House Health Care Reform Issues (HR 3200) #1

By: Kip Horstmann, 

Public Policy Analyst for AHCSM

LEGEND:

RED=True statement

GREEN=Possibly or Partially true statement

BLUE=Not true

 

• Page 16: Plan to “allow” you to keep current coverage—only allows you to keep coverage as long as the insurer does not add any new individuals, or make any changes to the plan.  If that happens the current plan is invalid, and you must go to a new “qualified plan”.  AFTER Y5(5 YEARS) ALL HEALTH PLANS MUST MEET THE BASIC GOVERNMENT STANDARDS TO BE QUALIFIED!!!! 

• Page 22: Directs the HHS Secretary, Labor Secretary, and the Commissioner to ensure that the law does NOT provide any incentives for small and mid-size employers to self-insure.  There is no mandatory audit of all businesses that self-insure, but there is direction to conduct a study of businesses that self-insure.

• Page 29: Admission: your health care will be rationed! This section does not ration health care.  It sets an annual limit on the cost-sharing required by individuals ($5000) and families ($10,000).

• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)  This is a true statement.  The Health Benefits Advisory Committee will be composed of:

                                -Surgeon General

                                -9 non-Federal  Government members appointed by the POTUS.

                                -9 non-Federal Government members  appointed by the Comptroller General of the US

                                -up to 8 Federal Employees appointed by the POTUS

 

This committee shall be composed of providers, consumers, employers, labor, health insurance experts, health care financing experts, racial and ethnic disparity experts, care for disabled experts, representatives of relevant government agencies, and at least one practicing doctor or health care professional, and an expert on children health.  They will make recommendations to the HHS Secretary as to what medical benefits should be covered under the basic, enhanced, and premium plans.  The HHS Secretary either recommends adoption of the proposal, or notifies the Committee to review plan.  It is unclear as to who ultimately adopts the proposals (Congress?).

Not sure what is meant by appeals process, there is a public input period like most other government proposals.  This is really no different than allowing the insurance company to dictate the coverage, except there you really don’t have any input or appeal.

• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.   I’m not sure where this one came from.  This section does not say anything about health benefits.  The commissioner is responsible for determining what plans are considered Qualified Health Benefits Plans by establishing/enforcing standards as outlined in this Act.

• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.  This could be a true statement because of the vagueness of the language.  It only says that medical care shall be “provided without regard to personal characteristics extraneous to the provision of high quality health care or related services”.  Not quite sure what that statement means.

• Page 58: Every person will be issued a National ID Healthcard. This is a true statement.  In regards to using electronic means to make real-time, or near real-time determinations of a person’s financial responsibility and eligibility at the point of service, it may be necessary to utilize a “machine-readable health plan beneficiary identification card”.  There are 2 troubling aspects here:  the ID card, and the determination of a “person’s eligibility for a specific service with a specific physician, at a specific facility”.  That sounds kind of like rationing.

• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.   This is potentially a true statement.  They want to “enable electronic fund transfers, in order to allow automated reconciliation with the related health care payment and remittance advice”. 

• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (example: SEIU, UAW and ACORN) This statement is partially true.  A temporary reinsurance program will be established for employment-based health plans for retirees.  The retiree must be 55+, not eligible for Medicaid/Medicare, and not an active employee.  This could include unions, ACORN, etc., but it could be other businesses also.  The troubling part is that there is not established time limitation on how long the subsidies will continue.

• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.   This is a true statement, although PAGES 84 & 89 are really where it talks of Qualified Health Benefits Plans (QHBP).

• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)   This is a true statement because on PAGE 17 it specifies that any non-Exchange plans in effect prior to Y1 have 5 years to meet the same requirements as QHBPs.  Additionally, PAGE 84 specifies that the Commissioner cannot contract with any plan that doesn’t meet the QHBP requirements.

• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens This is a true statement, and one can read in “illegal aliens”, but there are plenty of legal aliens who don’t speak English, and aren’t forced to because of the accommodation of the states.

• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan. I don’t see anything about paying organizations to sign up people for health care in this section.  PAGE 100 does say that the commissioner can use appropriate entities to disseminate information, but doesn’t speak of paying them.

• Page 97: Non-Medicaid eligible individuals will be automatically signed up for an Exchange plan. This is a true statement.  The commissioner is to provide a process whereby individuals eligible for an Exchange plan are automatically enrolled.  These people are:  Affordablity credit eligible people, and people that are in terminated plans.

• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. This is a true statement.  Anyone who is a non-Traditional Medicaid eligible individual, and has not chosen to enroll in an Exchange plan will be automatically enrolled in Medicaid.

• Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.  This is potentially true.  The statement reads “There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224”.  I’m not sure how you can make a law or other government regulation that is NOT subject to judicial review.???

• Page 127: The AMA sold doctors out: the government will set wages. This is partially true.  This section is speaking about physicians participating in the public health insurance option, therefore they must accept payment arrangements similar to Medicaid/Medicare.  This is NOT speaking about any private health insurance plans, the government is not setting price fees for everyone (yet).

• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives. This is not a true statement.  This section (actually PAGE 147) says that an employer must automatically enroll employees in the employment-based health benefits plan (company plan) for individual coverage at the lowest premium, UNLESS they opt-out.  This may be done after 30 days.

• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families. This is a true statement.  Employers will be expected to contribute some percentage of coverage for part-time employees based on hours worked, etc.  That’s the whole point of Universal Coverage.

• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll.  This is partially true.  You must go back up to PAGE 143 and start there.  It says that an employer must offer each employee coverage under a QHBP of some sort.  This is the employer mandate.  If the employee accepts this coverage, the employer pays the health insurance company like we do today.  AFTER Y2, If the employer does NOT offer a company plan, or IF the employee DECLINES coverage under the company plan, and goes to the Health Insurance Exchange to get their own insurance, the company must make a contribution to the Health Insurance Exchange.  This is where the 8% of wages paid by the employer during that period comes into play.  It does NOT mention anything about a public plan, unless there happens to be one offered at the Health Insurance Exchange.

•Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll.  This is partially true.  Just as above, the “tax” is on companies who either don’t offer a plan, or have employees that go and get their own insurance.   It has nothing to do with a public option, unless that is included in the Health Insurance Exchange.

• Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income. This is partially true.  Any individual that does not have acceptable insurance coverage, whether it be government, company, or private, will face a 2.5% tax on the EXCESS of their modified adjusted gross income.  This tax will NOT exceed the national average premium for a self-only (or family coverage) basic plan offered by the Health Insurance Exchange, as determined by the HHS.

• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them). This is a true statement.  Non-Resident aliens will NOT be taxed for failing to have health insurance.

• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.  This is partially true.  Tax return information may be provided to the Health Choices Adminstration or State-based Health Insurance Exchange in order to determine “Affordability Credits”.  The information is limited to:  Taxpayer ID, Filing status, Modified AGI, # of dependents, and other information as prescribed by the HHS Secretary that might indicate Affordability Credit eligibility, and the tax year of the return.  This information may ONLY be used to determine the eligibility for the Affordability Credit, or provide for repayment of any credit that was in excess of the appropriate amount (ie.-penalty).

• Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.  This is a true statement, but it deals with surcharges on high income individuals, those whose AGI is over $350,000.  It says that this tax shall not be used in the determination of certain credits.

• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."   This is not really a true statement.  This section is dealing with Medicaid rate reform, NOT reducing physician services.  It appears to be pertaining to which fee schedule to use depending on the service provided.

• Page 241: Doctors: no matter what speciality you have, you'll all be paid the same (thanks, AMA!) This is not really a true statement.  What it says is that payment will be based on the service provided, NOT on the title of the DR performing the service.  For example, if a Family Practice Dr delivered a baby, he would get the same payment as an OB Dr who delivered the same baby.  This should not affect many Drs.  If you are a heart specialist you are going to be doing procedures that are different from General Practice Dr’s so it is doubtful that there is going to be a pay issue.

• Page 253: Government sets value of doctors' time, their professional judgment, etc.  This is a true statement, at least in regards to any government run health plans.  The HHS will decide how much a particular service is worth based on skill required, risk, etc.  Does NOT affect private plans.

• Page 265: Government mandates and controls productivity for private healthcare industries.  This is a true statement.  HOWEVER, THEY ALREADY DO THIS AS PART OF THE SOCIAL SECURITY ACT (42 USC).  This is not something new.

• Page 268: Government regulates rental and purchase of power-driven wheelchairs. This is a true statement.  HOWEVER, IT IS ONLY CHANGING THE DESCRIPTIVE TITLE OF AN ELECTRIC WHEEL CHAIR.  This is not something new.

• Page 272: Cancer patients: welcome to the wonderful world of rationing! This is not really a true statement.  This section says that if the costs at Cancer Hospitals are more than other hospitals, the HHS Secretary may authorize an adjustment in the payments.  In other words, cancer hospitals may receive a higher payment

 

• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions. I will admit that I don’t understand this one totally.  The only thing I can make from the language is that perhaps hospitals were discharging Medicare patients in order to get payment, and then readmitting those patients again a short time later and starting the billing over again.  This provision will set a certain time limit, which if a patient is readmitted to any hospital for a reason associated with the previous admission, the payment will be reduced, making such a practice less than lucrative.?????

• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government. Same as above.

• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies! This is only partially true.  There is a prohibition in Medicare against doctors “self-referring” patients to hospitals or clinics which they own.  It is a good provision to prevent fraud.  There are exemptions, however, for rural areas, and even for doctors who are part owners of hospitals, as long as it doesn’t exceed a specific percentage.  This does NOT pertain to Dr’s who are practicing outside the Medicaid system.

• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval. This is partially true.  It pertains to hospitals that are receiving HHS money for operations.  It does NOT pertain to private hospitals.

• Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN. This is a fairly specious statement.  It has nothing to do with ACORN, or even anything to do with payments.  If there is a hospital say in a rural area that is funded by Medicaid, and they want to increase the size of the hospital they need to apply to the HHS for approval.  Approval will be granted under certain circumstances (population growth, etc.).  This allows the citizens of the community to respond favorably or negatively to the proposal to expand.

• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing. This is partially true.  This applies to Medicare Advantage plans only.  HHS will develop a list of quality performance measures for the Medicare Advantage plans.  Beginning in 2014, the scores of the plans on these measures will be used in relation to payments made to providers.  This has NOTHING to do with private plans.

• Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc. This is a partially true statement.  It ONLY applies to Medicare Advantage plans, NOT HMOs or private plans.  HHS can disqualify a plan if there are deficiencies (makes sense—if you play with the government you must abide by their rules).

• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals. This is NOT a true statement.  This section is authorizes the extension of a section of the Social Security Act which is already in place.  THEY ALREADY HAVE RESTRICTIONS ON WHO QUALIFIES AS A SPECIAL NEEDS CASE!

• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone). This is a true statement.  They are adding an advisory committee to an ALREADY EXISTING provision (Telehealth) in the SSA.