facilities?


More commentary to come…

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