PG 102 Lines 12-18 HC Bill - Medicaid Eligible Indiv. will be automat.enrolled in Medicaid. No choice

• Current law allows individuals to be auto-enrolled in Medicaid if they show up for health services and are eligible, so this is not a radical change.  Only individuals that fall under 133% of the poverty level who have not had health insurance for six months will be auto-enrolled.

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

• There is no judicial or administrative review for the payment rates set for the public option.

pg 127 Lines 1-16 HC Bill - Doctors/ #AMA - The Govt will tell YOU what u can make.

• This section outlines payment policies for physicians participating in the public option only.  No physician has to take the public option.
  

Pg 145 Line 15-17 An Employer MUST auto enroll employees into pub opt plan. NO CHOICE

• No. You get to choose your health insurance from the choices your employer offers you.  If you fail to do so, your employer will auto-enroll you in the lowest premium health plan (for employees) unless or until you opt into a different plan.  You could not be auto-enrolled into the public option in the vast majority of cases because the public option is not even available outside the Exchange (only to individuals and small businesses).  The bill specifically mandates that employers provide employees with info on how to opt out of the auto-enrollment coverage.

Pg 126 Lines 22-25 Employers MUST pay 4 HC 4 part time employees AND their families.(this will insure bankruptcies of many small businesses)

• Employers will only pay a proportion of what they must pay for full-time employees.  There is also a tax credit equal to 50% of the amount paid by a small employer for employee health coverage available to help with these costs and other protections to ensure that new requirements don’t cause undue hardship for small businesses.

Pg 149 Lines 16-24 ANY Employer w payroll 400k & above who does not prov. pub opt. pays 8% tax on all payroll  (this will insure more bankruptcies of many small businesses)
 

• All businesses, except some small businesses that are exempted, must contribute to their employees’ health insurance.  Most employers that are required to provide coverage under this bill already provide coverage—so little will change for them under this bill.  They will continue to offer the coverage that they do today, and will not pay a tax.  Some employers may choose to do so through the Exchange, but no employer nor employees will be forced to choose any option.  Employers that don’t contribute to employees’ health care will make a contribution to the Exchange, so their employees can access coverage there.

pg 150 Lines 9-13 Biz w payroll btw 251k & 400k who doesn't prov. pub. opt pays 2-6% tax on all payroll (this will insure even more bankruptcies of many small businesses)

• All businesses, except certain small businesses that are exempted, must contribute to their employees’ health insurance.  Small businesses typically pay more for the same insurance that a large employer might offer.  Small businesses will benefit from this legislation, because it will help lower their administrative costs and insurance rating, and increase options available to them. The House legislation helps level the playing field between large and small businesses that want to offer health insurance.

Pg 167 Lines 18-23 ANY individual who doesn't have acceptable HC according 2 Govt will be taxed 2.5% of inc (this insures the government can collect extra taxes from you anytime they want)

• No, they can only collect the tax if you don’t have insurance and can afford to purchase it.  Acceptable coverage includes grandfathered individual and employer coverage (ie what you have now providing your insurance company complies with new laws), certain government coverage (e.g., Medicare, Medicaid, certain coverage provided to veterans, military employees, retirees, and their families), and coverage obtained pursuant to the Exchange or an employer offer of coverage. 

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from indiv. taxes. (Americans will pay)  (this will attract more millions to America..... legally and illegally.... it will kill our economic engine....DEAD!)
 

• Nonresident aliens and illegal aliens are not the same thing.  A nonresident alien is a non-citizen in the country legally (for example on a visa) who has not resided in the country long enough to be considered a resident.  This provision is consistent with current law governing tax treatment of non resident aliens.

Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will have access 2 ALL Americans finan/pers recs

• The Health Choices Commissioner can receive taxpayer return information from the Internal Revenue Service in order to assist the Exchange in determining subsidy eligibility.  This is the only allowable use for this information.
  

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

• This is a technical wording to ensure appropriate function of the tax under the tax code.

Pg 239 Line 14-24 HC Bill Govt will reduce physician svcs 4 Medicaid. Seniors, low income, poor affected
 

• Completely wrong. This section adjusts the way the sustainable growth rate (SGR) formula is calculated, helping to prevent massive cuts for physicians.  All physicians and AMA are in strong support of this section.  Also it is for Medicare, not Medicaid.

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

• Again, this still is part of the SGR adjustment- which applies to all specialties.  Providers and AMA very strong supporters of this.

PG 253 Line 10-18 Govt sets value of Dr's time, prof judg, etc. Literally value of humans.

• This section directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare.  It allows the secretary to incorporate all the work that a doctor does outside of the procedure when evaluating fee schedules:  such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk, and may include validation of the pre, post, and intra-service components of work.  This doesn’t have anything to do with the value of human lives.

PG 265 Sec 1131 Govt mandates & controls productivity for private HC industries
(this will kill free enterprise and drive many out of business.... less resources yet available for the boomers)
 

• This is a complete misreading of what this section is.  This section updates the market basket payment for hospital outpatient services.  Just because the word productivity is in there doesn’t mean it is mandating productivity of industry – it just holds providers accountable to the same level of productivity as the whole economy, putting them on a level playing field.

PG 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs

• No, this changes the way Medicare pays for power drive wheelchairs (13 month payments vs. one lump sum).  It is essentially rent-to-own for power wheelchairs, and is one of the ways that Medicare already pays for wheelchairs.

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

• This is the opposite of rationing.  This section allows Medicare to pay cancer hospitals more if they are incurring higher costs.

Page 280 Sec 1151 The Govt will penalize hospitals 4 what Govt deems preventable readmissions.

• Preventable readmissions are never desirable.  Hospitals are dangerous places, and the more time spent in one, the greater risk of infection or harm to the patient.  Right now, hospitals are paid for quantity of care, so the more you are readmitted, the more they get paid.  This provision will help incentivize preventative measures and post-treatment coordination of care to keep you healthier.
  

Pg 298 Lines 9-11 Drs, treat a patient during initial admiss that results in a readmiss-Govt will penalize u.

• Preventable readmissions are never desirable.  Hospitals are dangerous places, and the more time spent in one, the greater risk of infection or harm to the patient.  Right now, hospitals and doctors are paid for quantity of care, so the more you are readmitted, the more they get paid.  This will help incentivize preventative measures and post treatment coordination of care to keep you healthier. 

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.

• This prohibits expansion of physician-owned hospitals because they often drive up costs, duplicate health services, drain resources from community hospitals, and provide perverse incentives for doctors to self-refer patients to hospitals they have a stake in to perform procedures.  For example, if a doctor self-refers you for a heart operation, he makes money on the procedure and the hospital he owns makes money too.
  

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

• Same as above.

pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required. Can u say ACORN?!!

• Physician-owned hospitals can apply for an exception to expand- and input of the community they serve is required to determine how valuable the hospital is to the patients they serve.  Why does community automatically mean acorn?

Pg335 L 16-25 Pg 336-339 - Govt mandates estab. of outcome based measures. HC the way they want. Rationing

• This section creates an incentive system to increase payments to high quality Medicare Advantage plans and plans that demonstrate improvement and better outcomes such as reduced readmissions, and better outcomes of its enrollees.  This is about better quality care, not rationed care.  A plan that cuts back on care and produces worse outcomes would not receive any extra payment.

Pg 341 Lines 3-9 Govt has authority 2 disqual Medicare Adv Plans, HMOs, etc. Forcing peeps in2 Govt plan
 

• This only says it can disqualify participating plans from Medicare Advantage.  This would not result in seniors being forced into the public option.  They would remain on Medicare (which is, by the way, a government plan). 

Pg 354 Sec 1177 - Govt will RESTRICT enrollment of Special needs ppl! WTF. My sis has down syndrome!!

• This ensures that chronic condition special needs plans (SNPs) enroll beneficiaries only during their eligibility periods and extends the SNP program through 2012, and extends certain fully integrated dual eligible SNPs through 2015. 

Pg 379 Sec 1191 Govt creates more bureaucracy - Telehealth Advisory Cmtte. Can u say HC by phone? 84 new govt agencies!

• Telehealth is a critical service for rural populations and the disabled who may have difficulty traveling to health centers and hospitals.  A committee at HHS does not constitute a new agency.  This section expands Medicare’s telehealth benefit to beneficiaries who are receiving care at freestanding dialysis centers (ie very sick patients who have difficulty traveling).  It Also establishes a Telehealth Advisory Committee to provide HHS with additional expertise on the telehealth program. 

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

• There is no mandate for this sort of counseling.  The only mandate is that Medicare must pay for the consultation between patients and practitioners to discuss plans for end-of-life care.  These are important individual decisions that take time and consideration, and AARP supports inclusion of this planning provision.

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

• Not mandatory!  These are consultations between you and your provider, not the government.

PG 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding u in death

• CMS will provide planning resources to discuss with your doctor about how you would like to be treated in your final days.

PG 427 Lines 15-24 Govt mandates program 4 orders 4 end of life. The Govt has a say in how ur life ends

• You decide how your life ends- that is the whole point of an advance directive.

Pg 429 Lines 1-9 An "adv. care planning consult" will b used frequently as patients health deteriorates

• Those lines don’t say that.

PG 429 Lines 10-12 "adv. care consultation" may incl an ORDER 4 end of life plans. AN ORDER from GOV
 

• No, an order from you for your doctor

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

• The bill specifies which categories of licensed health care professionals can write them but not which specific doctor – you can still choose your doctor.

PG 430 Lines 11-15 The Govt will decide what level of treatment u will have at end of life

• No, you decide with your doctor

Pg 469 - Community Based Home Medical Services= Non profit orgs. Hello, ACORN Medical Svcs here!!?
 

• This section is the Medical home pilot program.  This in no way refers to ACORN.

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

• The community based medical home, is targeted at a broader population of Medicare beneficiaries with chronic diseases and allows for State-based or non-profit entities to provide care-management supervised by a beneficiary designated primary care provider.  A provision inclusive of all non-profit entities in no way targets ACORN

PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt in 2 ur marriage
 

• Medicare will now cover state licensed marriage and family therapists.  You are not forced to receive these services.

Pg 494-498 Govt will cover Mental Health Svcs including defining, creating, rationing those svcs

• Medicare will now cover mental health counselors.  It will not ration these services.

Check back for additional updates

Support for the HR 3200 - America's Affordable Health Choices Act »

Key Conclusions from the EPI report

• “It is highly unlikely that a health care reform package including a play-or-pay policy will lead to job losses. On the contrary, such policy reform is likely to cause significant boost to employment.”
• “In short: concerns over job losses from comprehensive health care reform proposals that include play-or-pay employer contribution are overstated and unfounded.” 
• “Moreover, it is likely that the positive effects on employment from health care reform will surpass by several orders of magnitude any modest job losses caused by a play-or-pay policy considered in isolation, providing a substantial boost for the U.S. economy and U.S. workers.”
  

What about other studies that show significant job losses associated with play-or-pay?

• “Prior studies instead modeled a requirement that all employers provide private health insurance to their employees. With average costs of compliance of 40% of payroll or more for employers facing such a requirement, it is not surprising that those prior studies found much larger effects on employment that would be expected from a play-or-pay policy with a cost of compliance of just 4-8% of payroll.”

More information on the Tri-Committee discussion draft.

We’ve met with our respective Democratic and Republican committee members, with our Senate colleagues, with the CBO, and with administration officials in an open and collaborative process.

To further this open and collaborative process, our three committees will hold hearings on this draft starting next week.

After the July Fourth district work period, our committees will then work to make refinements to the draft, vote on it, and send a bill to the House floor.

This is truly exciting news.

The House decided to use this unified approach because we recognized that our ability to succeed at health care reform rests in our ability to work together.

We know that inside-the-beltway turf battles will not advance reforms.

We believe that in order to change America’s health care system, Congress itself must change.  

When the voters elected Barack Obama President, they did not only send a message that the White House must change.

They sent an equally strong message to the Congress that we must work together for the common good of our nation.

They told us that we will not be rewarded for standing on the sidelines or for raising every conceivable argument against taking action.  

Americans will judge us, and rightly so, by our willingness and our determination to cooperate and focus on the ultimate and necessary goal of reforming our health care system so that it works not just for the few but for everyone in our country.

That is why the approach that the three of us have taken in this process is one of the key factors that makes this year the year that we will finally fix our broken health care system.    

The current path is unsustainable. No one disagrees with that.

Health care premiums have spiraled out of control – dealing a crushing blow to families and businesses alike and placing our fiscal future in peril. Rising costs are unsustainable.

President Obama is absolutely correct when he says that health care reform is essential to the health of our nation and the strength of our economy.  

In fact, health care reform is the single greatest tool to reduce runaway budget deficits.  

Our discussion draft is the first step in building a truly American solution that will reduce costs, offer real choice, and guarantee affordable, quality health care for all.

It will build a health care system that emphasizes keeping Americans healthy, not waiting until they become sick to get treated.

In the coming weeks, our committees will continue to seek input from all the stakeholders, the American people, and all members of Congress.

But let me say again that we must and we will continue to move forward.  If there is one thing that is ‘off of the table’ it is saying ‘no’ to health care reform.  

There is not one child, not one worker, not one employer, nor one taxpayer who can further bear the cost of doing nothing.  

I am confident that we have the ability to respond to their needs.

I’d like to thank Speaker Pelosi, Majority Leader Hoyer, the rest of our Democratic Leadership, and all of our Caucus for giving us the support and input we’ve needed to develop this uniquely American solution for finally bringing quality, affordable health care to our country.

Support for the House Tri-Committee Health Reform Discussion Draft

• AARP »
  
• Health Care for America Now »
• Small Business Majority »
• U.S. PIRG »
  

1.    QUESTION: Who is eligible for the premium reduction?

A.    To be eligible for the premium reduction, you must be a COBRA qualified beneficiary who meets all of the following requirements:

•    Is eligible for COBRA continuation coverage as a result of Federal or State law at any time during the period beginning September 1, 2008 and ending December 31, 2009;
•    Elects COBRA coverage (when first offered or during the additional election period); and
•    Was involuntarily terminated during the period beginning September 1, 2008 and ending December 31, 2009.  

If you are eligible for other group health coverage (such as through a spouse's plan) or for Medicare, you are not eligible for the premium reduction.  In addition, your same year (2009 and/or 2010) modified adjusted gross income must not exceed $125,000 (or $250,000 for families).  If your income exceeds this limit, all or part of the amount of your premium reduction may be recaptured by an increase in your income tax liability for the year.  

2.    QUESTION:  How do I know whether or not I have been involuntarily terminated from employment?

A.    Involuntary termination is a termination that is at the direction of the employer.  Note that termination for gross misconduct will generally disqualify an employee and his/her family from COBRA coverage.  For more information on whether your termination is involuntary please call the Department of Labor’s Employee Benefits Security Administration’s Benefits Advisors at 1-866-444-3272.

3.    QUESTION:  How does the premium reduction work?  

A.    It works the same way as standard COBRA coverage.  However, instead of paying the full premium to the former employer/insurer, you will pay 35% of the premium.  The former employer/insurer will be compensated for the other 65% of the premium by the federal government.  
The premium reduction is available as of your first period of coverage beginning on or after February 17, 2009, the date of enactment of this law.  Some plans may have already sent out bills for the full premium.  If you get a bill for the full premium and pay it, you will either be reimbursed for the overpayment or receive a credit toward future premium payments.

4.    QUESTION:  How do I sign up for the premium reduction?  

A.    To sign-up for the premium reduction, you must enroll in COBRA coverage and fill out the premium reduction enrollment forms provided by your health plan.  Generally, under COBRA the employer must notify your health plan that you are being terminated within 30 days.  After that, your health plan must notify you within 14 days regarding your COBRA eligibility and provide you with materials regarding enrollment.  After February 17, 2009, plans will also begin sending out information regarding the premium reduction.  If you have not yet received information from your health plan, you can contact your plan directly.  

5.    QUESTION:  I was involuntarily terminated after September 1, 2008 and am enrolled in COBRA now.  How do I get the premium reduction?

A.    As of your first period of coverage beginning on or after February 17, 2009, you are only required to pay 35% of your total premium.  You should immediately contact the former employer/insurer that administers your COBRA to obtain the documents necessary to establish eligibility for the premium reduction and explain that you intend to take advantage of the premium reduction and pay 35% of your premium.  If you have already paid the full amount for the next pay period, your former employer or insurer is required to reimburse you or credit a future payment.

6.    QUESTION:  What if I was involuntarily terminated after September 1, 2008 but didn’t elect COBRA within 60 days as required by law?

A.    If you were involuntarily terminated from September 1, 2008 through February 16, 2009, but failed to initially elect COBRA you will get a second chance to elect COBRA and receive the premium reduction. No later than April 18, 2009 health plans should notify individuals about the second election period, in addition to providing any forms and information needed to enroll.  You will have 60 days after receipt of that notice to enroll in COBRA and the premium reduction.  However, you can contact your former employer now and say you want to take advantage of the second chance election period.  In either case, your coverage begins with the first period of coverage beginning on or after February 17, 2009.  

7.    QUESTION:  What if I was involuntarily terminated after September 1, 2008, elected COBRA within 60 days as required by law, but dropped the coverage?

A.    If you were involuntarily terminated during the period from September 1, 2008 through February 16, 2009 and initially elected COBRA, but dropped the coverage (for example, because it was unaffordable), you will get a second chance to elect COBRA and receive the premium reduction.  No later than April 18, 2009 your health plan should notify individuals about the second election period and should provide any forms and information needed to enroll.  You will have 60 days after receipt of that notice to enroll in COBRA and sign up for the premium reduction.  However, you can contact your former employer now and say you want to take advantage of the second chance election period.  In either case, your coverage begins with the first period of coverage beginning on or after February 17, 2009.    

8.    QUESTION:  Who can take advantage of the additional election period?

A.    Only plans subject to the Federal COBRA provisions are required to provide an additional election period when certain involuntary terminations occurred from September 1, 2008 through February 16, 2009.  ARRA does not require coverage provided under state continuation coverage provisions (including state mini-COBRA coverage) to offer an additional election period.  States may choose but are not required to offer a second election period.

9.    QUESTION:  Is death considered an involuntary termination?

A.    No.  While death of an employee can be a qualifying event for that person’s beneficiaries to be eligible for COBRA coverage, death is not an involuntary termination of employment.  The beneficiaries would be required to pay the full premium amount if they elected COBRA.  However, if an employee dies after an involuntary termination, the employee’s beneficiaries may be entitled to the premium reduction for the remainder of the 9 month period that would otherwise be available.  

10.    QUESTION:  How long can I receive the premium reduction?  

A.    Generally, individuals who qualify can receive the 65% premium reduction for up to 9 months.  COBRA coverage is still available for up to 18 months and 36 months in some cases.  If you remain on COBRA after the premium reduction period expires, you may be responsible to pay the full premium amount.  
In certain situations, however, you would not be eligible to receive the premium reduction for 9 months.  If one of the following events occurred, the premium reduction would end at the earliest occurring event:  

•    your employer (which in this case includes any responsible related or successor employer) no longer offers any group health plan to employees;

•    you fail to make your premium payment; or

•    you become eligible to receive health care through Medicare or another group health plan (such as the plan of a new employer or a spouse’s employer).  

It is important to note that if and when you become eligible for coverage through Medicare or another group health plan, you must notify the plan administrator immediately.  While you remain eligible for COBRA when offered new coverage, you will no longer be eligible to receive the premium reduction.  Continuing to receive the premium reduction after becoming eligible for other coverage could result in a penalty equal to 110 percent of the premium provided to you after your eligibility ends.

11.    QUESTION:  What do I do if I think I qualify for the COBRA premium reduction but my plan tells me I do not?  

A.    If your health plan finds that you are ineligible for the premium reduction, you can apply for review of that determination by the Secretary of Labor or by the Secretary of Health and Human Services depending on your type of plan (see following question).  The Secretary will review your application and make a determination within 15 business days.  

12.    QUESTION:  Where do I send my appeal?

A.    The Departments of Labor (DOL) and Health and Human Services (HHS) are currently developing processes and an official form that will be required to be completed for applications for review.  

•    DOL will handle appeals related to private sector employers who are subject to ERISA’s COBRA provisions.  For more information or assistance determining where to file your appeal, visit www.dol.gov/COBRA or contact DOL at 1-866-444-3272.

•    HHS will handle appeals for all government employees (federal and non-federal) as well as for those individuals covered by so-called mini-COBRA (insurance policies offered by employers with fewer than 20 employees).  

13.    QUESTION:  How does the income cap work?

A.    The income cap is designed to ensure that the premium reductions are going to people who most need the help.  If your income for the year in which you are receiving the premium reduction (2009 and/or 2010) is more than $125,000 (or $250,000 for married couples filing a joint federal income tax return) all or part of the premium reduction may be recaptured by an increase in your income tax liability for the year.  If you think that your income may exceed the amounts above, consult your tax preparer or contact the IRS at 1-800-829-1040.

14.    QUESTION:  If I elect COBRA and receive the premium reduction, can I change my coverage or do I have to retain the coverage I had while employed?

A.    Group health plans are permitted, but not required, to allow qualified beneficiaries to enroll in coverage that is different than the coverage they had at the time of the qualifying event.  Changing coverage will not cause an individual to be ineligible for the COBRA premium reduction, provided that: the premium for the different coverage is the same or lower than the coverage the individual had at the time of the qualifying event; the different coverage is also offered to active employees; and the different coverage is not limited to only dental coverage, vision coverage, counseling coverage, a flexible spending account, or on-site medical clinic.  If the plan permits individuals to change coverage options, the plan must provide the individuals with a notice of their opportunity to change.  Individuals have 90 days to elect to change their coverage after the notice is provided.

15.    QUESTION:  What if I was laid off before September 1, 2008, can I receive the premium reduction?  

A.    No.  To be eligible for the premium reduction you must have lost your job on a date between September 1, 2008 and December 31, 2009.  

16.    QUESTION:  What if my employer went out of business and did not continue the company health plan, can I receive COBRA coverage and the premium reduction?  

A.    If your employer terminates all its health plans, COBRA continuation coverage will generally not be available unless another related or successor employer sponsors a group health plan responsible under COBRA for providing coverage to you.  

17.    QUESTION:  As an employer, how can I get more information about how the premium reduction works and how I will report the reductions on my quarterly federal tax return Form 941?

A.    Contact the IRS at 1-800-829-4933.  

18.    QUESTION:  Where can I get more information if I have additional questions about the COBRA premium reduction?

A.    Contact the Department of Labor’s Employee Benefits Security Administration’s Benefits Advisors at 1-866-444-3272.  In addition, the Employee Benefits Security Administration has developed a dedicated COBRA web page www.dol.gov/COBRA that will contain information on the program as it is developed.  Subscribe to this page to get up to date fact sheets, FAQs, model notices and applications.