House Bill 3200.. Broken Down

Posted by courage On October - 13 - 2009

Yes I admit it, I have read the entire  1,000 page plus of House Bill 3200.  What made me decide to embark on this tedious and mind-numbing adventure?  Perhaps it was the challenge or perhaps it was because far to many elected officials have neglected their duty as representatives.  I’m sure no one has forgotten the negligence they displayed in failing to read the Stimulus Bill.

To add me in this endeavor, I used a meta-analysis method as I read through the bill.  See others, from individuals to organizations had already read the bill and were offering their analysis of its contents.  I found myself wondering if what they interpreted as to the meaning of the bill would coincide with what I was reading.  So I cross-referenced as I read House 3200 and surprisingly I found myself agreeing with most of the analysis as to meaning.  The italics in parts of my analysis are from the thoughts I had while reading the bill.  Here is what I found broken down…

Pg. 16, lines 3-9:  Plans currently in place will be “Grandfathered.”

Pg. 16, lines 22-26:  “Grandfathered” must not change including any terms or conditions, which include benefits or cost-sharing provisions or are no longer recognized as “grandfathered.” (So if at any time your plan changes you will be mandated to either have a plan that meets federal guidelines or be automatically placed in the government plan.)

Pg. 27-28:  Mandates “qualified plan” including insuring under parents plan “children” until the age of 21. (No higher education inclusion or requirement. Do you know any plan that covers “children” to age 21 if they are not in college?)

Pg 30-32, Sec. 123:  Establishes a government committee, “Health Benefits Advisory Committee” which shall include; providers, labor, consumer representatives, employers, health insurance insurers, experts in health care financing and delivery, experts in ethnic and racial diversity, representatives of relevant government agencies… and at least one practicing physician or health care provider.. (The start of a giant government controlled bureaucracy and I question why some of these organizations are being included, such as labor and racial diversity.)

Pg. 42 the “Health Care Commissioner” (appointed by the President) will establish standards for “qualified plans” , including enforcement standards in corporation with State insurance regulators and the Secretary of Labor and the Secretary of the Treasury. (“Qualified plans are yet undefined.)

Pg. 50-51, Sec. 152: Extends coverage to all regardless of personal characteristics (Illegal aliens?)

Pg. 58, D., lines 5-13: Require a “machine-readable” health plan beneficiary identification card and the maintaining of electronic health data. (Creation of national ID card?)

Pg. 65, Sec 164: Establishes federally-subsidized coverage to retirees who currently participate in employment-based plans.

Pg. 85-87: Health Care Commissioner dictates benefits package of all private insurance polices. (Insurers must meet requirements and those insured may not make personal choices re: health care coverage. Rationing?)

Pg. 91, lines 4-7:  Mandate that health care providers provide “culturally and linguistically appropriate communication and health care services.” (Illegal aliens? Or the Islamic practice of female genital circumcision? )

Pg, 95, lines 8-18: Mandates “outreach” to vulnerable populations, to inform and educate individuals and employers about Health Care Exchange program. (p. 100, line 14, use of organizations such as SEIU, who by the way is the largest union covering current health care workers, Acorn and AmeriCorps?)

Pg. 102, lines 12-18: Mandates enrollment into Medicare for all those that fit the criteria. (You have NO choice.)

Pgs 124-125, lines 24-25: Bans companies from judicial redress related to government established payments of services including payments to provide for the more efficiency of services. (No redress for Government price-fixing, no judicial review against a Government monopoly.)

Pg. 137: Establishes rates of cost for those from 150% federal Poverty Level to 400%

Pg. 150: Places health care surcharges (tax) on businesses which have accumulated payrolls for all employees above $250,000/ per year. (This provision has been changed in committee, the income level for payroll totals with the surcharge, now starts at $500,000.)

Pg. 167, lines 18-23: Imposes 2.5% income tax penalty on individuals who are not in qualified plans. (You will have no choice in your coverage, Government qualified plan or 2.5% tax.)

Pg. 170 lines 1-3: Stipulates that all non-resident aliens are exempt from taxes and penalties within this bill. (Non-resident aliens pay nothing, while you a resident may be taxed under certain conditions.)

Pg. 195: Federal officials will have full access to every citizen’s financial records via amendments to IRS code to verify coverage in a qualified health care program. (Big brother is watching.)

Pg. 197: Imposes escalating rate of surcharges on those individuals which make over $350,000/year

Pg. 203, lines 13-15: “The tax imposed under this section shall not be treated as tax…” (Orwellian doublespeak.)

Pg. 239, lines 14-24: Reduces physicians serves for Medicaid, Senior citizens, low income, and poor. (Rationing)

Pg. 241, lines 6-8:  Mandates that all physicians are paid the same, regardless of specialty. (A Neurosurgeon will make the same as a Chiropractor, what is the incentive to become a Neurosurgeon?)

Pg. 253, lines 10-18:  Sets value associated with physician’s time and professional judgment. (In essence places a value cost on patients.)

Pg. 265, Sec. 1131:  Government mandates and controls productivity for private health care companies.  (Something the government has failed to do adequately for any program they currently run.)

Pg. 268, Sec 1141:  Government regulation for the purchase and rental of power driven wheelchairs.

Pg. 272, Sec 1145:  After a cost-analysis, the Government will ration treatment of yet undetermined types of Cancer. (More rationing, meaning the government will make a cost analysis to see if you deserve treatment.)

Pg. 280, Sec 1151:   Government will penalize hospitals for what Government deems preventable readmission of disease. (Encourages Hospitals to use more invasive and potentially life altering techniques in treating disease.)

Pg. 298, lines 9-11:  Physicians which treat upon initial admission will be penalized, should the patient need to be readmitted.  (Encourages physicians to order tests, procedures they may not normally prescribe to avoid liability.)

Pg. 317, lines 13-20:  Physicians will be prohibited increasing ownership or additional investing in any hospital or other entity affiliated with health care. (Government tells physicians what they can own, will they do this next with real estate professionals.. not allow them to buy/invest in real estate?)

Pg.317-18, Sec. (C):  Hospitals will be prohibited from expanding including operating rooms, procedure rooms and beds. (Mandating hospitals cannot expand.)

Pg. 321, lines 2-13: Hospitals may apply for an exceptions, BUT “community input” is required. (From community groups like Acorn, SEIU, community organizations?)

Pg. 335, lines 16-25: Additional rationing of services, as yet to be defined. (More rationing.)

Pgs. 336-339:  Additional rationing. (Undefined)

Pg. 341, lines 3-9: Grants Government the authority to disqualify Medicare Advantage plans, HMO’s etc. and place individuals into the Government plan. (Forcing people into the Government plan, MEDICARE ADVANTAGE IS GONE.)

Pg. 354, Sec 1177: Government to oversee “Extension of Authority of Special Needs Plans to Restrict Enrollment.” (Restricting enrollment to people with special needs.)

Pg. 379, Sec 1191:  Creates new TeleHealth Advisory Committee for rural areas.  (Health care by phone?)

Pgs. 424-425, lines 20-25 and lines 1-2:  mandates an “Advanced Care Planning Consultations” every 5 years. (Think end of life care with seniors.)

Pg. 425, lines 7-9:  Government mandates instruction and consultation regarding living wills, and durable powers of attorney. (Mandatory end-of-life planning. The government should mandate this, why?)

Pg. 425, lines 4-11:  Government mandates Advanced Care Planning consultations for those who receive Medicare. (Required end-of-life planning with Government intimately involved in the discussion.)

Pg. 425, lines 19-23:  Government mandates end-of-life counseling. Providing explanation of what the health care plan covers. (Guiding you through death.)

Pgs. 426-427, lines 22-24, and lines 1-25:  Government mandates program for orders for life-sustaining treatment (i.e. end of life.) (The government has a say in how your life ends.)

Pg. 428, lines 17-25:  “Advanced care planning may be conducted more frequently” than every 5 years, if there are significant changes in the health condition of the individual. (As your health deteriorates, you will be required to make life ending decisions. This planning is regulated and  performed between you and a government sanctioned health care provider, no family involvement.)

Pg. 430, lines 4-17: Government will decide the level of treatment the individual receives. (There will be preset methods; neither you nor your family will make decisions.)

Pg. 468, lines 16-21: “Community-based medical home model” must be either non-profit or state based organization.  (SEIU, Acorn or one of its numerous affiliated programs?)

Pg 469, lines 18-20:  “Community-based medical agency” includes organizations which help beneficiaries access health care and community-based resources in their local geographic area. (SEIU,  they are already trying to unionize family members who take care of loved ones in various states acroos the country like Illinois and Oregon.)

Pg. 472, lines 3-6:  Payments to Community-based organizations will be made on a monthly basis. (Groups like SEIU and Acorn line-up for their piece of the government pie.)

Pgs. 494-498: Government will cover Mental Health counseling including defining, creating and rationing of services in conjunction with primary care physician. (Primary Care Physicians are not trained nor do they have the knowledge in Mental Health counseling to make educated decisions.)

Pg. 502, Sec 1401:  Government will establish “Center for Comparative Effectiveness Research.” (Big Brother will be watching how your medical treatment works and will be doing a cost analysis every step in the treatment process.)

Pg. 503, lines 3-9:  Government will build registries and data networks from your electronic health records. (You will have no control over who views these documents.)

Pg 503, lines 11-18:  The government (“The Center for Comparative Effectiveness”) may secure data directly from any department or agency of the United States, including your data.  (Meaning your public and private information will be available.)

Pg. 503, lines 19-25:  The “Center for Comparative Effectiveness Research” will collect data both “published and unpublished” (meaning your private and public information.)

Pg 504, lines 10-14:  The Comptroller General will have “unrestricted access” to all data gathered.  (There is no mention of how oversight in this position will occur.)

Pgs. 523-524, lines 22-25 and lines 1-4:  Establishment of the “Comparative Effectiveness Research Trust Fund,” IRS Code to establish funding for Center for Comparative Effectiveness Research Commission. (Taxes)

Pg. 619, Sec 1441: Establishment of “NEW QUALITY” measures in health care, based on data from both private and public information gathering.

Pg 621, lines 4-11: To pay for the Quality standards, government will transfer money from “qualified entities,” such as Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Trust Fund. (Start defunding of programs and more taxes.)

Pg. 623, lines 5 -6:  “Quality measures shall be designed to assess outcomes and functional status of patients.”  (Moving toward rationing. Cost analysis based on your age and life worth.)

Pg. 624, lines 19-23:  Application for grant money to study “Quality Standards” under bill will only be offered to entities which are public, nonprofit or academic institutions “with technical expertise in the area of health quality measurement.”  (SEIU)

Pg. 628, Sec 1443: “Multi-Stakeholders” will be given pre-rulemaking input into selection of “quality” measures.  (Government and other entities will make decisions regarding your health options.)

Pg 629-630, lines 9-24 and lines 1-9:  Multi-Stakeholders are defined to include labor organizations, health care quality alliances (SEIU and ACORN), employers, health plans and more. (Losing the ability to work with your primary care doctor to make medical decisions.)

Pg. 632, lines 14-25:  The government may implement any “Quality measure” of health care which the bureaucrats deem viable.  (You become a number, not an individual.)

Pgs. 634-652, Sec 1251: “Physicians Payments Sunshine Provision” mandatory reporting of financial relations between various health care entities.  (Yet the government is not requiring the same oversight to itself with all committees created in this bill.)

Pgs. 659-670: Doctors in Residence, the government will take over many aspects to residency training, as well as where a resident physician will perform their training.

Pgs. 675-685:  Government will regulate hospitals in every aspect of residency programs, including teaching hospitals.

Pgs. 685-699:  Increased funding to fight waste, fraud and abuse. (Why aren’t the acknowledged waste, fraud and abuse being stoppede now?)

Pgs. 704-708, Sec 1128G:  If Secretary determines there is “significant risk of fraudulent activity,” of health care provider or supplier; the government can do a background check.

Pg. 710, lines 8-14:  Allows the Secretary broad powers in denying health care providers and supplier’s admittance into health care Exchange, by the undefined criteria of “fraud, waste or abuse.” (Your physician could lose the ability to provide you services.)

Pgs. 718-719, Sec 1637:  Any physician which orders durable medical equipment or home medical services is mandated to be enrolled in or eligible for, Medicare. (Physicians are not allowed to control which insurance options they will accept.)

Pg. 721, lines 17-21:  Mandates physicians must have a “face-to-face” with patient to certify patient for home health services.

Pg. 723, lines 5-15:  Allows “face-to-face” meeting to include “telehealth,” yet stipulates that prior to issuing orders for durable medical equipment, the physician must have had contact with the client 6-months prior to such order being written.

Pg. 723, lines 16-22:  The government reserves the right to apply face-to-face with patient to certify patient for home health services.  (Some government hack can make a better determination than you and your physician?)

Pgs 734-735, lines 16-25, lines 1-3:  Allows for purposes of law enforcement, to grant the Secretary the authority to give access to the Attorney General all medical data.  (Numerous government agencies will have access to your records.)

Pgs 739-756:  Government sets guidelines for subsidizing the uninsured.

Pgs 756-761:  Federal government outlines how it will shift burden of cost derived from Disproportionate Share Hospitals (DSH) to the states. (As the state burden increases, the state will have no option then to raise taxes to cover price.)

Pg 768, lines 3-5: Nurse Home Visitation- Service #1:  “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.”  (Compulsory abortions?  What business is it of the government how many children you have?)

Pg. 768, lines 11-14: Nurse Home Visit Services include determining self-sufficiency, employment advancement and school-readiness.  (What training or training do nurses receive, that would allow them to make any determination in these areas?  Why is the government placing itself between the parent and child?)

Pg. 788-798:  Government will set and mandate drug prices, thereby controlling which drugs are brought to market. (Innovation and private research will grind to a fault.  President Obama has already met with pharmaceutical companies and told these companies they will NOT have to lower the priceof their drugs. )

Pgs. 796-799:  The government will establish payments for graduate medical education.  Included will be which institutions are eligible for payments and the field or types of education that will be supported.  (Complete control of the health care field by the government.)

Pg. 800: “MEDICAID NON-PAYMENT FOR CERTAIN HEALTH CARE-ACQUIRED CONDITIONS.”

The Government will decide which medical conditions will be covered.  (Rationing)

Pg. 809: Requires all billing agents, clearinghouses or alternative payees to register and be approved by the government.  (Government oversees private payment systems.)

Pgs. 819-828: Through IRS data the Government will identify individuals “likely to be ineligible” for subsidies.

Pgs. 823-828:  Government will set up a “Comparative Effectiveness Research Trust Fund” (CERTF) (More taxes.)

Pg. 824, lines 6-10: Part of funding for CERTF will be from “fees imposed under subchapter B of chapter 34 (relating to fees on health insurance and self-insured plans) for such fiscal year.”  (The taxing of private health care plans.)

Pgs. 828-832:  Government will impose a fee on ALL private health insurance policies, including self-insured, to pay for CERTF.  (Outlines taxing of private health insurance.)

Pg. 835: “Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted.”

Pgs. 837-839: The government will design and implement a Home Visitation Program for families with young children and families expecting children. (The government is going to decide the structure of the family.)

Pgs 843-844:  The Home Visitation Program is designed to instruct parents on how they should parent their children. (Government will tell you how to raise your children.)

Pg. 858:  The government will establish a Public Health Fund at the cost of $88, 8000,000,000 (that’s billions) over a nine-year period.  (Government spending run amok)

Pg. 864: The government will mandate the establishment of a National Service Corps (NHS).  Physicians will be required to perform mandatory health care for 2 years in exchange for partial loan repayment.

Pgs. 757-791:  Government takes over the education of medical students and physicians through education and loans.  (Complete government control from education, schools, disease treatment, disease coverage..)

Pg.  897:  The government will establish a Public Health Workforce Corps (PHW) to ensure an adequate supply of public health professionals.  (How does this work?)

Pg. 899:  The PHW will include veterinaries. (Unsure whether insurance coverage will extend to family pets, but why is this in a health care bill?)

Pg 909:  Government will institute a Public Health Grant Program for educational institutions, state and local health departments and hospitals. 

Pg 914:  Government mandates cultural and linguistic competency training for health care professionals.

Pg. 919, lines 9-14:  The Secretary will set up an “Advisory Committee on Health Workforce Evaluation and Assessment”   (the “Advisory Committee”)

Pg. 922, line 15:  At least one labor representative will be placed on the “Advisory Committee” (A pay-off for organized labor’s support for this plan?)

Pg. 931:  Government will establish a Preventative and Wellness Trust fund, with initial cost of $30,800,000,000 (billions).  Secretary will submit a national strategy to improve the nation’s health.  (The ambiguous sections of this bill conintue.)

Pg. 934, lines 17 and 18:  “including core public health infrastructure improvement activities.”  (I have read elsewhere where this may involve community parks so individuals can walk and gain health benefits.)

Pg. 935, lines 1 and 2:  Government will develop “Healthy People & National Public Health Performance Standards.”

Pg 936, lines 8-14:  The Government will establish the “Task Force on Community Preventive Services.”

Pg. 959, lines 9-15: Defines “core public health infrastructure,” workforce capacity, lab systems, health information systems etc.

Pg.  992:  Government will establish school-based health clinics. (Exactly what will these school-based health clinics be offering?  Is there parently consent involved prior to treatment?)

Pgs. 997-998:  Description of school based program: Comprehensive health assessments, diagnosis, treatment for chronic and acute conditions, referrals and follow-up care; Mental Health assessment, crisis intervention, counseling, community support programs in and out patient therapy; Optional serves: oral health, social and age-appropriate health education services, includes nutritional counseling.

Full text access to the bill is available at:

http://www.govtrack.us/congress/bill.xpd?bill=h111-3200

If you have made it to the end of this piece.. CONGRADULATIONS, you are probably more informed then many of  our elected officials.  If you are like me numerous aspects of this bill concern me… write your elected officials and tell them NO!

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