There's so much discussion about the contents of the proposed "health care" bill that I decided to try to work my way through it. Yes, it's over 1,000 pages. Yes, it's complicated and would take months to figure it out. Yes, I see a lot of constitutional issues, including privacy rights, property rights, separation of powers issues, and 10th Amendment rights reserving power to the states and to the people. This chart is probably pretty close to accurate. (Left click on chart to enlarge it).
It appears to me that many of the complaints about the proposed legislation are well-founded, and that this is definitely a move for national health care and elimination of individual policies and protections. No, I would not support this legislation at all. There's too much in the text of the bill to address it all. Below are some excerpts of the actual text, which I have high-lighted in red. It would be best to read the actual text of the bill yourself. Here's the link to the actual text of the proposed house bill: http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf and here's the link to the analysis done by Duke Professor John David Lewis in plain english, which does a better job than me, but which does confirm the suspicions I found on my own by reading the bill: http://www.classicalideals.com/HR3200.htm
Selected excerpts I found pertinent--
QUALIFIED HEALTH BENEFITS PLAN
3 A QHBP offering entity is required to comply with
4 standards for electronic financial and administrative
5 transactions under section 1173A of the Social Security
6 Act, added by section 163(a).
3 A QHBP offering entity is required to comply with
4 standards for electronic financial and administrative
5 transactions under section 1173A of the Social Security
6 Act, added by section 163(a).
* * *
1 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.
3 (a) GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED
4 —Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov
6 erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef
15 fective date of coverage is on or after the first
16 day of Y1.
1 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.
3 (a) GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED
4 —Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov
6 erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef
15 fective date of coverage is on or after the first
16 day of Y1.
8 (b) GRACE PERIOD FOR CURRENT EMPLOYMENT
9 BASED HEALTH PLANS.—
10 (1) GRACE PERIOD.—
11 (A) IN GENERAL.—The Commissioner
12 shall establish a grace period whereby, for plan
13 years beginning after the end of the 5-year pe
14 riod beginning with Y1, an employment-based
15 health plan in operation as of the day before
16 the first day of Y1 must meet the same require
17 ments as apply to a qualified health benefits
18 plan under section 101
* * *
1 (1) IN GENERAL.—Individual health insurance
2 coverage that is not grandfathered health insurance
3 coverage under subsection (a) may only be offered
4 on or after the first day of Y1 as an Exchange-par
5 ticipating health benefits plan.
* * *
1 (1) IN GENERAL.—Individual health insurance
2 coverage that is not grandfathered health insurance
3 coverage under subsection (a) may only be offered
4 on or after the first day of Y1 as an Exchange-par
5 ticipating health benefits plan.
* * *
(c) TRANSFERS TO TRUST FUND.—
23 (1) DEDICATED PAYMENTS.—There is hereby
24 appropriated to the Trust Fund amounts equivalent
25 to the following:
1 (A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE
2—The amounts re
3 ceived in the Treasury under section 59B of the
4 Internal Revenue Code of 1986 (relating to re
5quirement of health insurance coverage for indi
6viduals).
7 (B) EMPLOYMENT TAXES ON EMPLOYERS
8 NOT PROVIDING ACCEPTABLE COVERAGE.—The
9 amounts received in the Treasury under section
10 3111(c) of the Internal Revenue Code of 1986
11 (relating to employers electing to not provide
12 health benefits).
13 (C) EXCISE TAX ON FAILURES TO MEET
14 CERTAIN HEALTH COVERAGE REQUIRE MENTS
15—The amounts received in the Treasury
16 under section 4980H(b) (relating to excise tax
17 with respect to failure to meet health coverage
18 participation requirements).
* * *
23 (1) DEDICATED PAYMENTS.—There is hereby
24 appropriated to the Trust Fund amounts equivalent
25 to the following:
1 (A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE
2—The amounts re
3 ceived in the Treasury under section 59B of the
4 Internal Revenue Code of 1986 (relating to re
5quirement of health insurance coverage for indi
6viduals).
7 (B) EMPLOYMENT TAXES ON EMPLOYERS
8 NOT PROVIDING ACCEPTABLE COVERAGE.—The
9 amounts received in the Treasury under section
10 3111(c) of the Internal Revenue Code of 1986
11 (relating to employers electing to not provide
12 health benefits).
13 (C) EXCISE TAX ON FAILURES TO MEET
14 CERTAIN HEALTH COVERAGE REQUIRE MENTS
15—The amounts received in the Treasury
16 under section 4980H(b) (relating to excise tax
17 with respect to failure to meet health coverage
18 participation requirements).
* * *
14 ‘‘(6) NOT TREATED AS TAX IMPOSED BY THIS
15 CHAPTER FOR CERTAIN PURPOSES.—The tax im
16 posed under this section shall not be treated as tax
17 imposed by this chapter for purposes of determining
18 the amount of any credit under this chapter or for
19 purposes of section 55.
* * *
15 CHAPTER FOR CERTAIN PURPOSES.—The tax im
16 posed under this section shall not be treated as tax
17 imposed by this chapter for purposes of determining
18 the amount of any credit under this chapter or for
19 purposes of section 55.
* * *
15 ‘‘(f) ENFORCEMENT OF HEALTH COVERAGE PAR
16 TICIPATION REQUIREMENTS.—
17 ‘‘(1) CIVIL PENALTIES.—In the case of any em
18 ployer who fails (during any period with respect to
19 which the election under subsection (a) is in effect)
20 to satisfy the health coverage participation require
21 ments with respect to any employee, the Secretary
22 may assess a civil penalty against the employer of
23 $100 for each day in the period beginning on the
24 date such failure first occurs and ending on the date
25 such failure is corrected.
* * *
16 TICIPATION REQUIREMENTS.—
17 ‘‘(1) CIVIL PENALTIES.—In the case of any em
18 ployer who fails (during any period with respect to
19 which the election under subsection (a) is in effect)
20 to satisfy the health coverage participation require
21 ments with respect to any employee, the Secretary
22 may assess a civil penalty against the employer of
23 $100 for each day in the period beginning on the
24 date such failure first occurs and ending on the date
25 such failure is corrected.
* * *
‘‘(C) OVERALL LIMITATION FOR UNINTEN
23 TIONAL FAILURES.—In the case of failures
24 which are due to reasonable cause and not to
25 willful neglect, the penalty assessed under para-
23 TIONAL FAILURES.—In the case of failures
24 which are due to reasonable cause and not to
25 willful neglect, the penalty assessed under para-
1 graph (1) for failures during any 1-year period
2 shall not exceed the amount equal to the lesser
3 of—
4 ‘‘(i) 10 percent of the aggregate
5 amount paid or incurred by the employer
6 (or predecessor employer) during the pre
7ceding taxable year for group health plans,
8 or
9 ‘‘(ii) $500,000.
* * *
2 shall not exceed the amount equal to the lesser
3 of—
4 ‘‘(i) 10 percent of the aggregate
5 amount paid or incurred by the employer
6 (or predecessor employer) during the pre
7ceding taxable year for group health plans,
8 or
9 ‘‘(ii) $500,000.
* * *
18 ‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE
19 HEALTH CARE COVERAGE.
20 ‘‘(a) TAX IMPOSED.—In the case of any individual
21 who does not meet the requirements of subsection (d) at
22 any time during the taxable year, there is hereby imposed
23 a tax equal to 2.5 percent of the excess of—
19 HEALTH CARE COVERAGE.
20 ‘‘(a) TAX IMPOSED.—In the case of any individual
21 who does not meet the requirements of subsection (d) at
22 any time during the taxable year, there is hereby imposed
23 a tax equal to 2.5 percent of the excess of—
1 ‘‘(1) the taxpayer’s modified adjusted gross in
2 come for the taxable year, over
3 ‘‘(2) the amount of gross income specified in
4 section 6012(a)(1) with respect to the taxpayer.
‘‘(2) NONRESIDENT ALIENS.—Subsection (a)
2 shall not apply to any individual who is a non
3 resident alien.
* * *
2 come for the taxable year, over
3 ‘‘(2) the amount of gross income specified in
4 section 6012(a)(1) with respect to the taxpayer.
‘‘(2) NONRESIDENT ALIENS.—Subsection (a)
2 shall not apply to any individual who is a non
3 resident alien.
* * *
16 ‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
17 ‘‘(a) GENERAL RULE.—In the case of a taxpayer
18 other than a corporation, there is hereby imposed (in addi
19 tion to any other tax imposed by this subtitle) a tax equal
20 to—
21 ‘‘(1) 1 percent of so much of the modified ad
22 justed gross income of the taxpayer as exceeds
23 $350,000 but does not exceed $500,000,
17 ‘‘(a) GENERAL RULE.—In the case of a taxpayer
18 other than a corporation, there is hereby imposed (in addi
19 tion to any other tax imposed by this subtitle) a tax equal
20 to—
21 ‘‘(1) 1 percent of so much of the modified ad
22 justed gross income of the taxpayer as exceeds
23 $350,000 but does not exceed $500,000,
1 ‘‘(2) 1.5 percent of so much of the modified ad
2 justed gross income of the taxpayer as exceeds
3 $500,000 but does not exceed $1,000,000, and
4 ‘‘(3) 5.4 percent of so much of the modified ad
5 justed gross income of the taxpayer as exceeds
6 $1,000,000.
* * *
2 justed gross income of the taxpayer as exceeds
3 $500,000 but does not exceed $1,000,000, and
4 ‘‘(3) 5.4 percent of so much of the modified ad
5 justed gross income of the taxpayer as exceeds
6 $1,000,000.
* * *
‘‘(A) REPORTING.—Any person who is re
2 quired, but fails, to meet a reporting require
3 ment of paragraphs (1) and (2)(A) of sub
4 section (f) is subject to a civil money penalty of
5 not more than $10,000 for each day for which
6 reporting is required to have been made.
7 ‘‘(B) DISCLOSURE.—Any physician who is
8 required, but fails, to meet a disclosure require
9 ment of subsection (f)(2)(B) or a hospital that
10 is required, but fails, to meet a disclosure re
11 quirement of subsection (f)(2)(C) is subject to
12 a civil money penalty of not more than $10,000
13 for each case in which disclosure is required to
14 have been made.
* * *
2 quired, but fails, to meet a reporting require
3 ment of paragraphs (1) and (2)(A) of sub
4 section (f) is subject to a civil money penalty of
5 not more than $10,000 for each day for which
6 reporting is required to have been made.
7 ‘‘(B) DISCLOSURE.—Any physician who is
8 required, but fails, to meet a disclosure require
9 ment of subsection (f)(2)(B) or a hospital that
10 is required, but fails, to meet a disclosure re
11 quirement of subsection (f)(2)(C) is subject to
12 a civil money penalty of not more than $10,000
13 for each case in which disclosure is required to
14 have been made.
* * *
22 (9) LANGUAGE SERVICES.—The term ‘‘lan
23 gauge services’’ means provision of health care serv
24 ices directly in a non-English language, interpreta
25 tion, translation, and non-English signage.
* * *
23 gauge services’’ means provision of health care serv
24 ices directly in a non-English language, interpreta
25 tion, translation, and non-English signage.
* * *
the Secretary shall include
12 quality measures on end of life care and ad
13 vanced care planning that have been adopted or
14 endorsed by a consensus-based organization
* * *
12 quality measures on end of life care and ad
13 vanced care planning that have been adopted or
14 endorsed by a consensus-based organization
* * *
1 ‘‘(i) IN GENERAL.—Subject to clause
2 (ii), a qualifying ACO that meet or exceeds
3 annual quality and performance targets for
4 a year shall receive an incentive payment
5 for such year equal to a portion (as deter
6 mined appropriate by the Secretary) of the
7 amount by which payments under this title
8 for such year relative are estimated to be
9 below the performance target for such
10 year, as determined by the Secretary. The
11 Secretary may establish a cap on incentive
12 payments for a year for a qualifying ACO.
* * *
2 (ii), a qualifying ACO that meet or exceeds
3 annual quality and performance targets for
4 a year shall receive an incentive payment
5 for such year equal to a portion (as deter
6 mined appropriate by the Secretary) of the
7 amount by which payments under this title
8 for such year relative are estimated to be
9 below the performance target for such
10 year, as determined by the Secretary. The
11 Secretary may establish a cap on incentive
12 payments for a year for a qualifying ACO.
* * *
3 ‘‘(C) TARGETED HIGH NEED BENEFICIARY
4 DEFINED.—For purposes of this subsection, the
5 term ‘targeted high need beneficiary’ means a
6 high need beneficiary who, based on a risk score
7 as specified by the Secretary,
4 DEFINED.—For purposes of this subsection, the
5 term ‘targeted high need beneficiary’ means a
6 high need beneficiary who, based on a risk score
7 as specified by the Secretary,
* * *
11 ‘‘(4) LIMITATION ON REVIEW.—There shall be
12 no administrative or judicial review under section
13 1869, section 1878, or otherwise, respecting—
12 no administrative or judicial review under section
13 1869, section 1878, or otherwise, respecting—
* * *
‘‘(v) LIMITATION.—In no case shall
12 more than 20 full-time equivalent addi
13 tional residency positions be made available
14 under this subparagraph with respect to
15 any hospital.
16 ‘‘(vi) APPLICATION
* * *
‘‘(v) LIMITATION.—In no case shall
12 more than 20 full-time equivalent addi
13 tional residency positions be made available
14 under this subparagraph with respect to
15 any hospital.
16 ‘‘(vi) APPLICATION
* * *
8 ‘‘(10) The Secretary may disenroll, for a period of
9 not more than one year for each act, a physician or sup
10 plier under section 1866(j) if such physician or supplier
11 fails to maintain and, upon request of the Secretary, pro
12 vide access to documentation relating to written orders or
13 requests for payment for durable medical equipment, cer
14 tifications for home health services, or referrals for other
15 items or services written or ordered by such physician or
16 supplier under this title, as specified by the Secretary.’’
* * *
9 not more than one year for each act, a physician or sup
10 plier under section 1866(j) if such physician or supplier
11 fails to maintain and, upon request of the Secretary, pro
12 vide access to documentation relating to written orders or
13 requests for payment for durable medical equipment, cer
14 tifications for home health services, or referrals for other
15 items or services written or ordered by such physician or
16 supplier under this title, as specified by the Secretary.’’
* * *
For purposes of law
18 enforcement activity, and to the extent consistent with ap
19 plicable disclosure, privacy, and security laws, including
20 the Health Insurance Portability and Accountability Act
21 of 1996 and the Privacy Act of 1974, and subject to any
22 information systems security requirements enacted by law
23 or otherwise required by the Secretary, the Attorney Gen
24 eral shall have access, facilitation by the Inspector General
25 of the Department of Health and Human Services, to
1 claims and payment data relating to titles XVIII and XIX,
2 in consultation with the Centers for Medicare & Medicaid
3 Services or the owner of such data.’’
* * *
18 enforcement activity, and to the extent consistent with ap
19 plicable disclosure, privacy, and security laws, including
20 the Health Insurance Portability and Accountability Act
21 of 1996 and the Privacy Act of 1974, and subject to any
22 information systems security requirements enacted by law
23 or otherwise required by the Secretary, the Attorney Gen
24 eral shall have access, facilitation by the Inspector General
25 of the Department of Health and Human Services, to
1 claims and payment data relating to titles XVIII and XIX,
2 in consultation with the Centers for Medicare & Medicaid
3 Services or the owner of such data.’’
* * *
8 ‘‘(1) MAINTENANCE OF EFFORT.—A State is
9 not eligible for payment under subsection (a) for a
10 calendar quarter beginning after the date of the en
11actment of this subsection if eligibility standards,
12 methodologies, or procedures under its plan under
13 this title (including any waiver under this title or
14 under section 1115 that is permitted to continue ef
15 fect) that are more restrictive than the eligibility
16 standards, methodologies, or procedures, respect
17 tively, under such plan (or waiver) as in effect on
18 June 16, 2009.
* * *
9 not eligible for payment under subsection (a) for a
10 calendar quarter beginning after the date of the en
11actment of this subsection if eligibility standards,
12 methodologies, or procedures under its plan under
13 this title (including any waiver under this title or
14 under section 1115 that is permitted to continue ef
15 fect) that are more restrictive than the eligibility
16 standards, methodologies, or procedures, respect
17 tively, under such plan (or waiver) as in effect on
18 June 16, 2009.
* * *
GENERAL.—A State is not eligible
2 for payment under subsection (a) for a calendar
3 quarter beginning on or after the first day of
4 Y1 (as defined in section 100(c) of the Amer
5 ica’s Affordable Health Choices Act of 2009), if
6 the State applies any asset or resource test in
7 determining (or redetermining) eligibility of any
8 individual on or after such first day
* * *
2 for payment under subsection (a) for a calendar
3 quarter beginning on or after the first day of
4 Y1 (as defined in section 100(c) of the Amer
5 ica’s Affordable Health Choices Act of 2009), if
6 the State applies any asset or resource test in
7 determining (or redetermining) eligibility of any
8 individual on or after such first day
* * *
V9 SEC. 2541. LIMITATION ON FEDERAL FUNDS.
10 A State is eligible for Federal funds under the provi
11 sions of the Public Health Service Act (42 U.S.C. 201 et
12 seq.) only if the State—
13 (1) agrees to be subject in its capacity as an
14 employer to each obligation under division A of this
15 Act and the amendments made by such division ap
16 plicable to persons in their capacity as an employer;
17 and
18 (2) assures that all political subdivisions in the
19 State will do the same.
10 A State is eligible for Federal funds under the provi
11 sions of the Public Health Service Act (42 U.S.C. 201 et
12 seq.) only if the State—
13 (1) agrees to be subject in its capacity as an
14 employer to each obligation under division A of this
15 Act and the amendments made by such division ap
16 plicable to persons in their capacity as an employer;
17 and
18 (2) assures that all political subdivisions in the
19 State will do the same.
I just kinda scanned this article, and I'll read it in detail when I get home.
ReplyDeleteIt's nice to hear from a conservative who may have actually read the thing.
Now I can see why nobody reads it. Can you "digest" it for the simpleminded individuals like myself? And how is that for a question... I'm sure the pushers of this bill are doing just that for the decision-makers, but not necessarily being straightforward. The end justfies the means.
ReplyDelete