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  • Some Substantive Review of the Obamacare Bill

    Posted by Lexington Green on August 13th, 2009 (All posts by )

    We get told that opposition to the Bill is “hysterical”. Yet I get emails like what I have put below the fold all the time. People who are going to have to live with this thing are reading it, understanding it, and very sensibly, getting alarmed by it. That is not hysteria, it is rationality.

    This thing is a pig in a poke. Obama and Pelosi and Reid are trying to rush it through before anyone can figure out how bad it is.

    The longer people have to read and understand this thing, the more they are going to oppose it.

    Take a look and decide if you like what you see.

    [To be absolutely clear, the analysis below the fold was not prepared by me. I received it as an email. It was prepared by a gentleman named John David Lewis.]

    UPDATE: And of course Gov. Palin is correct about the Death Panels.

    UPDATE 2: Is President Obama telling lies about surgical care in America because he (1) knows the facts but is dishonest, (2) does not know the facts because he ignorant and inept, (3) is desperate and hysterical about the disintegration of political support for his Plan? (Hat tip The Corner.)

    The Health Care Bill: What HR 3200, ‘‘America’s Affordable Health Choices Act of 2009,” Says
    John David Lewis
    August 6, 2009

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

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

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

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

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

    1. 1. WILL THE PLAN RATION MEDICAL CARE?

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

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

    and, under “Definitions”:

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

    and:

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

    and:

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

    EVALUATION OF THE PASSAGES:
    1. This section amends the Social Security Act
    2. The government has the power to determine what constitutes an “applicable [medical] condition.”
    3. The government has the power to determine who is allowed readmission into a hospital.
    4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.
    5. This is government rationing, pure, simple, and straight up.
    6. There can be no judicial review of decisions made here. The Secretary is above the courts.
    7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.

    2. WILL THE PLAN PUNISH AMERICANS WHO TRY TO OPT OUT?

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

    ‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
    (1) the taxpayer’s modified adjusted gross income for the taxable year, over
    (2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .”

    EVALUATION OF THE PASSAGE:

    1. This section amends the Internal Revenue Code.
    2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.
    3. The IRS will be a major enforcement mechanism for the plan.

    3. WHAT CONSTITUTES “ACCEPTABLE” COVERAGE?

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

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

    (b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:
    (1) Hospitalization.
    (2) Outpatient hospital and outpatient clinic services . . .
    (3) Professional services of physicians and other health professionals.
    (4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .
    (5) Prescription drugs.
    (6) Rehabilitative and habilitative services.
    (7) Mental health and substance use disorder services.
    (8) Preventive services . . .
    (9) Maternity care.
    (10) Well baby and well child care . . .

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

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

    EVALUATION OF THE PASSAGES:

    1. The bill defines “acceptable coverage” and leaves no room for choice in this regard.
    2. By setting a minimum 70% actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.

    4. WILL THE PLAN DESTROY PRIVATE HEALTH INSURANCE?

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

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

    (1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and
    (2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.

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

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

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

    EVALUATION OF THE PASSAGES:

    1. The bill does not prohibit a person from buying private insurance.
    2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”
    3. The pressure for business owners to terminate the private plans will be enormous.
    4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.
    5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.
    6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.

    5. DOES THE PLAN TAX SUCCESSFUL AMERICANS MORE THAN OTHERS?

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

    ‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
    ‘‘(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—
    ‘‘(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,
    ‘‘(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
    ‘‘(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

    EVALUATION OF THE PASSAGE:

    1. This bill amends the Internal Revenue Code.
    2. Tax surcharges are levied on those with the highest incomes.
    3. The plan manipulates the tax code to redistribute their wealth.
    4. Successful business owners will bear the highest cost of this plan.

    6. 6. DOES THE PLAN ALLOW THE GOVERNMENT TO SET FEES FOR SERVICES?

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

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

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

    EVALUATION OF THE PASSAGES:

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

    7. WILL THE PLAN INCREASE THE POWER OF GOVERNMENT OFFICIALS TO SCRUTINIZE OUR PRIVATE AFFAIRS?

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

    ‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—
    ‘‘(i) taxpayer identity information with respect to such taxpayer,
    ‘‘(ii) the filing status of such taxpayer,
    ‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),
    ‘‘(iv) the number of dependents of the taxpayer,
    ‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
    ‘‘(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.

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

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

    EVALUATION OF THE PASSAGE:

    1. This section amends the Internal Revenue Code
    2. The bill opens up income tax return information to federal officials.
    3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.
    4. Employers are required to report whatever information the government says it needs to enforce the plan.

    8. 8. DOES THE PLAN AUTOMATICALLY ENROLL AMERICANS IN THE GOVERNMENT PLAN?

    What it says, page 102, Section 205, OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN:

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

    And, page 145, section 312:

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

    EVALUATION OF THE PASSAGES:

    1. Do nothing and you are in.
    2. Employers are responsible for automatically enrolling people who still work.

    9. 9. DOES THE PLAN EXEMPT FEDERAL OFFICIALS FROM COURT REVIEW?

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

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

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

    ‘‘(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—
    ‘‘(i) the identification of a county or other area under subparagraph (A); or
    ‘‘(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).

    EVALUATION OF THE PASSAGES:

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

     

    11 Responses to “Some Substantive Review of the Obamacare Bill”

    1. tdaxp Says:

      I guess that first line is directed at me. ;-)

      There is hysterical opposition to the bill.

      There is also thoughtful, well reasoned opposition to the bill.

      This is clearly the latter! :)

      PS: Considering the never-ending struggle fro control of the agenda between the W.H. and Congress, Obama may soon become more wedded to passage than Pelosi. For the Speaker, getting the Left wing’s dream through the House may become a better goal, because this would be defeated in the Senate, make Obama look weak, and indicate that she is the appropriate power-broker.

    2. Lexington Green Says:

      No, Dan. I was not thinking of you on this one. If you had made that statement, I forgot about it. But I agree that this is reasoned opposition. I am not opposed to angry opposition, since this is an incredibly abusive power-grab and it should be strongly opposed. So, if that looks like hysteria to some people, possibly you, I suppose, then so be it.

      As to the Kremlinology of Obama v. Pelosi and kto kogo among the bad guys, I have no opinion.

      The whole thing comes down to the so-called Blue Dogs. It cannot pass without them. So the question must be “what can make the Blue Dogs vote for Obamacare”? If the answer is “nothing” then it cannot pass. If the answer is some revised version of the Bill, then something will be passed. That is where the action is going to be.

    3. Marty Says:

      The Blue Dogs and RINOs have to understand that this time, people are paying attention, and this time memories will be long and people will neither forget nor forgive.

      Given the last 100 years, they may not believe this, as it would be the first time they couldn’t do what they damn well please and then soft-soap the electorate and get away with it.

      I’m not sure I believe it, for that matter. The proposal is monstrous, but enough of the public either supports it or can be anesthetized afterward, that it is not at all clear how dangerous it would be to vote for it, when contrasted to the threats and bribes that will be used to line up votes in favor.

      I am a bit more hopeful than I was 2 weeks ago, but not really optimistic.

    4. Jonathan Says:

      When proponents of this monstrous legislation complain that some opponents are rude in public forums, the proponents either don’t understand what is going on or are being disingenuous. These public events are being described as open discussions when many of them are not. They are, as Tom Smith put it, more like infomercials. Citizens sense that their Congressional representatives are ignoring their views, and are showing up at “town hall meetings” in a last-ditch effort to get those views across. When these citizens find that the meetings are not being run as real exchanges of opinion, but instead are rigged to push Obamacare and suppress questions and criticism, they have a choice of going along with the script or of doing what they have to do to make themselves heard. In other words, they are not the problem. The problem is that Obama and the Congressional Democrats are trying to force this legislation through while maintaining a pretense of debate. Citizens have no obligation to go along with this sham.

    5. Lexington Green Says:

      “Citizens have no obligation to go along with this sham.”

      The people who founded the country expressly allowed free speech and peaceful assembly because they had personally had to resort to unruly demonstrations when their speech and peaceful assembly had been suppressed. The people can and will raise Hell when their government is unresponsive. You would think that Lefties would understand this. You would think that Obama, a former community organizer in the school of Saul Alinsky, would understand it. (Of course they do understand it. They just want to use their power and control of the media to intimidate the opposition into silence.) I would love to see what Alinsky would have done to one of these bogus meetings if he correctly concluded that it was a giant scam. In any case, those tactics are available whatever your view on this issue. Take a look at anything written by Shel Trapp, for example. One great thing about the hardcore community organizers is that they have zero respect for formality, protocol, or any notion that some politician or bureaucrat should be shown any deference. Shel Trapp talks about walking into a meeting with some bureaucrats and immediately sitting at the head of the table, and taking over. THEY have come to your meeting, and are there to listen and respond. Also, you go to these pre-packaged dog and pony shows with a big sign with a Yes or No question on it, and demand that the politician or business guy or whoever answer it yes or no. This is an art form. I have long hoped that conservatives and libertarians would learn it. Maybe that is happening.

    6. Martin Luther Says:

      Interesting that the Democrats have been able to awaken the Jacksonians with a domestic issue. `And one which is likely to have long term impact on their interest group coalition. They are directly threatening one of their core constituencies, the elderly. And somehow this time it’s not just Hillary’s Folly. They’ve put too many chips on the table and called their opponents too many names for this to be soon forgotten.

    7. david foster Says:

      Harry Reid: “The public option is something that the vast majority of Americans want. They know that the enemy is the insurance industry”

      The enemy is the insurance industry.

      The Democratic leadership is very reluctant to use the word “enemy” in referring to terrorists sworn to our destruction. But they are very eager to use this word when talking about other Americans.

    8. Bill Waddell Says:

      Redardless of any merits there may be to the government executed health care insurance portion, no one’s health is better served by turning their health and that of their families over to the people who cannot even handle something as simple as Cash For Clunkers.

      This from http://www.foxnews.com/politics/2009/08/13/auto-dealers-await-reimbursement-uncle-sam-despite-refueled-clunkers/

      “David Wilson, a Toyota dealer in Orange County, Calif., told Automotive News that he has been paid for only three of 92 claims he submitted before Aug. 2, leaving him on the hook for about $374,000. In total, he has 450 unpaid claims filed for $1.9 million.”

      “Several dealers told Automotive News that their applications were rejected because of procedural issues that they couldn’t clear because they were unable to reach Transportation Department employees by phone or e-mail.”

      No one in their right minds wants their cancer treatment in the hands of the same bumbling fools.

      Health Care, like Cash For Clunkers and the $800 billion stimulus still less than 15% paid out after almost 6 months, is long on liberal good intentions and devoid of any hope of effective execution. The libs just can’t seem to understand that the average guy is not in favor of government run anything, because the government has demonstrated that it is incapable of running anything … even if all of the fairness issues were to be resolved.

    9. onparkstreet Says:

      You know, I was thinking a bit about the accusations that there is a lot of misinformation floating around about the proposed health care bill, and while I think that is true, whose fault is that, really?

      If you try and push a large and unwieldy bill, so soon after the stimulus bill, that affects a huge chunk of our economy, why wouldn’t there be misconceptions? How can any ordinary person absorb all that needs to be absorbed in such a short time, how can the President adequately explain the bill (I don’t think he really understands health care very well, whoever is preparing him is doing a woeful job), how can even well meaning elected officials read such a thing and understand it adequately? It really is unfair to set up such a circumstance and then complain there is misinformation and people don’t understand. You never made the proper effort FOR them to understand. Because, of course, it would make things worse because understanding will make no one feel better, imo….

      Personally, I’ve never seen physicians as energized by a bill as this one. I’ve never heard of so many physicians writing letters or writing to elected officials. It is unprecedented in my personal experience. I have a sinking feeling, however, that it may do no good.

    10. plumpplumber(balding) Says:

      Well, here goes….We the People have the right to protest and act up and generally raise hell with our “employees”. You see, Obama has practiced panic as a form of pressure. We now know that the man is actually, literally, a bald faced liar. His plan was to ram this thru without any scrutiny. I believe that any Senator or Represtative that votes on ANY bill without reading it and being able to discuss it with their public is guilty of treason. Straight up. So, I was once a republican, but now I’m a Tea Partier.

      Our country is broke, and we know it. Obama has no intention of paying the insane debt he is running up. He is a red diaper marxist, and is dedicated to our economic ruin. He’s been raised to view capitalism as his “class enemy”, and as any astute student of tactics, he’s identified the best way to destroy us. He’s gonna load us up with so much debt that we’re gonna default. Once that happens, well, folks, we’re in for it. The Chinese won’t protest too much, as this will be a cheaper way to destroy us than fighting us. That’s what he’s after, and make no mistake. He hates us, and has been raised to destroy us. Anyone with any sense could have seen this coming, when you took a good look at the folks in his past. The MSM is a leftist fifth column that didn’t vet him.

      As has been pointed out, elections have consequences, don’t they? We can’t let all of this happen. Our Country needs people to rise up and protest! And so we are…..By the way, did ya know that Grandma is an evil, wicked nazi for protesting? I seriously expect folks to quit paying their taxes. I’m curiously optomistic, in this dark hour, because we can stop these leftist-marxists from taking over.

      As more of the nasty details come to light about what the democrats are up to, the more folks howl! I don’t think that most folks actually appreciate just how rough democracy has been in the past. Bare knuckled, I’d say…..Marxism can’t stand in the light of a free people. However, if we don’t fight them off, then we’re lost.

    11. Lexington Green Says:

      “… make no mistake. He hates us, and has been raised to destroy us.”

      PP(b)– Malice is one possibility. Stupidity, pride, ignorance, arrogance, groupthink, etc. are more likely explanations.

      I know of one person who thinks BHO is the biblically prophesied AntiChrist.

      I think the Devil has better taste.

      It doesn’t really matter if he means us ill, or is just doing us ill without meaning to. The merits are the merits, and he can and should be opposed on that basis.