For reference, all of my excerpts are taken from
docs.house.gov/edlabor/AAHCA-BillText-071409.pdf.
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Original post by Chris Reynolds
1.) This will eventually lead to a single-payer system, aka "socialized" healthcare.
Negative to you, positive to me. I have no problems with Republicans being opposed to this, I just want to know
why and what their
alternative is to improve healthcare in America.
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Original post by Chris Reynolds
2.) Government allowed real-time access to individuals' bank accounts for electronic transfers (pg. 59)
That's not what it says. It says:
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(4) REQUIREMENTS FOR SPECIFIC STANDARDS.-The standards under this section shall be developed, adopted and enforced so as to-
...
"(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;
In small words, it basically says that the government-run service will use technology standards to allow people to pay any health care-related expenses electronically - you know, ATMs, credit cards. Et cetera.
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Original post by Chris Reynolds
3.) Coverage given to non-us citizens, legal and illegal. (bottom of pg. 50)
That's not what it says. It says:
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SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE.
(a) IN GENERAL.-Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
It says nothing, on pages 50 or 51, or 52 for that matter, about citizenship, immigration or legal status.
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Original post by Chris Reynolds
3.) non-resident aliens exempt from individual taxes (pg. 70)
That's not what it says. In fact, there is no mention of "tax" on page 70, or in fact anywhere between pages 9 and 109. If I may borrow your expression, "
Read the bill." It appears you haven't.
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Original post by Chris Reynolds
4.) Government will set wages for doctors (pg. 127)
Not entirely. There is a class of "non-preferred, participating" physicians as outlined in §225(c)(1)(B). Your choice excerpt:
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"payment shall only be available if the provider agrees to accept the
payment rate established under section 223"
is actually from §225(c)(2), which covers "other providers" -
not doctors.
You have a legitimate argument here, but don't manufacture or skew the evidence.
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Original post by Chris Reynolds
5.) Employers exceeding a 250k payroll who do not choose the public plan will suffer a 2, 4, 6, or 8% PAYROLL tax (a lot of money) depending on the size of the company. (pg. 150)
This is part of §313, "Employer Contributions
In Lieu Of Coverage." In other words, since you're no longer purchasing health insurance for your employees, make this tax contribution to the public fund. The question is, how does this compare to what employers
currently contribute to private health insurance plans for their employees?
§313(b)(1) states that a company with payroll between $250,000 and $300,000 will contribute 2%, or $6,000. A September 2008 Henry J. Kaiser Family Foundation survey of employee benefits found that the annual premium that a health insurer charges an employer for a health plan covering a family of four averaged
$12,700 in 2008. Let's say that our small enterprise with a $300,000 payroll employs 10 people, paying $30,000 each on average, with 2 of the ten being family persons with dependents and the other 8 being single individuals. Assuming, then, the full $12,700 premium for the two employees with dependents, and amounts even one-fourth as much - $3,175 - for the other eight employees, the company's total insurance costs for one year would be
$50,800, a staggering
16% of payroll!
You quibble over a contribution one-eighth as much? Really?
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Original post by Chris Reynolds
6.) Rationing cancer patient coverage to not exceed amounts determined by the Secretary. (pg. 272)
That's not what it says. It says:
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SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.-
(A) STUDY.-The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).
(B) AUTHORIZATION OF ADJUSTMENT.-Insofar as the Secretary determines under sub-paragraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.
In plain, simple words: the Secretary is authorized to make adjustments if it is found that certain cancer hospitals consistently cost more than other comparable hospitals - ie, the Secretary is empowered to ensure nobody is gouging the government.
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Original post by Chris Reynolds
7.) Hospitals will be punished for having, as the government deems, "excess re-admissions" (chronically diseased patients) (pg. 280)
That's not what it says. The section, §1151, is titled "Reducing
Potentially Preventable Hospital Readmissions." It effectively incentivizes hospitals to prevent readmissions - to ensure that the patient has been comprehensively looked after before being discharged (since payments are linked to discharges). The specific amendment reads:
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(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR EXCESS READMISSIONS.-
(1) IN GENERAL.-With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would
otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of...<fiscal specifics>
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Original post by Chris Reynolds
8.) Hospitals cannot expand their capacity without government approval. (pg. 317 section C)
The section, §1156, is titled "Limitations on Medicare Exceptions to the Prohibition of Certain Physician Referrals Made to Hospitals." The controlling subsection, §1156(i), is titled "Requirements to Qualify for Rural Provider and Hospital Ownership Exceptions to Self-Referral Prohibition". In other words, limitations on expanding capacity only apply to rural providers and hospitals seeking
exceptions to the
self-referral prohibition. The self-referral prohibition is a regulation that exists to prevent physicians from referring patients to hospitals in which they have an ownership or investment stake without disclosure - much in the way that financial analysts are required to disclose any investment relationships they hold with stocks they comment on.
The provision in question, then, says "if you wish to be free to refer your patients to a hospital that you own or have an investment interest in without having to disclose that interest, then you must agree to hold steady the number of operating rooms, procedure rooms or beds in your hospital" - in effect, you agree not to
profit (expand) from being able to refer your patients effectively to yourself.
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Original post by Chris Reynolds
9.) Restricted enrollment for those with special needs (pg. 354)
"SEC. 1176. LIMITATION ON ENROLLMENT OUTSIDE OPEN ENROLLMENT PERIOD OF INDIVIDUALS INTO CHRONIC CARE"
It reads:
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"(C) The plan does not enroll an individual on or after January 1, 2011, other than during an annual, coordinated open enrollment period or when at the time of the diagnosis of the disease or condition that qualifies the individual as an individual described in subsection (b)(6)(B)(iii)."
In other words, you can only be enrolled into special needs/chronic care during an annual open enrollment period or at the time of diagnosis. What's the problem here?
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Original post by Chris Reynolds
"SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT."
What's your specific beef with this section? The title may appear ominous, but, well,
Read the Bill. It juggles some dates in the Social Security Act and authorizes the Secretary to perform a study on "cost, quality of care, patient satisfaction" on some select plans.
What's your criticism?
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Original post by Chris Reynolds
10.) Here's the big one. End of life care. Read the following quotes to understand where the republicans are coming from
...
The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions.
This is from §1233(a)(5)(B), even though you earlier quoted from §1233(a)(1)(A), which details an amendment to a completely different document: specifically, it proposes
42 U.S.C. 1395x §11861(hhh), which details resources to be made available to people to determine their own end-of-life care instructions:
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42 U.S.C. 1395x §11861(hhh)(1) Subject to paragraphs (3) and (4), the term "advance care planning consultation" means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
"(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
"(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
"(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
"(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
"(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
"(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include:...
This is interesting because of the definition laid out in §1233(a)(5)(A):
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"(5)(A) For purposes of this section, the term 'order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that
"(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
"(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
"(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
You stupid, stupid, stupid people.
Read the bill.
