OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol
I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!
Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol
Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.
Here are some key items of HC 3200
Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>
<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:
<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>
One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>
Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?
<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...
<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>
It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?
<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??
"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... 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 care or related services."</i>
What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?
<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.
<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>
So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?
<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.
It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.
<b>Page 84</b>
talks of Benefit Package Levels...
Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.
<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.
<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage
This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?
<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?
See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.
Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>
<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.
<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals
We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...
<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.
<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel
Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.
<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options
The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.
<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?
Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?
<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.
This most likely does not apply to our social workers.
<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.
I will report more as time allows and/or it seems relevant.
I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!
Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol
Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.
Here are some key items of HC 3200
Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>
<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:
<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>
One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>
Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?
<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...
<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>
It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?
<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??
"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... 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 care or related services."</i>
What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?
<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.
<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>
So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?
<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.
It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.
<b>Page 84</b>
talks of Benefit Package Levels...
Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.
<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.
<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage
This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?
<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?
See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.
Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>
<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.
<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals
We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...
<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.
<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel
Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.
<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options
The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.
<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?
Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?
<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.
This most likely does not apply to our social workers.
<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.
I will report more as time allows and/or it seems relevant.