I put the blog on autopilot while I was away for a few days.
I was a little surprised by the reactions to the Health Reform Bill post. My intent in posting that e-mail was to generate discussion and encourage everyone to actually read what our elected officials are putting forth as the law controlling our health care for the foreseeable future. I had planned to do a point-by-point analysis, but didn’t have the time before I left, so I picked the end-of-life issue to comment because the comments made by the person who created the e-mail sounded inflammatory. They were. It seems as if the mere fact that I posted the e-mail meant to most people that I ratified all of the contents. Not true.
However, some of the comments were still on point. Had hoped that others would analyze the wording similar to what I did with the end-of-life issue. Oh well.
For those who did look at the bill and post specific comments, I want to address them.
“Page 22: Mandates audits of all employers that self-insure! (Section 142(b))”
Here’s the exact text:
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.
The language “shall” is a mandate, it is not permissive. The wording of the remainder of the sentence is poor, but it appears that the mandate requires the commissioner to conduct audits of whether qualified health benefits plans are complying with federal requirements. Unlike Shadowfax’s assertion, the wording does not “require ‘random compliance audits and targeted audits in response to complaints.'” Instead, the plain language states that the mandated audits “MAY INCLUDE” random compliance audits and targeted audits. The language does not limit the audits to those vehicles and states nothing about the degree or extent of the audits.
Little different, don’tcha think?
Since Shadowfax also picked out the “All non-US citizens, legal or not, will be provided with free health care services” statement, let’s look at that one, too.
Section 401 changes Chapter 1 Subchapter A of the Internal Revenue Code to impose a 2.5% tax on a portion of the adjusted gross income any individual who does not have acceptable health care coverage. The exact language is
‘(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of–
‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over
‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
Section 6012(a)(1) of the IRS Code is here and it makes no mention of what the “gross income specified” should be, so I am unclear how the 2.5% tax will be computed.
However, the language of the Act creates exceptions for certain classes of people who have to pay this tax. Those exceptions include
(2) NONRESIDENT ALIENS- Subsection (a) shall not apply to any individual who is a nonresident alien
(5) a “RELIGIOUS CONSCIENCE EXEMPTION” where individuals do not have to pay such tax if their religious tenets make them conscientiously opposed to receiving benefits of any private or public insurance.
Another part of the Act, Section 246, states
SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
Nothing in this subtitle shall allow Federal payments for affordability credits [note: See Section 241] on behalf of individuals who are not lawfully present in the United States.
Now let’s do a little critical thinking.
EMTALA requires hospitals to provide a screening exam and stabilizing treatment to any patient coming to the emergency department and requesting care. Hospitals are mandated to evaluate and stabilize regardless of ability to pay.
According to this new Act, nonresident aliens are statutorily exempt from paying into the system.
Also according to this new Act, the federal government will not pay for care of individuals unlawfully in the United States.
Adding these three things together, who ends up paying for the care of undocumented/nonresident aliens and those who express a religious exemption?
Frydoc commented about a National ID card. Guess what? I think it would be a great idea. How much money could we save if every patient could be tracked from hospital to hospital and we could pull up previous testing whether the testing was done down the street or across the country? No repeat testing because you didn’t know the same test was done a week ago. Drug seekers that doctor shop – eliminated.
I think that a national ID card would vastly improve the continuity and quality of healthcare in this country.
Nick Dupree brought up the issue of Special Needs Plans and “restricting enrollment”. The title of this section in the Act is actually misleading. The title is “SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT”
On first blush, it may seem as if the special needs patients may have their enrollment restricted. Actually, according the Social Security Act section that the Act references, the Act allows some plans to restrict enrollment only to patients who have special needs. In effect, the Act tries to create more available care for special needs patients.
Surprised to find several people who criticized the post by making a general statement about the bona fides of the e-mail when they didn’t put forth any factual data to support their statements. Isn’t that exactly what you criticized me for doing?
At least I got some people to look at the proposed legislation – myself included.
Even after reading all 2541 sections, I still have a lot of concerns.
Want to respond to the questions Mass posted in one of the comments after I get some sleep.