Posts Tagged ‘ Socialized medicine ’

Summary Of Obama’s Proposal For Health Care Reform

Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs. Obama has now put forth a proposal that incorporates the work of the House and Senate. This proposal adds additional ideas from Republican members of Congress. It makes insurance more affordable by providing the largest middle class tax cut for health care. It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have. It will end discrimination against Americans with pre-existing conditions.

One key improvement is eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid. The proposal completely closes the Medicare prescription drug “donut hole” coverage gap. It strengthens the Senate bill’s provisions that make insurance affordable for individuals and families. The threshold for the excise tax on the most expensive health plans will be raised from $23,000 for a family plan to $27,500 and will start in 2018 for all such plans. And another important idea included is improving insurance protections for consumers and creating a new Health Insurance Rate Authority to review and rein in unreasonable rate increases and other unfair practices of insurance plans.

Download the full PDF of the President’s key improvements.

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.

Increase Tax Credits for Health Insurance Premiums
The House and Senate health insurance bills lower premiums through increased competition, oversight, and new accountability standards set by insurance exchanges. The bills also provide tax credits and reduced cost sharing for families with modest income. Relative to the Senate bill, the President’s Proposal lowers premiums for families with income below $44,000 and above $66,000. Relative to the House bill, the proposal makes premiums less expensive for families with income between roughly $55,000 and $88,000. The President’s Proposal also improves the cost sharing assistance for individuals and families relative to the Senate bill. Families with income below $55,000 will get extra assistance; the additional funding to insurers will cover between 73 and 94% of their health care costs.

Close the Medicare Prescription Drug “Donut Hole”.
The Medicare drug benefit provides vital help to seniors who take prescription drugs, but under current law, it leaves many beneficiaries without assistance when they need it most. Medicare stops paying for prescriptions after the plan and beneficiary have spent $2,830 on prescription drugs, and only starts paying again after out-of-pocket spending hits $4,550. This “donut hole” leaves seniors paying the full cost of expensive medicines, causing many to skip doses or not fill prescriptions at all. The Senate bill provides a 50% discount for certain drugs in the donut hole. The House bill fully phases out the donut hole over 10 years. Both bills raise the dollar amount before the donut hole begins by $500 in 2010.

Invest in Community Health Centers.
About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.

Strengthen Oversight of Insurance Premium Increases.
Both the House and Senate bills include significant reforms to make insurance fair, accessible, and affordable to all people, regardless of pre-existing conditions. One essential policy is “rate review” meaning that health insurers must submit their proposed premium increases to the State authority or Secretary for review.

Extend Consumer Protections against Health Insurer Practices.
The Senate bill includes a “grandfather” policy that allows people who like their current coverage, to keep it. The President’s Proposal adds certain important consumer protections to these “grandfathered” plans. Within months of legislation being enacted, it requires plans to cover adult dependents up to age 26, prohibits rescissions, mandates that plans have a stronger appeals process, and requires State insurance authorities to conduct annual rate review, backed up by the oversight of the HHS Secretary. When the exchanges begin in 2014, the President’s Proposal adds new protections that prohibit all annual and lifetime limits, ban pre-existing condition exclusions, and prohibit discrimination in favor of highly compensated individuals. Beginning in 2018, the President’s Proposal requires “grandfathered” plans to cover proven preventive services with no cost sharing.

Improve Individual Responsibility.
The House and Senate bills require individuals who have affordable options but who choose to remain uninsured to make a payment to offset the cost of care they will inevitably need. The House bill’s payment is a percentage of income. The Senate sets the payment as a flat dollar amount or percentage of income, whichever is higher (although not higher than the lowest premium in the area). Both the House and Senate bill provide a low-income exemption, for those individuals with incomes below the tax filing threshold (House) or below the poverty threshold (Senate). The President’s Proposal raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years – the same percent of income as in the House bill, which makes the assessment more progressive.

Strengthen Employer Responsibility.
Under the Senate bill, there is no mandate for employers to provide health insurance. But as a matter of fairness, the Senate bill requires large employers (i.e., those with more than 50 workers) to make payments only if taxpayers are supporting the health insurance for their workers. The assessment on the employer is $3,000 per full-time worker obtaining tax credits in the exchange if that employer’s coverage is unaffordable, or $750 per full-time worker if the employer has a worker obtaining tax credits in the exchange but doesn’t offer coverage in the first place. The House bill requires a payroll tax for insurers that do not offer health insurance that meets minimum standards. The tax is 8% generally and phases in for employers with annual payrolls from $500,000 to $750,000; according to the Congressional Budget Office (CBO), the assessment for a firm with average wages of $40,000 would be $3,200 per worker. The President’s Proposal, small businesses will receive $40 billion in tax credits to support coverage for their workers beginning this year. Consistent with the Senate bill, small businesses with fewer than 50 workers would be exempt from any employer responsibility policies.

Comprehensive Sanctions Database.
The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities. (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))

Registration and Background Checks of Billing Agencies and Individuals.
In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs (Source: H.R. 3970, “Medical Rights & Reform Act” ( Kirk bill))

Expanded Access to the Healthcare Integrity and Protection Data Bank.
Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers.
In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

Community Mental Health Centers.
The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers.
The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

Use of Technology for Real-Time Data Review.
The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse. (Source: Roskam Amendment offered in House Ways & Means Committee markup)

Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.
Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

Study of Universal Product Numbers Claims Forms for Selected Items and Services under the Medicare Program.
The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), Roskam Amendment offered in House Ways & Means Committee markup)

Medicaid Prescription Drug Profiling.
The President’s Proposal requires States to monitor and remediate high-risk billing activity, not limited to prescription drug classes involving a high volume of claims, to improve Medicaid integrity and beneficiary quality of care. States may choose one or more drug classes and must develop or review and update their care plan to reduce utilization and remediate any preventable episodes of care where possible. (Source: President’s FY 2011 Budget)

Medicare Advantage Risk Adjustment Errors.
The President’s Proposal requires in statute that the HHS Secretary extrapolate the error rate found in the risk adjustment data validation (RADV) audits to the entire Medicare Advantage contract payment for a given year when recouping overpayments. Extrapolating risk score errors in MA plans is consistent with the methodology used in the Medicare fee-for-service program and enables Medicare to recover risk adjustment overpayments (Source: President’s FY 2011 Budget)

Modify Certain Medicare Medical Review Limitations.
The Medicare Modernization Act of 2003 placed certain limitations on the type of review that could be conducted by Medicare Administrative Contractors prior to the payment of Medicare Part A and B claims. The President’s Proposal modifies these statutory provisions that currently limit random medical review and place statutory limitations on the application of Medicare prepayment review. (Source: President’s FY 2011 Budget)

Establish a CMS-IRS Data Match to Identify Fraudulent Providers.
The President’s Proposal authorizes the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with the Internal Revenue Service (IRS) to determine which providers have seriously delinquent tax debt to help identify potentially fraudulent providers sooner. The data match will primarily target certain high-risk provider types in high-vulnerability areas. (Source: President’s FY 2011 Budget)

Preventing Delays in Access to Generic Drugs.
Brand-name pharmaceutical companies can delay generic competition through agreements whereby they pay the generic company to keep its drug off the market for a period of time, called “pay-for-delay.” The President’s proposal adopts a provision from the bipartisan legislation that gives the FTC enforcement authority to address this problem. Specifically, it makes anti-competitive and unlawful any agreement in which a generic drug manufacturer receives anything of value from a brand-name drug manufacturer that contains a provision in which the generic drug manufacturer agrees to limit or forego research, development, marketing, manufacturing or sales of the generic drug.

Republican Ideas Included in the President’s Proposal

• Includes personal responsibility incentives: Allows health insurance premium to vary based on participation in proven employer wellness programs
o (Sources: H.R. 3468, “Promoting Health and Preventing Chronic Disease through Prevention and Wellness Programs for Employees, Communities, and Individuals Act” (Castle bill); H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), “Coverage, Prevention and Reform Act”)
• Advances medical liability reform through grants to States: Provides grants to States to jump-start and evaluate promising medical liability reform ideas to put patient safety first, prevent medical errors, and reduce liability premiums.
o (Sources: S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 4529, “Roadmap for America’s Future Act” (Ryan bill); S. 1099, “Patients’ Choice Act” (Burr-Coburn, Ryan-Nunes bill))
• Extends dependent coverage to age 26: Gives young adults new options.
o (Sources: H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
• Allows automatic enrollment by employers in health insurance: Allows employee to opt-out.
o (Sources: House Republican Substitute; H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); “Coverage, Prevention, and Reform Act” )
• Mechanisms to improve quality.
o (Sources: H.R. 4529, “Roadmap for America’s Future Act;” S. 1099, “Patients’ Choice Act;” H.R. 3400, Republican Study Group bill; S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill))
• Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.
o (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
• Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs. It ensures that entities that bill for Medicare on behalf of providers are in good standing. It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Expanded Access to the Healthcare Integrity and Protection Data Bank. Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.
o (Source: Roskam Amendment offered in House Ways & Means Committee markup)
• Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges. Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
o (Source: H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)

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Obama’s Health Care, A Bad Idea
H.R. 3962 Tax Hikes
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Obama Health Reform Lies
Impeach Obama
Bush Billboard, Miss Me Yet?
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Zumante Lucero, 9, Dies After State Cut Off Medicaid.

Zumante Lucero, a 9 year-old Denver boy with asthma, died in July after a severe attack. His family had previously been on Medicaid. Repeat: His family had previously been on Medicaid, but was unexpectedly cut off from the program by the State of Colorado.

According to Zuton Lucero, Zumante’s mother, she called Denver Human Services every few days for months. Human Services responded by affirming that all of her children were in fact covered under Medicaid. However, when local pharmacists’ computers did not register the family as having prescription drug coverage. This pattern continued until Zumante’s death in July. State officials have said that errors in a $243 million computer system installed in 2004 are to blame for mistakes like the one that led to Zumante Lucero’s death. A group of lawyers is now considering suing the state for rampant flaws in its benefits management system. The Colorado Benefits Management System’s computer problems also account for rampant delays in processing food stamp cases. Let’s send some prayers to the Lucero’s family.

Question: Who is the blame here? State Funded Healthcare? $243 million computer system installed in 2004? Local pharmacists’ lack of data? Human Services? The State of Colorado? The Mother for not finding another pediatrician? Could private Healthcare coverage plans give better services?

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Obama’s Health Care, A Bad Idea
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Affordable Health Care For America Act “H.R. 3962″

barack-obama-5aUnveiled by Obama’s Democrats. The Affordable Health Care for America Act H.R. 3962 has been updated with three versions of previous bills passed by the House committees of jurisdiction in July.  H.R. 3962 Complete Bill (1990 Pages)

Key Provisions:

Public Health Insurance Option
The Health Insurance Marketplace
Shared Responsibility
Guaranteed Benefits
Making Coverage Affordable
Consumer Protections and Insurance Market Reforms
Employers and Health Reform
Strengthening the Nation’s Health Workforce
Lowering Health Care Costs
Prevention and Wellness
Delivery System Reforms
Preventing Waste, Fraud and Abuse
Strengthening Medicare
Improving Medicare Part D Drug Program
Maintaining and Improving Medicaid
Medicare Advantage
Health Care Surcharge and Households
Health Care Surcharge and Small Businesses
Women Have the Most to Gain
Small Businesses
A Guide for Seniors
Young Americans
Rural Communities
Health Care Disparities
Indian Health

Top 14 Provisions That Take Effect Immediately »

Top 10 Changes to the Health Insurance Reform Bill

What Health Insurance Reform Means for You

Additional Information:
Complete Bill Text »

Top Line Changes »
4 Page Bill Summary »
10 Page Bill Summary »

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H.R. 3962 Summary

healthcareforbrainandspineinjuries-300x235The Affordable Health Care for America Act [H.R. 3962], which blends and updates the three versions of previous bills passed by the House committees of jurisdiction.

DETAILED SUMMARY

Insurance reforms. Prohibits insurance rating based on health status or pre-existing conditions, and limits age rating to 2:1. Prohibits annual or lifetime limits on medical spending. Grandfathers current individual policies.
Exchange.
Creates a new marketplace called the national “Health Insurance Exchange”, with an option for states that agree to meet federal standards to run their own exchange.
Eligibility.
People are eligible to enter the Exchange and purchase health insurance on their own as long as they are not enrolled in employer sponsored insurance, Medicare or Medicaid. The Exchange is also open to businesses, starting with small firms and growing over time.
Benefits.
Outlines broad categories of covered services in the law, and creates a Health Benefits Advisory Commission, with physicians and other expert members, to help the Secretary of HHS define the essential benefit package.
Public health insurance option.
The bill establishes a public health insurance option available within the Exchange to ensure choice, competition and accountability. Like other private plans, the public option must survive on its premiums.
New health insurance options.
The legislation authorizes start-up loans to assist states with the creation of health insurance co-operatives as an additional option. It also permits states to enter into agreements to allow for the sale of health insurance across state lines when the state legislatures agree to such compacts.
Repealing the antitrust exemption for insurers.
The bill promotes competition among health insurers and medical malpractice insurers by removing the antitrust exemption so that it no longer shields these insurers from liability for fixing prices, dividing up territories, or monopolizing their market.
Help for early retirees (temporary reinsurance program).
Creates a $10 billion fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.
Limitation on post-retirement reductions of retiree healthcare benefits.
Prohibits employers from reducing retirees‘ health benefits after those retirees have retired, unless the reduction is also made to benefits for active participants.
Employers.
Employers must either provide health insurance to their employees or make a contribution to help fund affordable health insurance. Employers that choose to offer coverage contribute at least 72.5 percent of premium for workers, 65 percent for families.
Small business protections.
Small businesses with annual payrolls below $500,000 are exempt from requirements to offer or contribute to coverage, including the 8 percent payroll contribution for failure to provide health benefits to their workers. There is also a tax credit program to help low-wage small businesses offer coverage to their employees.
Small business tax credits.
Small business tax credits are available for businesses with 10 or fewer employees and $20,000 or less in average wages. The credits phase-out if the employer has 25 or more employees or if average wages are $40,000 or more.
Individuals.
Individuals are required to obtain health insurance coverage or pay a fee equal to lower of 2.5 percent of their adjusted income above the filing threshold or the average premium on the Exchange. Individuals and families below the income tax filing are exempt.
Government responsibility.
It is the responsibility of the federal government to ensure that essential health coverage is affordable and available to all Americans by establishing consumer protections and insurance reforms, affordability credits and overseeing a fair marketplace for people to choose among options.
Affordability credits.
Provides financial assistance for premiums and cost sharing for individuals and families with incomes up to 400 percent of the federal poverty level (FPL). Affordability credits are offered on a sliding scale such that premiums range from 1.5 percent of income at the lowest tier to 12 percent at 400 percent FPL.
Eligibility
. Affordability credits are available to American citizens and legal residents whose employers do not offer coverage or whose share of employer-sponsored health insurance costs more than 12 percent of their family income.
Caps out-of-pocket spending and limits.
Helps prevent medical bankruptcy by limiting out-of pocket costs to no more than $5,000 for individuals and $10,000 for families; these levels are indexed to inflation.
Medicaid and CHIP.
Expands Medicaid coverage to everyone within income at or below 150 percent FPL ($33,100 per year for a family of 4) who is not eligible for Medicare. Eliminates assets tests for eligibility groups other than for long-term care. Requires States that now cover those above 150 percent FPL to maintain eligibility.
Revenue.
The bill would impose a surcharge on taxpayers with adjusted gross income in excess of $1 million (married filing a joint return) and $500,000 (single) at a rate of 5.4 percent. The bill also clarifies that an employee’s share of premiums for employer-provided coverage offered through the Exchange may be paid on a pre-tax basis through a cafeteria plan.
Hospitals.
Substantial delivery and payment system reforms, including productivity adjustments and reductions in market basket updates for most providers, per recommendations from MedPAC, OIG, GAO and others.
Skilled nursing facilities.
Follows recommendations from MedPAC and others to encourage payment accuracy that more accurately reflects the costs of services provided.
Medicare DSH payments.
Directs the Secretary of HHS to study Medicare DSH payments and report to Congress with recommendations on how best to ensure that DSH is properly targeted to adequately reflect the higher costs of care associated with treating low-income patients.
Graduate medical education.
Provides incentives for the training of primary care physicians. Encourages medical residency training in non-hospital settings so that the future physicians of America will be able to provide coordinated care across the spectrum of provider settings.
Hospice moratorium.
Extends a one year moratorium on regulatory changes that would phase out the budget neutrality adjustment factor for Hospice providers to ensure that hospices continue to receive the same reimbursement rate for wages for fiscal year 2010.
Reducing potentially preventable hospital readmissions.
Changes payment incentives to hospitals and post-acute care providers to discourage preventable hospital readmissions.
Post-acute care bundling.
Promotes bundled payments that encourage providers to coordinate a patient’s care across the entire spectrum, from the doctor’s office, to the hospital, through a rehabilitative or nursing facility stay, and back to home.
Center for Medicare & Medicaid Innovation.
Establishes a Center for Medicare & Medicaid Innovation to empower CMS to pursue additional payment and delivery system reforms.
Healthcare-associated infections.
Requires hospitals and ambulatory surgical centers to report public health information on healthcare-associated infections to the Centers for Disease Control and Prevention.
IOM study of the appropriateness of Medicare payment rates based on geography.
Within one year of enactment, the Institute of Medicine is required to report to CMS on the validity of the geographic adjusters that apply to Medicare physician and hospital payments and include any recommendations for improvements.
Productivity adjustments.
Expands productivity adjustments to Medicare providers who receive CPI updates in addition to those that receive market basket updates. These providers are: ambulatory surgical centers, ambulances, clinical laboratories, and durable medical equipment not competitively bid.
Accountable Care Organization program.
Establishes a new program that allows providers to share in Medicare savings they help create through care coordination and quality improvement initiatives. Ensures that doctors can join with hospitals and others when forming these organizations.
Telehealth.
Expands Medicare’s telehealth benefit to beneficiaries who are receiving care at freestanding dialysis centers.
Quality measures.
Creates a timely process to allow for a multi-stakeholder group to provide the Secretary with input into the selection of quality measures and provides for consultation by the Secretary of a consensus-based entity in the use of quality measures.
Cost sharing for preventive services.
Eliminates deductibles and co-payments for all preventive services covered by the Medicare program.
Improved access to vaccines.
Makes it easier for Medicare beneficiaries to get access to needed vaccinations by covering all vaccines under Part B of the program rather than Part D.
Extend Qualified Individuals (QI) program.
Extends the QI program two years to help low-income beneficiaries pay their Part B premiums.
Extends months of coverage of immunosuppressive drugs for kidney transplant patients.
Lifts the current 36-month limitation on Medicare coverage of immunosuppressive drugs for kidney transplant patients who would otherwise lose this coverage on or after January 1, 2012.
Durable medical equipment in Medicare.
Provides protections for beneficiaries receiving oxygen therapy in the event an oxygen supplier goes out of business. Exempts certain pharmacies from the surety bond requirement and the need to be accredited to sell diabetic testing supplies and certain other items.
Payment for imaging services.
Instructs CMS to pay more accurately for imaging services in Medicare. Excludes lowtech imaging devices (such as ultrasound, mammograms, EKGs, and x-rays) from the adjustment in payment.
Medicare drug benefit
. Eliminates Part D donut hole over time and provides 50 percent discount in donut hole for Part D enrollees. Restores manufacturer rebate for Part D drugs used by dual eligibles, as well as low-income subsidy eligibles after 2015.
Medicare low-income subsidy.
Increases eligibility limits by raising assets test and clarifying what counts toward the asset test. Eliminates cost-sharing for certain non-institutionalized dual eligibles.
Encourage accurate dispensing of drugs.
Requires that Part D and MA-PD plans develop methods to reduce waste of drugs in the long-term care setting.
Increase use of generics.
Increases generic drug utilization by eliminating current requirements that prevent Part D and MA-PD plans from creating incentives for seniors to use lower-cost generic drugs.
Follow-on biologics.
Creates an FDA licensure pathway for “biosimilar” generic biological products, allowing these products to come to market and compete with brand name biologics. The biosimilar product must have no clinically meaningful differences in safety, purity or potency from the reference product, and may not be licensed until at least 12 years after the date that the brand-name product was licensed.
Physician Payment Sunshine.
Requires manufacturers or distributors to electronically report to the HHS OIG any payments or other transfers of value above a $5 de minimis made to a “covered recipient. Requires hospitals, manufacturers and group purchasing organizations to report the nature of ownership arrangements by physicians.
REDUCIING WASTE,, FRAUD,, AND ABUSE
Increases funding by $100 million annually for the Healthcare Fraud and Abuse Control Fund to fight Medicare and Medicaid fraud; improves provider and payment screening to prevent fraud and abuse before it occurs; creates enhanced oversight for Medicare and Medicaid programs at risk of fraud and abuse; creates new penalties for providers and suppliers that defraud federal health care programs; partners with the private sector to reduce waste and abuse by requiring that all Medicare and Medicaid providers establish compliance programs to reduce waste, fraud, and abuse.
PREVENTIION & WELLNESS
Creates a grant program to help small and mid-sized employers begin or strengthen workplace wellness programs. These grants will assist in improving the health of our nation’s workforce and will reduce employer health care costs.
Coverage for HIV-positive individuals.
Allows State Medicaid programs to cover low-income individuals who are HIV positive through December 31, 2013, after which coverage will be available through the Health Insurance Exchange or, for those with incomes at or below 133 percent of poverty, Medicaid.
Increasing prescription drug rebates.
Increases the minimum percentage rebate on brand-name drugs to 23.1 percent of average manufacturer price; extends rebates to new formulations of brand-name drugs; and extends rebate requirement to drugs prescribed by Medicaid managed care organizations.
Reductions in Medicaid DSH payments.
Directs the Secretary of HHS to reduce Medicaid DSH payments to States by a total of $10 billion using a methodology that imposes the largest reductions on states with the lowest percentages of uninsured individuals or the least effective targeting of funds on DSH hospitals.
Prohibitions on Medicaid and CHIP payment for undocumented Immigrants.
Provides that the Medicaid title does not change current prohibitions against Federal Medicaid or CHIP payments for persons not lawfully present in the U.S.
Primary care residencies in community health centers.
Establishes a new grant program to support the development and operation of primary care residency programs in community-based settings such as community health centers.
School-Based health clinics.
Establishes a new grants program to support school-based health clinics that provide health services to children and adolescents.
IHS reauthorization.
A new division is added to provide for the reauthorization of the Indian Health Care Improvement Act (IHCIA). IHCIA provides the main legal authority for the provision of health care to American Indians and Alaskan Natives.

Additional Information:
Complete Bill Text »
4 Page Bill Summary »
10 Page Bill Summary »

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Obama Health Reform Lies
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Marine Vet David William Hedrick Rips Rep. Brian Baird
Obama Lies About Abortion Funding in Healthcare Bill
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Obama Health Reform Lies

obamahealthcare1Lie. Obama has said health-care reform will be deficit neutral, does not steer tax dollars to abortions and that there are 46 million uninsured Americans.

Truth.  The legislation proposed by Democrats in Congress and backed by Obama would establishing a government plan to compete with private insurers, mandate employer and individual coverage and prohibit insurance companies from denying coverage based on a pre-existing condition.

Lie. During his Aug. 22, weekly address aimed at busting myths about the health reform plan, Obama insisted the legislation would not fund abortions.
Obama said  when it comes to the current ban on using tax dollars for abortions, nothing will change under reform.”

Truth. However, the House bill mandates that government-run insurance exchanges where people would buy insurance with government subsidies include at least one plan that covers abortion. Committees in both the House and Senate rejected amendment that would have explicitly forbid federal money from going to pay for abortion under the plan.  The House Energy and Commerce Committee rejected an amendment on July 31 that would said, “No funds authorized under this Act (or an amendment by this Act) may be used to pay for any abortion.”  It was defeated by a 30-29 vote. The committee then added an amendment by Rep. Lois Capps (D-Calif.) that would leave it up to private insurers whether to fund abortions, even if these private insurers are taking federally subsidized customers.  Her amendment also required that at least one insurer in the federal insurance exchange cover abortion, and left it up to the secretary of health and human services to decide if the public option itself would provide abortion coverage.

Lie. During his July 22 news conference, the president stressed that one important goal of the legislation was to save money. Obama said: “Now, what we did very early on was say two-thirds of the costs of health care reform–which includes providing coverage for people who don’t have it, making it more affordable for folks who do, and making sure that we’re over the long term creating the kinds of systems where prevention and wellness and information technologies make the system more efficient–that the entire cost of that has to be paid for and it’s got to be deficit-neutral.”

Truth. Congressional Budget Office (CBO) has shown that the health care overhaul legislation would add another $1.04 trillion in federal spending over the next 10 years if enacted. That estimate primarily reflects $438 billion in additional federal outlays for Medicaid and $773 billion in federal subsidies that would be provided to purchase coverage through the new insurance exchanges. Not all enrollees in the exchanges would receive subsidies, but the average subsidy among those who would be subsidized is projected to rise from roughly $4,800 in 2015 to roughly $6,000 in 2019. The other main element of the proposal that would increase federal deficits is the tax credit for small employers who offer health insurance, which is estimated to reduce revenues by $53 billion over 10 years.

Lie. During the July 22 news conference, Obama said talked about the 47 million Americans who have no health insurance. In an op-ed in The New York Times, Obama said, “I don’t have to explain to the nearly 46 million Americans who don’t have health insurance how important this is.” During an Aug. 11 town hall meeting in Portsmouth, N.H., he also said, “nearly 46 million Americans don’t have health insurance coverage today,” and that “46 million of our fellow citizens have no coverage.”

Truth. The U.S. Census Bureau reports that 35.9 million U.S. citizens and 9.7 million foreign nationals living in the United States are without medical insurance. That is according to the bureau’s report on “Income, Poverty, and Health Insurance Coverage in the United States: 2007,” the most recent publicly available statistics. The president has overstated the number of Americans who are uninsured by as much as 10 million.

Lie. When speaking to the AARP, Obama said, “Nobody is talking cutting Medicare benefits.”

Truth.  Obama has supported eliminating subsidies to Medicare Advantage, which allows seniors to buy certain private plans with public dollars. The president has called the program “costly and redundant.” Obama has stated, “What we do want to do is eliminate some of the waste that is being paid for out of the Medicare trust fund that could be used more effectively to cover more people and to strengthen the system,”

Lie.
Obama has stated that everyone would be able to keep their existing plan. If you like your doctor, you can keep your doctor.  If you like your private insurance plan, you can keep your plan.

Truth. The government-run health insurance exchange and the public option, employers would have incentives to change the plan offered to their employees, according to studies by the CBO and the Lewin Group, a private health care analysis firm. The Lewin Group projects that if the government option extended to all employers, enrollment would grow to 131.2 million and 119.1 million Americans would leave private plans for the public option. When fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges.

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Obama’s Health Care, A Bad Idea

obamahealthcare1Obama’s own doctor, Dr. David Scheiner, the Chicago doctor who treated President Barack Obama for more than two decades, said “It’s a bad program. I don’t think it’s what he feels in his heart is necessary. I think it’s what he feels politically is the best way,” said Scheiner, who acknowledged he has not discussed the subject directly with Obama.

The reserve fund would not have to cover the costs of some important healthcare reforms already enacted and paid for.

Socialized medicine has failed every time it is tried. Socialized medicine means, among other things, rationing, waiting for availability, all financial controls and the authority to deny treatment that is not considered cost effective, even though it may be a life or death decision. Control of the system, financial and medical decisions, will be made by politicians and bureaucrats. The medical doctor and patient will have no say in the medical treatment.

The House bill sets out a system of low-deductibles, co-pays, and “actuarial equivalents” that would make it impossible for a high-deductible plan with only catastrophic-care coverage, costing around $5,000, to qualify. So consumers would be trapped in expensive plans — in our case, costing $13,500.

Middle- and upper-middle class Americans could face an enormous increase in their premiums. The hit could easily approach $4,000 for someone earning less than $90,000 — or more than double that increase as soon as the worker’s pay hits six figures. That’s because Obama’s plan would collect hundreds of billions of dollars in new taxes at the expense of medium earners, and re-channel the money into subsidies for the uninsured, low-income earners, and union retirees over age 55.

53% Of U.S. Voters Opposed To Obama’s Health Care Plan. Recent polling data from Rasmussen and Gallup indicates that more Americans disapprove than approve of the proposed Democrat-sponsored health care reform legislation that is currently up for consideration in the U.S. Congress.

44-year-old couple with an income of $66,150, slightly over the eligibility limit for a state insurance subsidy, policies cost at least $1,000 a month, or $12,000 a year—eighteen percent of their income. The cheapest policy, at $820 a month.  A family with kids could only afford $364 in monthly premiums.

America does not have enough doctors in the country to care for 35 million more patients.

This “pay or play” provision requires that they pay an 8% payroll tax in exchange for canceling coverage — only employers with revenues below $400,000 would pay less (see pages 149-150 of H.R. 3200).

It’s socialized medicine. America has had corporate medicine for about 35 years which is managed medicine by the government, and it has been a total disaster. And it didn’t work, so now we only have one other choice, it seems, and that is going towards total government medicine.

About 35 million Americans will be added to the system, and everyone will have access to a rich, standard package of benefits. These benefits are far more than what the average American needs or would be normally paying for.

The bottom line is that socialized medicine simply doesn’t work.  It hasn’t worked in the United States.  The citizens of Massachusetts and Hawaii can tell you that.  And it hasn’t worked in other countries abroad.  That’s why people from Britain and Canada come to the United States for treatment.

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