Obamacare, Deconstructed [video]

Video:  ObamaCare Deconstructed

Think the Affordable Care Act is good for America? Think again.
Oct 14: This just in: People are figuring out just how much "free" health care costs.
http://www.forbes.com/sites/theapothe...
The momentum is on our side.

SOURCES:
1)
Jackson & Coker
Survey: Physician Opinions of the American Medical Association (2011)
http://www.jacksoncoker.com/Promos/in...
Forbes
"Doctors and AMA split over Contentious Issue of Obamacare" by Sally Pipes (Sept. 2011)
http://www.forbes.com/sites/sallypipe...
2)
The New York Times
"White Coast in the Rose Garden, as Obama Rallies Doctors on Health Overhaul" by Sheryl Gay Stolberg (Oct. 5, 2009)
http://prescriptions.blogs.nytimes.co...
Doctors For America
White House Rose Garden Ceremony - Press Release (Oct. 5, 2009)
http://www.drsforamerica.org/news-2/p...
3)
Congressional Budget Office Report
Effects of the Affordable Care Act (March 2010)
http://www.cbo.gov/sites/default/file...
4)
Congressional Budget Office Report
Effects of the Affordable Care Act (May 2013)
http://www.cbo.gov/sites/default/file...
5)
House Energy & Commerce Committee Report (May 2013)
http://energycommerce.house.gov/sites...
6)
Gallup
Survey of Small Business Owners (May 2013)
http://www.gallup.com/poll/162386/hal...
US Chamber of Commerce
Small Business Outlook Study (July 2013)
http://uschambersmallbusinessnation.c...
7)
Supreme Court Decision on the Affordable Care Act
http://hastings.house.gov/uploadedfil...
8)
US Dept. of HHS
Federal Poverty Guidelines (2013)
http://aspe.hhs.gov/poverty/13poverty...
House of Representatives' Committee on Oversight and Government Reform
"IRS: Enforcing Obamacare's New Rules and Taxes"
http://oversight.house.gov/wp-content...
9)
Washington Examiner
"IRS employee union: We don't want Obamacare" by Joel Gehrke
http://washingtonexaminer.com/irs-emp...
10)
Kaiser Family Foundation
ACA Subsidy Calculator
http://kff.org/interactive/subsidy-ca...
11)
Office of Personnel and Management - Salaries (April 2013)
http://www.opm.gov/policy-data-oversi...
12)
Pew Research Center
"Baby Boomers Retire" (Dec. 29, 2010)
http://www.pewresearch.org/daily-numb...
13)
American Association of Medical Colleges
"Physician Shortages to Worsen Without Increases In Residency Training" (2010)
https://www.aamc.org/download/153160/...
14)
American Association of Medical Colleges
"Recent Studies and Reports on Physician Shortages in the US" (Oct. 2012)
https://www.aamc.org/download/100598/...
15)
National Association of Community Health Centers
"Access Denied: A Look At America's Medically Disenfranchised" (2007)
http://www.nachc.com/client/documents...
16)
American Association of Medical Colleges
State Physician Workforce Data Book (2011)
https://www.aamc.org/download/263512/...
17)
Merritt Hawkins & Associates
Survey of Physician Appointment Wait Times (2009)
http://www.merritthawkins.com/pdf/mha...
18)
Wall Street Journal
"The Affordable Care Act's Rate Setting Won't Work" by Howard Dean. (July 28, 2013)
http://online.wsj.com/article/SB10001...
19)
Forbes
"Unpublished CRS Memo: Obama Administration Has Missed Half Of Obamacare's Legally Imposed Implementation Deadlines" by Avik Roy
http://www.forbes.com/sites/theapothe...

States’ refusal to establish exchanges could undo Obamacare

The Daily Caller:  The Obama administration is waiving the deadline for states to establish a health insurance exchange in accordance with Obamacare, reports The New York Times. But it should not be taken as a sign of deference to the states, or a willingness to be flexible; it should be taken as a sign of desperation.

The announcement is in fact an attempt by the administration to shore up the health care law’s inherent weaknesses and to cajole states into enacting a federal scheme. Contrary to what the feds now claim, the latest and most glaring weakness of Obamacare is that it was crafted to depend on states to establish health insurance exchanges. These exchanges are meant to be the vehicles for the distribution of tax credits and subsidies to buy qualified health insurance plans.

If a state refuses to set up an exchange, and so far 25 have refused,the federal government must step in and create one. However, the law does not authorize tax credits and subsidies to flow through federally created exchanges, only those created by states. An Internal Revenue Service (IRS) rule issued in May 2012 attempted to fix this problem — initially dismissed as a “drafting error” — by extending credits and subsidies to federal exchanges and so-called “partnership exchanges,” which a number of states have indicated they will adopt.

But the law’s plain meaning, and Congress’ intent, cannot be swept aside by a rule issued by the IRS. Oklahoma Attorney General Scott Pruitt is challenging the IRS in federal court over the rule and the case will likely end up before the U.S. Supreme Court. It has huge implications. If federal exchanges cannot facilitate tax credits and subsidies, they also cannot be used to impose penalties on employers that fail to comply with the law’s “employer mandate” — a fine of $2,000 per employee per year. States that refuse to set up an exchange could therefore shield thousands of their residents and small businesses from onerous federal taxes and penalties.

The Cato Institute’s Michael Cannon has made this argument forcefully and in great detail, and it seems to be gaining ground. Cannon, along with Jonathan Adler, a law professor at Case Western Reserve University, have authored what will likely be the definitive argument against the legality of the IRS rule in a forthcoming Health Matrix article.

They argue that once it became clear that a significant number of states were not going to set up exchanges, the IRS sought to fix the problem by regulatory decree. However, by stipulating that tax credits and subsidies would be available only through state-created exchanges, Congress sought to create an incentive for states to set up their own exchanges — because it could not simply order states to create them without overstepping constitutional boundaries. It seems that it did not occur to Obamacare’s authors that many states would simply refuse, or that offering tax credits and subsidies would not be sufficient inducement for them to comply. It was a gross miscalculation, and could mean the undoing of Obamacare.

Seen in this light, this week’s announcement by HHS Secretary Kathleen Sebelius looks more like a plea to recalcitrant states to cooperate and set up exchanges so the feds won’t have to. Sebelius was supposed to determine by January 1 whether states were prepared to run an exchange, but she knew as far back as Nov. 15 that Texas, at least, would not establish one.

Waiving the deadline isn’t a deferential gesture by HHS to the states; it is the latest attempt by the federal government to deputize states into implementing federal policy, and a desperate attempt at that.

Texas and other states should remain steadfast in their resolve not to become tools for Washington, D.C. If the feds want Obamacare exchanges, let them set up those exchanges themselves. Americans would be much better off with weak federal exchanges than they would with the state-based exchanges Congress first envisioned in the law.

John Davidson is a policy analyst for the Center for Health Care Policy with the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. He may be reached at jdavidson@texaspolicy.com.  -  Cross-Posted at Ask Marion and at True Health Is True Wealth

Technorati Tags: ObamaCare,healthcare,ObamaCare Exchanges,passive resistance,stand-up America,Repeal and Replace ObamaCare

Myth Busted: Vaccinations Are Not Immunizations

The facts…

Craig Stellpflug  -  Natural News  -  May 16, 2012 – Cr0ss-Posted at True Health Is True Wealth

There is only one kind of immunity and that is natural immunity which is achieved by battling the infectious diseases itself.

Vaccination is merely the artificial triggering of temporary responses to manmade pathogens. Vaccines are both harmful and dangerous and are leading to generations of humans with no natural defenses to disease.

Vaccines do not provide long-term immunity; only temporary at best. In vaccines, an antigen is injected into the body to produce a reaction and the immune system responds in the form of antibodies, but antibody presence does not confer immunity. People still catch the diseases that they are vaccinated against. Vaccines actually skip the normal immune responses to activate killer cells which can trigger an overproduction of cytokines in response to the toxic vaccine adjuvants and can damage tissues and organs and even stop the heart and block air pathways.

Vaccines should never be called immunizations because that is a misnomer. Immunity and vaccinations are two different subjects altogether. In fact, breast milk is so potent with immune energizing effects in the infant that researchers at the CDC recommend women withhold breastfeeding their children in order to boost the “effectiveness” of childhood vaccines. The paper claims that women should stop breastfeeding long enough for the man-made poison to work on artificial/temporary “immunity.”

There is no such thing as a “side effect”

After-effects of vaccines are only followed for a very short time. Effects that are not seen for 30 years will not even be associated with the vaccine. Immunizations are contributing to the lowering of immunity along with the spread of auto-immune diseases such as arthritis and even AIDS throughout the world. Research clearly shows that aluminum mixed into vaccines carries a risk for autoimmunity, long-term brain inflammation, and subsequent neurological complications and may have profound and widespread adverse health complications. Many vaccines contain both aluminum and trace amounts of mercury. When you mix these 2 metals together it causes Extreme Synergistic Toxicity.

The facts:

As vaccinated disease rates go down (but not necessarily as a result of toxic vaccinations), the rate of chronic disease goes up in lock-step. Vaccines, as they are commonly given, destroy the natural immunity process and accelerate the auto-immune disease process.

Deaths from measles in 1900 were 13 per 100,000 people. In 1948: less than one. Measles vaccines introduced in 1963 but took full credit for what they never did – eliminate measles. Japanese health authorities realized that early inoculations were causing crib deaths so they postponed them until the 24th month and SIDS virtually disappeared along with whooping cough (pertussis) during the first two years of babies’ lives. Instead of preventing whooping cough the DPT promotes it as well as SIDS. Reuters recently reports that according to the CDC, the number of pertussis cases is growing – in the fully vaccinated population!

The recent Bachmair vaccine study reveals that the allergy rate in vaccinated children is more than double the rate in unvaccinated ones. Vaccinated children are also nearly eight times more prone to develop asthma or chronic bronchitis than unvaccinated. Furthermore, vaccinated kiddos suffer from more neurodermatitis, herpes, otitis media, hay fever, hyperactivity, scoliosis, epilepsy and seizures, migraine headaches, thyroid disease, and SIDS than unvaccinated children. Vaccinated kids historically also have more measles than unvaccinated kids.

Doctor after doctor will tell you that vaccinations have reduced the incidence of many infectious diseases but they have no real proof. In fact, all the epidemical evidence shows that disease rates rise after vaccines – in the vaccinated population. Should we trust them just on their word? Make an informed decision about you and your child’s health.

Sources for this article include:
http://www.ncbi.nlm.nih.gov/pubmed/20442687
Tomljenovic L and Shaw CA. Aluminum vaccine adjuvants: Are they Safe? Current Medicinal Chemistry. 2011; 18: 2630-2637.
http://www.flcv.com/hgsynerg.html

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1. Study: Unvaccinated children less prone to allergies and disease than vaccinated children
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3. What they won’t admit about measles outbreaks: Most children who catch measles were already vaccinated
4. Door to Door Vaccinations: Training the Public for Forced Innoculations
5. U.S. government panel now pushing “vaccinations for all!” No exceptions…
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Technorati Tags: Autism,childhood vaccines,childhood autism,MMR,Italy,watch the other hand,vaccines,gut flora,probiotics,autoimmune disorders,immunizations,innoculation,shots

Democrats Set to Rush Through Government-Run Healthcare

Senate Democrats announced plans Tuesday to begin committee work next week on health care legislation designed to assure coverage for millions of Americans who now lack it, a key objective of the Obama administration.

IBut Sen. Chris Dodd, D-Conn., said the measure that goes before the Senate Health, Education, Labor and Pensions Committee would contain gaps rather than include several controversial features included in a draft that circulated only last week. Among them are a proposed government-run insurance plan to compete with private companies -- vociferously opposed by nearly all Republicans -- and a requirement for employers to pay a penalty if they fail to provide coverage for their workforce.

Dodd said he would preside over the sessions in the place of Sen. Edward M. Kennedy, D-Mass., the committee chairman, who was diagnosed more than a year ago with brain cancer and has not been in the Capitol in recent days. The committee work will take about three weeks, he said.

Sen. Mike Enzi, R-Wyo., the top Republican on the health committee, responded dismissively to Dodd's comments about leaving gaps for GOP lawmakers to debate.

He said Democrats did so "because they know we're not going to like what they've written and they don't want us to have any time to comment," he said in an interview.

Enzi also said Democrats would have behaved differently if Kennedy were present.

"I've never worked a process on any bill with him that went like this where there was absolutely no input taken from the other party," Enzi said. "And I never treated him that way either."

"What the question is, is Senator Dodd in charge or is he just running the meeting, and we don't know yet," Enzi said.

Dodd's announcement signaled a quickening pace of activity on health care legislation, and came as senior House Democrats disclosed they are considering a new tax on employer-provided health benefits to help pay for expanding coverage to the 50 million uninsured. President Barack Obama opposed a tax on benefits during last year's campaign and aired numerous television commercials criticizing the idea when his Republican rival, Sen. John McCain, proposed it.

Several officials also said an outline of emerging legislation in the House envisions a requirement for all individuals to purchase affordable coverage, with an unspecified penalty for those who refuse and a waiver for those who cannot cover the cost.

"There's no sense having a mandate unless you have a contribution," Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, said Monday. He referred to the suggestion as "play or pay."

Rangel and other senior Democrats arranged to bring members of the party's rank and file up to date at a midday session Tuesday on the effort to draft health care legislation at the top of President Barack Obama's agenda.

The officials spoke on condition of anonymity, saying they did not want to pre-empt the presentation to rank-and-file Democrats on Tuesday.

Under an outline of the House Democratic plan, individuals and small businesses would be able to purchase coverage from a "health exchange" and the government would require all plans to contain a minimum benefit. No applicant could be rejected for pre-existing conditions, nor could one be charged a higher premium.

The outline shows Democrats want to provide subsidies to families up to about $88,000 a year to help them pay for insurance, and to require new policies to limit out-of-pocket spending as a way to prevent personal bankruptcies.

House Democrats also are considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to providers, according to several officials. Medicaid is a joint state-federal program of health coverage for the poor.

The measure also envisions several changes to Medicare, the government program that provides health care to seniors, although details are lacking.

According to the outline, the gap between primary care physician fees and those of specialists would be narrowed, and beneficiaries would not incur out-of-pocket costs for preventive services. The outline also mentions unspecified improvements in the prescription drug benefit. Democrats vociferously opposed that benefit when Republicans passed it, saying it provided billions in unnecessary subsidies to pharmaceutical companies.

The outline does not include an overall cost for the legislation, which is expected to exceed the $1.2 trillion, 10-year price tag Obama's proposal carried last winter.

Part of the cost would be covered in the form of cuts in the government payments under Medicare plans run by private insurance companies, which receive more per patient than the cost of traditional coverage.

Strikingly, the outline made no mention of the possible tax on health benefits, or of the proposed penalty for those refusing to purchase affordable insurance.

Several officials stressed that no final decisions would be made for several days on the possible tax on health benefits.

The idea has been gaining currency in recent weeks as Congress intensifies its search for more than $1 trillion to help pay for a health care overhaul.

America… Do your homework, contract your Representative and Senator (no matter which side you are on) and do not let them pass this legislation without reading it, without having ‘real’ funds to pay for it and a real plan, and without being satisfied that you will be receiving and will continue to receive the same or better health care treatment than you do today… which means better than the care in any country that now has socialized or nationalized healthcare. If not… do not let the government force you into a plan of worse healthcare that nobody can pay for!!

Source: Associated Press/MoneyNews.com

Understanding the House Democrats’ health care bill

Posted Tuesday, June 9th, 2009, at 10:30 am

Yesterday I posted and described the draft Kennedy-Dodd health care bill. Today I would like to do the same for an outline produced by House Democrats.

Here is a three-page outline of “Key Features of the Tri-Committee Health Reform Draft Proposal in the House of Representatives,” dated yesterday (June 8, 2009).

The three committees are:

• The House Ways & Means Committee, chaired by Rep. Charlie Rangel (D-NY). The Health Subcommittee is chaired by Rep. Pete Stark (D-CA).
• The House Energy & Commerce Committee, chaired by Rep. Henry Waxman (D-CA). The Health Subcommittee is chaired by Rep. Frank Pallone, Jr. (D-NJ).
• The House Committee on Education & Labor, chaired by Rep. George Miller (D-CA). The Health, Employment, Labor and Pensions Subcommittee is chaired by Rep. Robert Andrews (D-NJ).

The document suggests this is a joint product of the three committees and/or their subcommittees. My sense, however, is that it is Speaker Pelosi who is driving the bus. This is in contrast to the Senate, where the committee chairmen (Kennedy/Dodd and Baucus) appear to have the pen, in less well-coordinated efforts.

Kennedy-Dodd and the House bill outline are remarkably similar. Whether this represents House-Senate coordination or parallel thought processes is unclear.

I think the easiest way for me to present the House bill outline is in comparison with the Kennedy-Dodd bill. So here my description from yesterday of the Kennedy-Dodd bill, with today’s comparison to the House bill outline in red. I hope it’s comprehensible and useful this way. If you read yesterday’s post, you can skim the text in black and focus on the new text in blue.

Here are 15 things to know about the draft Kennedy-Dodd health bill and the House bill outline.

1. The Kennedy-Dodd bill would create an individual mandate requiring you to buy a “qualified” health insurance plan, as defined by the government. If you don’t have “qualified” health insurance for a given month, you will pay a new Federal tax. Incredibly, the amount and structure of this new tax is left to the discretion of the Secretaries of Treasury and Health and Human Services (HHS), whose only guidance is “to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).” The new Medical Advisory Council (see #3D) could exempt classes of people from this new tax. To avoid this tax, you would have to report your health insurance information for each month of the prior year to the Secretary of HHS, along with “any such other information as the Secretary may prescribe.”

   The House bill also contains an individual mandate. The outline is less specific but parallel: “Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship.”

2. The Kennedy-Dodd bill would also create an employer mandate. Employers would have to offer insurance to their employees. Employers would have to pay at least a certain percentage (TBD) of the premium, and at least a certain dollar amount (TBD). Any employer that did not would pay a new tax. Again, the amount and structure of the tax is left to the discretion of the Secretaries of Treasury and HHS. Small employers (TBD) would be exempt.

   The House bill outline also contains an employer mandate that appears to parallel that in Kennedy-Dodd: “Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers.”

3. In the Kennedy-Dodd bill, the government would define a qualified plan:
   1. All health insurance would be required to have guaranteed issue and renewal, modified community rating, no exclusions for pre-existing conditions, no lifetime or annual limits on benefits, and family policies would have to cover “children” up to age 26.

      The House bill outline is consistent with but less specific than the Kennedy-Dodd legislative language. The House bill outline would “prohibit insurers from excluding pre-existing conditions or engaging in other discriminatory practices.” I will keep my eye on what “other discriminatory practices” means in the legislative language. Does that mean that a health plan cannot charge higher premiums to smokers?

      Like the Kennedy/Dodd bill, the House bill outline would preclude health plans from imposing lifetime or annual limits on benefits: “Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.” This would raise premiums for new policies.

      The House bill outline “introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.” I don’t know what this means, but suggest keeping an eye on it.

   2. A qualified plan would have to meet one of three levels of standardized cost-sharing defined by the government, “gold, silver, and bronze.” Details TBD.

      Same: “… by creating various levels of standardized benefits and cost-sharing arrangements…”. It also contains this addition relative to Kennedy-Dodd: “… with additional benefits available in higher-cost plans.”

      But note the “various levels of standardized benefits.” This appears to be more expansive government control of health plan design than in the Kennedy-Dodd draft.

   3. Plans would be required to cover a list of preventive services approved by the Federal government.

      This is unspecified in the House bill outline. We’ll have to wait to see legislative language. The House bill would require plans to “waive cost-sharing for preventive services in benefit packages.”

   4. A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.” The MAC would have to include items and services in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.

      This appears parallel but is less specific for now: “Independent public/private advisory committee recommends benefit packages based on standards set in statute.” I find the “standards set in statute” interesting. It suggests that provider and disease interest groups will have two fora in which to lobby for their benefits to be mandated: Congress, and the advisory committee.

   5. The MAC would also define what “affordable and available coverage” is for different income levels, affecting who has to pay the tax if they don’t buy health insurance. The MAC’s rules would go into effect unless Congress passed a joint resolution (under a fast-track process) to turn them off.

      The House bill outline is silent on this.

4. Health insurance plans could not charge higher premiums for risky behaviors: “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.

   The House bill outline says it would “prohibit plans [from] rating (charging higher premiums) based on gender, health status, or occupation and strictly limits premium variation based on age.” If the bill were to provide nothing more, this would appear to parallel the Senate bill and preclude plans from charging higher premiums for risky behaviors.

5. Guaranteed issue and renewal combined with modified community rating would dramatically increase premiums for the overwhelming majority of those Americans who now have private health insurance. New Jersey is the best example of health insurance mandates gone wild. In the name of protecting their citizens, premiums are extremely high to cover the cross-subsidization of those who are uninsurable.

   The House bill outline is silent on guaranteed issue and renewal. I’m going to make an educated guess that the bill includes these provisions as part of “other discriminatory practices,” and they have just left them out of the outline. Given the philosophy behind this outline (with which I disagree), it would be a striking omission. But for now, the outline says nothing specific on these topics.

6. The bill would expand Medicaid to cover everyone up to 150% of poverty, with the Federal government paying all incremental costs (no State share). This means adding childless adults with income below 150% of the poverty line.

   The House bill outline “expands Medicaid for the most vulnerable, low-income populations,” so we have no specifics other than that there’s an expansion. I cannot tell if this is expanding eligibility or benefits. The outline also “improves payment rates to enhance access to primary care under Medicaid.” I assume this means the bill would expand the Federal share paid of each dollar spent by a State Medicaid program on primary care, rather than the Federal government actually mandating specific payment rates to be implemented by States. Federal micromanagement of specific Medicaid provider payment rates was eliminated in the mid 1990’s.

7. People from 150% of poverty up to 500% (!!) would get their health insurance subsidized (on a sliding scale). If this were in effect in 2009, a family of four with income of $110,000 would get a small subsidy. The bill does not indicate the source of funds to finance these subsidies.

   The House bill outline has a sliding scale up to 400% of poverty. If this were in effect in 2009, a family of four with income of $88,000 would get small subsidy.

8. People in high cost areas (e.g., New York City, Boston, South Florida, Chicago, Los Angeles) would get much bigger subsidies than those in low cost areas (e.g., much of the rest of the country, especially in rural areas). The subsidies are calculated as a percentage of the “reference premium,” which is determined based on the cost of plans sold in that particular geographic area.

   The House bill outline is not specific on this point. I would not expect it to be – this is something you can tell only from legislative language.

9. There would be a “public plan option” of health insurance offered by the federal government. In this new government health plan, the federal government would pay health care providers Medicare rates + 10%. The +10% is clearly intended to attract short-term legislative support from medical providers. I hope they are not so naive that they think that differential would last.

   The House bill outline “creates a new public health insurance within the Exchange … the public health insurance option competes on ‘level field’ with private insurers in the Exchange.” There are no specifics on how the public plan would work, or on provider payment rates.

10. Group health plans with 250 or fewer members would be prohibited from self-insuring. ERISA would only be for big businesses.

    The House bill outline is silent on this point.

11. States would have to set up “gateways” (health insurance exchanges) to market only qualified health insurance plans. If they don’t, the Feds will set up a gateway for them.

    The House calls it an Exchange rather than a Gateway. While the Senate bill would tell each State, “Create a Gateway or we’ll create one for you,” the House bill outline says to each State, “We’re creating a single new national Exchange. You’re in it unless you develop your own State or Regional Exchange.”

12. Health insurance plans in existence before the law would not have to meet the new insurance standards. This creates a weird bifurcated system and means you would (probably) be subject to a different set of rules when you change jobs.

    The House bill outline appears to parallel the Kennedy-Dodd draft: “Phases-in requirements to benefit and quality standards for employer plans.” This means that new plans will be more expensive than old plans. It also means they’re creating a bifurcated system with all sorts of perverse unintended consequences for employment flexibility.

13. The bill does not specify what spending will be cut or what taxes will be raised to pay for the increased spending. That is presumably for the Finance Committee to determine, since it’s their jurisdiction.

    The House bill outline lists specific topics for changes to Medicare reimbursement:

    • Changing (how?) the Medicare reimbursement for doctors, called the “Sustainable Growth Rate” (SGR).
    • “Increasing reimbursement for primary care providers”
    • “Improving” the Medicare drug program. I won’t be surprised if, when I see the specifics, I disagree that their changes are “improvements.” In the past this has meant having the federal government mandate specific prices for drugs.
    • Cutting payments to Medicare Advantage plans.
    • Expanding low-income subsidies for seniors and eliminating cost-sharing for all preventive services in Medicare.

    The House bill outline also uses positive language to describe things that might generate budgetary savings from Medicare and/or Medicaid. The hospital readmissions point is specific. The first two points could increase or decrease federal spending, depending on the specifics.

    • “Use federal health programs … to reward high quality, efficient care, and reduce disparities.”
    • “Adopt innovative payment approaches and promote[s] better coordinated care in Medicare and the new public option through programs such as accountable care organizations.”
    • “Attack the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.”
14. The bill defines an “eligible individual” as “a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”

    The House bill outline is silent on this point.

15. The bill would create a new pot of money for state gateways to pay “navigators” to educate people about the new bill, distribute information about health plans, and help people enroll. Navigators receiving federal funds “may include … unions, …”

    The House bill outline is silent on this point.

This would have severe effects on the more than 100 million Americans who have private health insurance today:

• The government would mandate not only that you must buy health insurance, but what health insurance counts as “qualifying.”
• Health insurance premiums would rise as a result of the law, meaning lower wages.
• A government-appointed board would determine what items and services are “essential benefits” that your qualifying plan must cover.
• You would find a tremendous new disincentive to switch jobs, because your new health insurance may be subject to the new rules and would therefore be significantly more expensive.
• Those who keep themselves healthy would be subsidizing premiums for those with risky or unhealthy behaviors.
• Far more than half of all Americans would be eligible for subsidies, but we have not yet been told who would pay the bill.
• The Secretaries of Treasury and HHS would have unlimited discretion to impose new taxes on individuals and employers who do not comply with the new mandates. (The House bill outline is not specific on this point.)
• The Secretary of HHS could mandate that you provide him or her with “any such other information as [he/she] may prescribe.” (The House bill outline is not specific on this point.)

I strongly oppose the Kennedy-Dodd bill and the House Tri-Committee bill.

If this topic interests you, I highly recommend Jim Capretta’s blog Diagnosis.

Source: Keith Hennessey.com

Posted: Daily Thought Pad

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