Sunday, September 6, 2009

A Letter from Dr. Stephen Fraser to Senator Evan Bayh

Multiple arguments have been made for and against the health care bills currently being discussed in Congress. Some of these are circulating in various internet and email forums. One such argument against a bill currently in the House of Representatives (HR3200 America’s Affordable Health Choices Act of 2009) has been outlined by a Dr. Stephen Fraser in a letter to Senator Evan Bayh. I have been emailed the letter from multiple sources and have also found it on many websites including: http://shorelinecaucus.com/?p=170. Here is the letter:

Senator Bayh,

As a practicing physician I have major concerns with the healthcare bill before Congress. I actually have read the bill and am shocked by the brazenness of the government's proposed involvement in the patient physician relationship. The very idea that the government will dictate and ration patient care is dangerous and certainly not helpful in designing a healthcare system that works for all. Every physician I work with agrees that we need to fix our healthcare system, but the proposed bills currently making their way through congress will be a disaster if passed.

I ask you respectfully and as a patriotic American to look at the following troubling lines that I have read in the bill. You cannot possibly believe that these proposals are in the best interests of the country and our fellow citizens.

Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self insure!!

Page 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.

Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

Page 42 of HC Bill:The Health Choices Commissioner will choose your HC Benefits for you. You have no choice!

Page 50 Section 152 in HC bill: HC will be provided to ALL non US citizens, illegal or otherwise

Page 58 HC Bill: Govt will have real-time access to individuals finances & a National ID Healthcard will be issued!

Page 59 HC Bill lines 21-24: Govt will have direct access to you ur banks accounts for elective funds transfer.

Page 65 Sec 164: is a payoff subsidized plan for retirees and their families in Unions & community organizations: (ACORN).

Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the Exchange.

Page 85 Line 7 HC Bill: Specifications for of Benefit Levels for Plans = The Govt will ration your Healthcare!

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. Example - Translation: illegal aliens.

Page 95 HC Bill Lines 8-18: The Govt will use groups i.e., ACORN & Americorps to sign up individuals for Govt HC plan.

Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. AARP members - your Health care WILL be rationed.

Page 102 Lines 12-18 HC Bill: Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

Page 124 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt Monopoly.

Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what you can make! (salary)

Page 145 Line 15-17: An Employer MUST auto enroll employees into public option plan. NO CHOICE!

Page 126 Lines 22-25: Employers MUST pay for HC for part time employees AND their families.

Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option pays 8% tax on all payroll.

Page 150 Lines 9-13: Business's with payroll btw 251k & 401k who doesn't provide public option pays 2-6% tax on all payroll.

Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.

Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)

Page 195 HC Bill: Officers & employees of HC Admin (GOVT) will have access to ALL Americans finances /personal records.

Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax" Yes, it says that!

Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors, low income and poor are affected.

Page 241 Line 6-8 HC Bill: Doctors, doesn't matter what specialty you have, you'll all be paid the same!

Page 253 Line 10-18: Govt sets value of Doctor's time, proffession, judgment etc. Literally value of humans.

Page 265 Sec 1131: Govt mandates & controls productivity for private HC industries.

Page 268 Sec 1141: Federal Govt regulates rental & purchase of power driven wheelchairs.

Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!

Page 280 Sec 1151: The Govt will penalize hospitals for whatever Govt deems preventable re-admissions.

Page 298 Lines 9-11: Doctors, treat a patient during initial admission that results in a re-admission -Govt will penalize you.

Page 317 L 13-20: PROHIBITION on ownership/investment. Govt tells Doctors what/how much they can own!

Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion- Govt is mandating hospitals cannot expand.

Page 321 2-13: Hospitals have opportunity to apply for exception BUT community input is required.. Can u say ACORN?!!

Page 335 L 16-25 Pg 336-339: Govt mandates establishment of outcome based measures. HC the way they want. Rationing.

Page 341 Lines 3-9: Govt has authority to disqualify Medicare Advance Plans, HMOs, etc. Forcing people into Govt plan.

Page 354 Sec 1177: Govt will RESTRICT enrollment of Special needs people! Unbelievable!

Page 379 Sec 1191: Govt creates more bureaucracy - Tele-health Advisory Comittee. Can you say HC by phone?

Page 425 Lines 4-12: Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life patients.

Page 425 Lines 17-19: Govt will instruct & consult regarding living wills, durable powers of attorney. Mandatory!

Page 425 Lines 22-25, 426 Lines 1-3: Govt provides approved list of end of life resources, guiding you in death. (assisted suicide)

Page 427 Lines 15-24: Govt mandates program for orders for end of life. The Govt has a say in how your life ends.

Page 429 Lines 1-9: An "advanced care planning consultant" will be used frequently as patients health deteriorates.

Page 429 Lines 10-12: "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from GOVT!

Page 429 Lines 13-25: The govt will specify which Doctors can write an end of life order.

Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end of life!

Page 469: Community Based Home Medical Services = Non profit organizations. Hello, ACORN Medical Services here!!?

Page 472 Lines 14-17: PAYMENT TO COMMUNITY-BASED ORIGINATION. 1 monthly payment 2 a community-based organization. Like ACORN?

Page 489 Sec 1308: The Govt will cover Marriage & Family therapy. Which means they will insert Govt into your marriage..

Page 494-498: Govt will cover Mental Health Services including defining, creating, rationing those services.

Senator, I guarantee that I personally will do everything possible to inform patients and my fellow physicians about the dangers of the proposed bills you and your colleagues are debating.

Furthermore, If you vote for a bill that enforces socialized medicine on the country and destroys the doctor/patient relationship, I will do everything in my power to make sure you lose your job in the next election.

Respectfully,

Stephen E Fraser MD

------------------------------------------------------------------------

Below I have written in red the various statements from the letter to Senator Bayh. Beneath each statement is the verbatim text of the Bill (in black). Highlighted in green are my summary comments. I have no idea if a Dr. Stephen Fraser did in fact write this letter, but since the letter contains many claims about HR3200, I have decided to look into the details of those claims and the parts of the specific legislation it addresses. Since I have the time to look up the info and I know that many people don't, I have decided to post my findings on this blog.


But before I get started on the point-by-point discussion, here are a couple of websites that might be of interest:

The American Medical Association. The American Medical Association supports HR3200. http://www.ama-assn.org/ama/pub/news/news/ama-supports-hr-3200.shtml

A point-by-point analysis by factcheck.org by the Annenberg Public Policy Center at the University of Pennsylvania
http://www.factcheck.org/2009/08/twenty-six-lies-about-hr-3200/

For background on the Bill from Wikipedia go here: http://en.wikipedia.org/wiki/America

Opposition to HR 3200 can be found at the following websites:

The Mason Contractor Association of America
http://www.masoncontractors.org/newsandevents/masonryheadlines/headline.php?id=20090730064710

Association of American Physicians and Surgeons on Healthcare Reform
http://www.aapsonline.org/newsoftheday/00category/health-care-reform


For the health insurer's perspective: American Health Insurance Plans (AHIP) "the voice of America's health insurers"
http://www.ahip.org/content/default.aspx?bc=3925680
http://www.ahip.org/content/default.aspx?bc=3934227941















HR3200 America's Affordable Health Choices Act of 2009

This bill can be found here: http://energycommerce.house.gov/Press_111/20090714/aahca.pdf
Points made in the letter from Dr. Stephen Fraser to Senator Evan Bayh:

Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self insure!!

[This section describes a study comparing insured and self-insured health plans and does not discuss 'audits'.]

Pages. 21-2: The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following: (A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure. (B) The similarities and differences between typical insured and self-insured health plans. (C) The financial solvency and capital reserve levels of employers that self-insure by employer size. (D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent. (E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure. (2) Reports—Not later than 18 months after the date of the enactment of the Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Comissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.

Page 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.

[The private-public health benefits advisory committee will be established to determine ‘benefit standards’ as defined as “standards respecting (A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost sharing; and (B) the cost-sharing levels for enhanced and premium plans (as provided under 203(c)) consistent with paragraph (5).” ]

Section 123, Page 30: HEALTH BENEFITS ADVISORY COMMITTEE (a) Establishment (1) 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. (2) Chair.-The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee. (3) Membership-The Health Benefits Advisory Committee shall be composed of the following members in addition to the Surgeon General: (A) 9 members who are not Federal employees or officers and who are appointed by the President. (B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act. (C) Such even number of members (not to exceed 8) who are Federal employees and officers as the President may appoint. Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act. (4) Terms—Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms or the initial members shall be adjusted in order to provide for a staqggered term of appointment for all such members. (5) Participation-The membership of the Health Benegits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee. Duties—(1) Recommendations on Benefit Standards-The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities. (2) Deadline.—The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act. (3) Public Input.—The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection. (4) Benefit Standards Defined.

Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

[There is nothing in this section that directly discusses rationing of healthcare. This section describes the limits that individuals and families will pay in cost-sharing if they have the public option (cost-sharing = co-pays, deductibles, coinsurance). The cost-sharing cap (the most an individual or family will pay) is $5,000 per individual, or a family $10,000. I have started with page 28 line 21 for accuracy. I have included the definition of cost-sharing, as defined earlier in the Bill, page 8. ]

(c) Requirements relating to cost-sharing and minimum actuarial value- (1) not cost sharing for preventative services.—There shall be no cost-sharing under the essential benefits package for preventative items and services (as specified under the benefit standards), including well baby and well child care. (2) Annual Limitation.—(A) Annual limitation—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B). (B) Applicable Level.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

[Cost sharing is defined earlier in the bill as (General Definitions, page 8, line 11): “(4) Cost-sharing.—The term “cost-sharing” includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services”. ]

Page 42 of HC Bill:The Health Choices Commissioner will choose your HC Benefits for you. You have no choice!

[There is nothing in Section 142 that discusses choice of benefits. However, Section 102 (page 16) is titled “Protecting the Choice to Keep Current Coverage’ and does discuss choice. I have included this section below Section 142]

p. 42 Section. 142. Duties and Authority of Commissioner. (a) Duties—The Commissioner is responsible for carrying out the following functions under this division: (1) Qualified Plan Standards. The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury. (2) Health Insurance Exchange—The establishment and operation of a Health Insurance Exchange under subtitle A of title II. (3) Individual affordability credits—The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits. (4) Additional functions—Such additional functions as may be specified in this division. (b) Promoting accountability (1) In General.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange. (2) Compliance examination and audits.—(A) In general—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance. (B) Recoupment of costs in connection with examination and audits. The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities. (c) Data Collection. The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services. (d) Sanctions Authority.—(1) In General—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2). (2) Remedies.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act; (B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur; (C) in the case of an Exchange-participating health benefits plan, suspension of payments to the entity under the Health Insurance Exchange for individuals enrolled in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur; or (D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title. (e) Standard Definitions of Insurance and Medical terms. The commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms. (f) Efficiency in Administration.—The Commissioner shall issue regulations for the effective and efficient administration of the Health Insurance Exchange and affordability credits under subtitle C, including, with respect to the determination of eligibility for affordability credits, the use of personnel who are employed in accordance with the requirements of title 5, United States Code, to carry out the duties of the Commissioner or, in the case of sections 208 and 241(b)(2), the use of State personnel who are employed in accordance with standards prescribed by the Office of Personnel Management pursuant to section 208 of the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728).

Sections on Choice

Section 102. Protecting the Choice to Keep Current Coverage. (a) Grandfathered Health Insurance Coverage Defined.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met: (1) Limitation on new enrollment.—(A) In General—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage is the first effective date of coverage is on or after the first day of Y1. (B) Dependent Coverage Permitted.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day. (2) Limitation on changes in terms or conditions. Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1. (3) Restrictions on premium increases. The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner. (b) Grace period for current employment-based health plans.—(1) Grace period.—(a) In general. The commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.












Section 201. Establishment of Health Insurance Exchange; Outline of Duties; Definitions
(a) Establishment.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.

Section 202. Exchange-eligible individuals and employers. (a) access to coverage.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.



Page 50 Section 152 in HC bill: HC will be provided to ALL non US citizens, illegal or otherwise


[Section 152 does not explicitly discuss coverage for non US citizens (see below). However, Section 242 states that health care credits will only be given to those legally in the United States. Section 242 states that an “affordable credit eligible individual” “means subject to subsection (b), an individual who is lawfully present in a State in the United States.]


Section 152, page 50: Prohibiting Discrimination in Healthcare.(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. (b) Implementation.—To implement the requirements set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.

Page 58 HC Bill: Govt will have real-time access to individuals finances & a National ID Healthcard will be issued!

[This section is an amendment to Part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.)]

Page 57 line 17 “Goals for financial and administrative transactions—The goals for standards under paragraph (1) are that such standards shall—(A) be unique with no conflicting or redundant standards; (B) be authoritative, permitting no additions or constraints for electronic transactions including companion guides; (C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications; (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; (E) enable, where feasible, near real-time adjudication of claims; (F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary; (G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upson set values in other fields and prohibit additional conditions; and (H) harmonize all common data elements across administrative and clinical transaction standards.”

Page 59 HC Bill lines 21-24: Govt will have direct access to your banks accounts for elective funds transfer.

Page 59, lines 21-4: “(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice”

Page 65 Sec 164: is a payoff subsidized plan for retirees and their families in Unions & community organizations: (ACORN).

[This section describes a reinsurance program for retirees and eligible family members, it does not specifically address unions or community organizations]

Section 164, page 65: Reinsurance Program for Retirees. (a) Establishment.—(1) In General.—Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the “reinsurance program”) to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses, and dependents of such retirees. (2) Definitions.—For purposes of this section: (A) The term “eligible employment-based plan” means a group of health benefits plan that—(i) is maintained by one or more employers, former employers or employee associations, or a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan, and (ii) provides health benefits to retirees. (B) The term “health benefits” means medical, surgical, hospital, prescription drug and such other benefits as shall be determined by the Secretary, whether self-funded or delivered through the purchase of insurance or otherwise. (C) The term “participating employment plan” means an eligible employment-based plan that is participating in the reinsurance program. (D) The term retiree means, with respect to a participating employment-benefit plan, an individual who—(i) is 55 years of age or older; (ii) is not eligible for coverage under title XVIII of the Social Security Act; and (iii) is not an active employee of an employer maintaining the plan or of any employer that makes or has made substantial contributions to fund such plan. (E) The term “Secretary” means Secretary of Health and Human Services.


Page 85 Line 7 HC Bill: Specifications for of Benefit Levels for Plans = The Govt will ration your Healthcare!

The Bill does specify that insurance plans on the exchange must be one of three levels: basic, enhanced or premium. The bill does not require employers to buy insurance through the exchange.


SPECIFICATION OF BENEFIT LEVELS FOR
PLANS.—(1) IN GENERAL.—The Commissioner shall establish the following standards consistent with this subsection and title I:(A) BASIC, ENHANCED, AND PREMIUM PLANS.—Standards for 3 levels of Exchange participating health benefits plans: basic, enhanced, and premium (in this division referred to as a ‘basic plan , ‘enhanced plan and premium plan’’, respectively).(B) PREMIUM-PLUS PLAN BENEFITS.— Standards for additional benefits that may be offered, consistent with this subsection and sub title C of title I, under a premium plan (such a plan with additional benefits referred to in this division as a ‘‘premium-plus plan’’).

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. Example - Translation: illegal aliens.

Health insurance provider are required to offer cultural and linguistically appropriate communication. The Bill does not include any health care insurance for illegal immigrants.

(7) CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES AND COMMUNICATIONS.—The entity [an entity that offers a Quality Health Benefits Plan] shall provide for culturally and linguistically appropriate communication and health services.

Page 95 HC Bill Lines 8-18: The Govt will use groups i.e., ACORN & Americorps to sign up individuals for Govt HC plan.

The bill allows the Commissioner to use ‘appropriate entities’ to disseminate information. The Bill does not clarify what type of entities these may be nor does it allocate any specific funds for these entities.

Page 95, lines 8-18 (a) IN GENERAL.—(1) OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection(c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.

(p. 100) USE OF OTHER ENTITIES.—In carrying out this subsection, the Commissioner may work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph (2).


Page 102 Lines 12-18 HC Bill: Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

Medicaid eligible individuals must enroll in Medicaid or enroll for benefits in an exchange-participating plan.

Page 102; lines 12-18 (3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.


Page 124 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt Monopoly.

The Bill specifies that there will be no review by the courts of payment rates established for the public option health benefit plan.

(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section [223] or under section 224.

Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what you can make! (salary)

The Bill does set payment rates for doctors for their treatment of patients that have the public option healthcare plan. Doctors are permitted to refuse treatment to patients with the public option and may charge other patients at whatever rate they choose.

(1) PHYSICIANS.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year,in one of 2 classes:(A) PREFERRED PHYSICIANS.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.(B) PARTICIPATING, NON-PREFERRED PHYSICIANS.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act. (2) OTHER PROVIDERS.—The Secretary shall provide for the participation (on an annual or other basis specified by the Secretary) of health care providers (other than physicians) under the public health insurance option under which payment shall only be available if the provider agrees to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.


Page 145 Line 15-17: An Employer MUST auto enroll employees into public option plan. NO CHOICE!

This is incorrect. An employer must auto enroll employees for any type of health plan, including the employer sponsored health benefits. The employee has a right to opt out of a health plan.

AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

Subsection (c) (c) AUTOMATIC ENROLLMENT FOR EMPLOYER SPONSORED HEALTH BENEFITS.—(1) IN GENERAL.—The requirement of this subsection with respect to an employer and an employee is that the employer automatically enroll such employee into the employment-based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium. (2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan (3) NOTICE REQUIREMENTS.—(A) IN GENERAL.—Each employer described in paragraph (1) who automatically enrolls an employee into a plan as described in such paragraph shall provide the employees,within a reasonable period before the beginning of each plan year (or, in the case of new employees, within a reasonable period before the end of the enrollment period for such a new employee), written notice of the employees’ rights and obligations relating to the automatic enrollment requirement under such paragraph. Such notice must be comprehensive and understood by the average employee to whom the automatic enrollment requirement applies.


Page 146 Lines 22-25: Employers MUST pay for HC for part time employees AND their families.

Employers must contribute a proportion of what they contribute for a full-time employee for each part-time employee, based on their average weekly hours of employment. The amount of the proportion will be decided by rules of the Health Choices Commissioner, Secretary of Labor, Secretary of Health and Human Services and Secretary of the Treasury.

(3) MINIMUM EMPLOYER CONTRIBUTION FOR EMPLOYEES OTHER THAN FULL-TIME EMPLOYEES.—In the case of coverage for an employee who is not a full-time employee, the amount of the minimum employer contribution under this subsection shall be a proportion (as determined in accordance with rules of the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury,as applicable) of the minimum employer contribution under this subsection with respect to a full-time employee that reflects the proportion of(A) the average weekly hours of employment of the employee by the employer, to (B) the minimum weekly hours specified by the Commissioner for an employee to be a full-time employee.


Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option pays 8% tax on all payroll.
Page 150 Lines 9-13: Business's with payroll btw 251k & 401k who doesn't provide public option pays 2-6% tax on all payroll.

If the employer does not provide private employee-based health insurance, businesses that have a payroll of greater than $400,000 must provide 8% tax on the payroll to the Health Insurance Exchange Trust Fund. For smaller companies, the same holds true, but they are required to pay between 2 and 6% depending on the size of payroll.


SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE.
(a) IN GENERAL.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and (2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.
(b) SPECIAL RULES FOR SMALL EMPLOYERS.—(1) IN GENERAL.—In the case of any employer who is a small employer for any calendar year, subsection (a) shall be applied by substituting the applicable percentage determined in accordance with the following table for ‘‘8 percent’’:
If the annual payroll of such employer for the preceding calendar year:
The applicable percentage is:
Does not exceed $250,000 .............. 0 percent
Exceeds $250,000, but does not exceed $300,000 2 percent
Exceeds $300,000, but does not exceed $350,000 4 percent
Exceeds $350,000, but does not exceed $400,000 6 percent

(2) SMALL EMPLOYER.—For purposes of this subsection, the term ‘‘small employer’’ means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed $400,000.(3) ANNUAL PAYROLL.—For purposes of this paragraph, the term ‘‘annual payroll’’ means, with respect to any employer for any calendar year, the aggregate wages paid by the employer during such calendar year.