45 Comments

  1. Just think, it’s 50% bigger than HR 3200! Over three reams of paper to spend, as Carl Sagan might have said, Billions, and Billions, but according to Harry Reid, it’s Trillions and Trillions. And it’s something 55% of the people don’t want, but we all know Dems know better than us yokels out in the sticks. Afterall, the great philospher, Bill Maher, said we’re all stupid anyway.

  2. Perry wrote:

    Right, Yorkshire, as you said, you are stupid, if you judge a bill by how many pages it has!

    Actually, it might be a good way to judge. For one thing, it means that few, if any, of our good congressmen have actually read the damned law that they wish to impose on all of us. And as you get laws written so voluminously, more little stuff gets hidden in there, things no one knows about, things no one sees, until it’s too late and the bill has been enacted into law.

  3. Perry:
    Right, Yorkshire, as you said, you are stupid, if you judge a bill by how many pages it has!

    OK Dumbass, you are the first to yell DOCUMENTATION, so I gave it to you. Bet you never bothered to open it. 1,502 pages is what you trust your future to, unread. So, here’s the frikkin index. GO READ IT YOURSELF. When I found the hidden GEMS in HR 3200 you blew off you HYPER-BLOWHARD-PARTISAN. And Harry Reid loves this one. Look that up yourself.

    Sec. 1. Short title; table of contents.
    TITLE I—HEALTH CARE COVERAGE
    Subtitle A—Insurance Market Reforms
    Sec. 1001. Insurance market reforms in the individual and small group markets.
    ‘‘TITLE XXII—HEALTH INSURANCE COVERAGE
    ‘‘Sec. 2200. Ensuring essential and affordable health benefits coverage for all Americans.
    ‘‘PART A—INSURANCE REFORMS
    ‘‘SUBPART 1—REQUIREMENTS IN INDIVIDUAL AND SMALL GROUP MARKETS
    ‘‘Sec. 2201. General requirements and definitions.
    ‘‘Sec. 2202. Prohibition on preexisting condition exclusions.
    ‘‘Sec. 2203. Guaranteed issue and renewal for insured plans.
    ‘‘Sec. 2204. Premium rating rules.
    ‘‘Sec. 2205. Use of uniform outline of coverage documents.
    ‘‘SUBPART 2—REFORMS RELATING TO ALLOCATION OF RISKS
    ‘‘Sec. 2211. Rating areas; pooling of risks; phase in of rating rules in
    small group markets.
    ‘‘Sec. 2212. Risk adjustment.
    ‘‘Sec. 2213. Establishment of transitional reinsurance program for individual
    markets in each State.
    ‘‘Sec. 2214. Establishment of risk corridors for plans in individual and
    small group markets.
    ‘‘Sec. 2215. Temporary high risk pools for individuals with preexisting
    conditions.
    ‘‘Sec. 2216. Reinsurance for retirees covered by employer-based plans.
    ‘‘SUBPART 3—PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE
    ‘‘Sec. 2221. Grandfathered health benefits plans.
    ‘‘SUBPART 4—CONTINUED ROLE OF STATES
    ‘‘Sec. 2225. Continued State enforcement of insurance regulations.
    ‘‘Sec. 2226. Waiver of health insurance reform requirements.
    ‘‘Sec. 2227. Provisions relating to offering of plans in more than one
    State.
    ‘‘Sec. 2228. State flexibility to establish basic health programs for low-income
    individuals not eligible for Medicaid.
    ‘‘SUBPART 5—OTHER DEFINITIONS AND RULES
    ‘‘Sec. 2230. Other definitions and rules.
    Subtitle B—Exchanges and Consumer Assistance
    Sec. 1101. Establishment of qualified health benefits plan exchanges.
    ‘‘PART B—EXCHANGE AND CONSUMER ASSISTANCE
    ‘‘SUBPART 1—INDIVIDUALS AND SMALL EMPLOYERS OFFERED AFFORDABLE
    CHOICES
    ‘‘Sec. 2231. Rights and responsibilities regarding choice of coverage through exchange.
    ‘‘Sec. 2232. Qualified individuals and small employers; access limited to citizens and lawful residents.
    ‘‘SUBPART 2—ESTABLISHMENT OF EXCHANGES
    ‘‘Sec. 2235. Establishment of exchanges by States.
    ‘‘Sec. 2236. Functions performed by Secretary, States, and exchanges.
    ‘‘Sec. 2237. Duties of the Secretary to facilitate exchanges.
    ‘‘Sec. 2238. Procedures for determining eligibility for exchange participation,
    premium credits and cost-sharing subsidies, and individual responsibility exemptions.
    ‘‘Sec. 2239. Streamlining of procedures for enrollment through an exchange
    and State Medicaid, CHIP, and health subsidy programs.
    Sec. 1102. Encouraging meaningful use of electronic health records.
    Subtitle C—Making Coverage Affordable
    PART I—ESSENTIAL BENEFITS COVERAGE
    Sec. 1201. Provisions to ensure coverage of essential benefits.
    ‘‘PART C—MAKING COVERAGE AFFORDABLE
    ‘‘SUBPART 1—ESSENTIAL BENEFITS COVERAGE
    ‘‘Sec. 2241. Requirements for qualified health benefits plan.
    ‘‘Sec. 2242. Essential benefits package defined.
    ‘‘Sec. 2243. Levels of coverage.
    ‘‘Sec. 2244. Application of certain rules to plans in group markets.
    ‘‘Sec. 2245. Special rules relating to coverage of abortion services.
    Sec. 1202. Application of State and Federal laws regarding abortion.
    Sec. 1203. Application of emergency services laws.
    PART II—PREMIUM CREDITS, COST-SHARING SUBSIDIES, AND SMALL
    BUSINESS CREDITS
    SUBPART A—PREMIUM CREDITS AND COST-SHARING SUBSIDIES
    Sec. 1205. Refundable credit providing premium assistance for coverage under a qualified health benefits plan.
    ‘‘Sec. 36B. Refundable credit for coverage under a qualified health benefits
    plan.
    Sec. 1206. Cost-sharing subsidies and advance payments of premium credits
    and cost-sharing subsidies.
    ‘‘SUBPART 2—PREMIUM CREDITS AND COST-SHARING SUBSIDIES
    ‘‘Sec. 2246. Premium credits.
    ‘‘Sec. 2247. Cost-sharing subsidies for individuals enrolling in qualified
    health benefit plans.
    ‘‘Sec. 2248. Advance determination and payment of premium credits and
    cost-sharing subsidies.
    Sec. 1207. Disclosures to carry out eligibility requirements for certain programs.
    Sec. 1208. Premium credit and subsidy refunds and payments disregarded for
    Federal and Federally-assisted programs.
    Sec. 1209. Fail-safe mechanism to prevent increase in Federal budget deficit.
    SUBPART B—CREDIT FOR SMALL EMPLOYERS
    Sec. 1221. Credit for employee health insurance expenses of small businesses.
    ‘‘Sec. 45R. Employee health insurance expenses of small employers.
    Subtitle D—Shared Responsibility
    PART I—INDIVIDUAL RESPONSIBILITY
    Sec. 1301. Excise tax on individuals without essential health benefits coverage.
    ‘‘CHAPTER 48—MAINTENANCE OF ESSENTIAL HEALTH BENEFITS COVERAGE
    ‘‘Sec. 5000A. Failure to maintain essential health benefits coverage.
    Sec. 1302. Reporting of health insurance coverage.
    ‘‘SUBPART D—INFORMATION REGARDING HEALTH INSURANCE COVERAGE
    ‘‘Sec. 6055. Reporting of health insurance coverage.
    PART II—EMPLOYER RESPONSIBILITY
    Sec. 1306. Employer shared responsibility requirement.
    ‘‘Sec. 4980H. Employer responsibility to provide health coverage.
    Sec. 1307. Reporting of employer health insurance coverage.
    ‘‘Sec. 6056. Large employers required to report on health insurance coverage.
    Subtitle E—Federal Program for Health Care Cooperatives
    Sec. 1401. Establishment of Federal program for health care cooperatives.
    ‘‘PART D—FEDERAL PROGRAM FOR HEALTH CARE COOPERATIVES
    ‘‘Sec. 2251. Federal program to assist establishment and operation of nonprofit,
    member-run health insurance issuers.
    Subtitle F—Transparency and Accountability
    Sec. 1501. Provisions ensuring transparency and accountability.
    ‘‘Sec. 2229. Requirements relating to transparency and accountability.
    Sec. 1502. Reporting on utilization of premium dollars and standard hospital
    charges.
    Sec. 1503. Development and utilization of uniform outline of coverage documents.
    Sec. 1504. Development of standard definitions, personal scenarios, and annual
    personalized statements.
    Subtitle G—Role of Public Programs
    PART I—MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS
    Sec. 1601. Medicaid coverage for the lowest income populations.
    Sec. 1602. Income eligibility for nonelderly determined using modified gross income.
    Sec. 1603. Requirement to offer premium assistance for employer-sponsored insurance.
    Sec. 1604. Payments to territories.
    Sec. 1605. Medicaid Improvement Fund rescission.
    PART II—CHILDREN’S HEALTH INSURANCE PROGRAM
    Sec. 1611. Additional federal financial participation for CHIP.
    Sec. 1612. Technical corrections.
    PART III—ENROLLMENT SIMPLIFICATION
    Sec. 1621. Enrollment Simplification and coordination with State health insurance exchanges.
    Sec. 1622. Permitting hospitals to make presumptive eligibility determinations
    for all Medicaid eligible populations.
    Sec. 1623. Promoting transparency in the development, implementation, and
    evaluation of Medicaid and CHIP waivers and section 1937
    State plan amendments.
    Sec. 1624. Standards and best practices to improve enrollment of vulnerable
    and underserved populations.
    PART IV—MEDICAID SERVICES
    Sec. 1631. Coverage for freestanding birth center services.
    Sec. 1632. Concurrent care for children.
    Sec. 1633. Funding to expand State Aging and Disability Resource Centers.
    Sec. 1634. Community First Choice Option.
    Sec. 1635. Protection for recipients of home and community-based services against spousal impoverishment.
    Sec. 1636. Incentives for States to offer home and community-based services as
    a long-term care alternative to nursing homes.
    Sec. 1636A. Removal of barriers to providing home and community-based services.
    Sec. 1637. Money Follows the Person Rebalancing Demonstration.
    Sec. 1638. Clarification of definition of medical assistance.
    Sec. 1639. State eligibility option for family planning services.
    Sec. 1640. Grants for school-based health centers.
    Sec. 1641. Therapeutic foster care.
    Sec. 1642. Sense of the Senate regarding long-term care.
    PART V—MEDICAID PRESCRIPTION DRUG COVERAGE
    Sec. 1651. Prescription drug rebates.
    Sec. 1652. Elimination of exclusion of coverage of certain drugs.
    Sec. 1653. Providing adequate pharmacy reimbursement.
    Sec. 1654. Study of barriers to appropriate utilization of generic medicine in
    federal health care programs.
    PART VI—MEDICAID DISPROPORTIONATE SHARE HOSPITAL (DSH)
    PAYMENTS
    Sec. 1655. Disproportionate share hospital payments.
    PART VII—DUAL ELIGIBLES
    Sec. 1661. 5-year period for demonstration projects.
    Sec. 1662. Providing Federal coverage and payment coordination for low-income
    Medicare beneficiaries.
    PART VIII—MEDICAID QUALITY
    Sec. 1671. Adult health quality measures.
    Sec. 1672. Payment Adjustment for Health Care-Acquired Conditions.
    Sec. 1673. Demonstration project to evaluate integrated care around a hospitalization.
    Sec. 1674. Medicaid Global Payment System Demonstration Project.
    Sec. 1675. Pediatric Accountable Care Organization Demonstration Project.
    Sec. 1676. Medicaid emergency psychiatric demonstration project.
    PART IX—IMPROVEMENTS TO THE MEDICAID AND CHIP PAYMENT AND
    ACCESS COMMISSION (MACPAC)
    Sec. 1681. MACPAC assessment of policies affecting all Medicaid beneficiaries.
    PART X—AMERICAN INDIANS AND ALASKA NATIVES
    Sec. 1691. Special rules relating to Indians.
    Sec. 1692. Elimination of sunset for reimbursement for all medicare part B
    services furnished by certain indian hospitals and clinics.
    Subtitle H—Addressing Health Disparities
    Sec. 1701. Standardized collection of data.
    Sec. 1702. Required collection of data.
    Sec. 1703. Data sharing and protection.
    Sec. 1704. Inclusion of information about the importance of having a health
    care power of attorney in transition planning for children aging out of foster care and independent living programs.
    Subtitle I—Maternal and Child Health Services
    Sec. 1801. Maternal, infant, and early childhood home visiting programs.
    Sec. 1802. Support, education, and research for postpartum depression.
    Sec. 1803. Personal responsibility education for adulthood training.
    Sec. 1804. Restoration of funding for abstinence education.
    Subtitle J—Programs of Health Promotion and Disease Prevention
    Sec. 1901. Programs of health promotion and disease prevention.
    Subtitle K—Elder Justice Act
    Sec. 1911. Short title of subtitle.
    Sec. 1912. Definitions.
    Sec. 1913. Elder Justice.
    Subtitle L—Provisions of General Application
    Sec. 1921. Protecting Americans and ensuring taxpayer funds in government
    health care plans do not support or fund physician-assisted suicide;
    prohibition against discrimination on assisted suicide.
    Sec. 1922. Protection of access to quality health care through the Department of Veterans Affairs and the Department of Defense.
    Sec. 1923. Continued application of antitrust laws.
    TITLE II—PROMOTING DISEASE PREVENTION AND WELLNESS
    Subtitle A—Medicare
    Sec. 2001. Coverage of annual wellness visit providing a personalized prevention plan.
    Sec. 2002. Removal of barriers to preventive services.
    Sec. 2003. Evidence-based coverage of preventive services.
    Sec. 2004. GAO study and report on medicare beneficiary access to vaccines.
    Sec. 2005. Incentives for healthy lifestyles.
    Subtitle B—Medicaid
    Sec. 2101. Improving access to preventive services for eligible adults.
    Sec. 2102. Coverage of comprehensive tobacco cessation services for pregnant women.
    Sec. 2103. Incentives for healthy lifestyles.
    Sec. 2104. State option to provide health homes for enrollees with chronic conditions.
    Sec. 2105. Funding for Childhood Obesity Demonstration Project.
    Sec. 2106. Public awareness of preventive and obesity-related services.
    TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF
    HEALTH CARE
    Subtitle A—Transforming the Health Care Delivery System
    PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE
    MEDICARE PROGRAM
    Sec. 3001. Hospital Value-Based purchasing program.
    Sec. 3002. Improvements to the physician quality reporting system.
    Sec. 3003. Improvements to the physician feedback program.
    Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs.
    Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.
    Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities and home health agencies.
    Sec. 3007. Value-based payment modifier under the physician fee schedule.
    Sec. 3008. Payment adjustment for conditions acquired in hospitals.
    PART II—STRENGTHENING THE QUALITY INFRASTRUCTURE
    Sec. 3011. National strategy.
    Sec. 3012. Interagency Working Group on Health Care Quality.
    Sec. 3013. Quality measure development.
    Sec. 3014. Quality measure endorsement.
    PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
    Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation
    within CMS.
    Sec. 3022. Medicare shared savings program.
    Sec. 3023. National pilot program on payment bundling.
    Sec. 3024. Independence at home pilot program.
    Sec. 3025. Hospital readmissions reduction program.
    Sec. 3026. Community-Based Care Transitions Program.
    Sec. 3027. Extension of gainsharing demonstration.
    PART IV—STRENGTHENING PRIMARY CARE AND OTHER WORKFORCE
    IMPROVEMENTS
    Sec. 3031. Expanding access to primary care services and general surgery services.
    Sec. 3031A. Medicare Federally qualified health center improvements.
    Sec. 3032. Distribution of additional residency positions.
    Sec. 3033. Counting resident time in outpatient settings and allowing flexibility
    for jointly operated residency training programs.
    Sec. 3034. Rules for counting resident time for didactic and scholarly activities and other activities.
    Sec. 3035. Preservation of resident cap positions from closed and acquired hospitals.
    Sec. 3036. Workforce Advisory Committee.
    Sec. 3037. Demonstration projects To address health professions workforce
    needs; extension of family-to-family health information centers.
    Sec. 3038. Increasing teaching capacity.
    Sec. 3039. Graduate nurse education demonstration program.
    PART V—HEALTH INFORMATION TECHNOLOGY
    Sec. 3041. Free clinics and certified EHR technology.
    Subtitle B—Improving Medicare for Patients and Providers
    PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER
    SERVICES
    Sec. 3101. Increase in the physician payment update.
    Sec. 3102. Extension of the work geographic index floor and revisions to the
    practice expense geographic adjustment under the Medicare physician fee schedule.
    Sec. 3103. Extension of exceptions process for Medicare therapy caps.
    Sec. 3104. Extension of payment for technical component of certain physician
    pathology services.
    Sec. 3105. Extension of ambulance add-ons.
    Sec. 3106. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities.
    Sec. 3107. Extension of physician fee schedule mental health add-on.
    Sec. 3108. Permitting physician assistants to order post-Hospital extended care services and to provide for recognition of attending physician
    assistants as attending physicians to serve hospice patients.
    Sec. 3109. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training services.
    Sec. 3110. Exemption of certain pharmacies from accreditation requirements.
    Sec. 3111. Part B special enrollment period for disabled TRICARE beneficiaries.
    Sec. 3112. Payment for bone density tests.
    Sec. 3113. Revision to the Medicare Improvement Fund.
    Sec. 3114. Treatment of certain complex diagnostic laboratory tests.
    Sec. 3115. Improved access for certified-midwife services.
    Sec. 3116. Working Group on Access to Emergency Medical Care.
    PART II—RURAL PROTECTIONS
    Sec. 3121. Extension of outpatient hold harmless provision.
    Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.
    Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.
    Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.
    Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals.
    Sec. 3126. Improvements to the demonstration project on community health integration models in certain rural counties.
    Sec. 3127. MedPAC study on adequacy of Medicare payments for health care
    providers serving in rural areas.
    Sec. 3128. Technical correction related to critical access hospital services.
    Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
    PART III—IMPROVING PAYMENT ACCURACY
    Sec. 3131. Payment adjustments for home health care.
    Sec. 3132. Hospice reform.
    Sec. 3133. Improvement to medicare disproportionate share hospital (DSH)
    payments.
    Sec. 3134. Misvalued codes under the physician fee schedule.
    Sec. 3135. Modification of equipment utilization factor for advanced imaging
    services.
    Sec. 3136. Revision of payment for power-driven wheelchairs.
    Sec. 3137. Hospital wage index improvement.
    Sec. 3138. Treatment of certain cancer hospitals.
    Sec. 3139. Payment for biosimilar biological products.
    Sec. 3140. Public meeting and report on payment systems for new clinical laboratory diagnostic tests.
    Sec. 3141. Medicare hospice concurrent care demonstration program.
    Sec. 3142. Application of budget neutrality on a national basis in the calculation
    of the Medicare hospital wage index floor for each allurban
    and rural state.
    Sec. 3143. HHS study on urban Medicare-dependent hospitals.
    Subtitle C—Provisions Relating to Part C
    Sec. 3201. Medicare Advantage payment.
    Sec. 3202. Benefit protection and simplification.
    Sec. 3203. Application of coding intensity adjustment during MA payment
    transition.
    Sec. 3204. Simplification of annual beneficiary election periods.
    Sec. 3205. Extension for specialized MA plans for special needs individuals.
    Sec. 3206. Extension of reasonable cost contracts.
    Sec. 3207. Technical correction to MA private fee-for-service plans.
    Sec. 3208. Making senior housing facility demonstration permanent.
    Sec. 3209. Development of new standards for certain Medigap plans.
    Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and
    MA–PD Plans
    Sec. 3301. Medicare prescription drug discount program for brand-Name
    drugs.
    Sec. 3302. Improvement in determination of Medicare part D low-income
    benchmark premium.
    Sec. 3303. Voluntary de minimus policy for subsidy eligible individuals under
    prescription drug plans and MA–PD plans.
    Sec. 3304. Special rule for widows and widowers regarding eligibility for lowincome assistance.
    Sec. 3305. Improved information for subsidy eligible individuals reassigned to
    prescription drug plans and MA–PD plans.
    Sec. 3306. Funding outreach and assistance for low-income programs.
    Sec. 3307. Improving formulary requirements for prescription drug plans and
    MA–PD plans with respect to certain categories or classes of drugs.
    Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.
    Sec. 3309. Simplification of plan information.
    Sec. 3310. Limitation on removal or change of coverage of covered part D
    drugs under a formulary under a prescription drug plan or an MA–PD plan.
    Sec. 3311. Elimination of cost sharing for certain dual eligible individuals.
    Sec. 3312. Reducing wasteful dispensing of outpatient prescription drugs in
    long-term care facilities under prescription drug plans and
    MA–PD plans.
    Sec. 3313. Improved Medicare prescription drug plan and MA–PD plan complaint system.
    Sec. 3314. Uniform exceptions and appeals process for prescription drug plans
    and MA–PD plans.
    Sec. 3315. Office of the Inspector General studies and reports.
    Sec. 3316. HHS study and annual reports on coverage for dual eligibles.
    Sec. 3317. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.
    Subtitle E—Ensuring Medicare Sustainability
    Sec. 3401. Revision of certain market basket updates and incorporation of productivity improvements into market basket updates that do not
    already incorporate such improvements.
    Sec. 3402. Temporary adjustment to the calculation of part B premiums.
    Sec. 3403. Medicare Commission.
    Sec. 3404. Ensuring medicare savings are kept in the medicare program.
    Subtitle F—Comparative Effectiveness Research
    Sec. 3501. Comparative effectiveness research.
    Sec. 3502. Coordination with Federal coordinating council for comparative effectiveness research.
    Sec. 3503. GAO report on national coverage determinations process.
    Subtitle G—Administrative Simplification
    Sec. 3601. Administrative Simplification.
    Subtitle H—Sense of the Senate Regarding Medical Malpractice
    Sec. 3701. Sense of the Senate regarding medical malpractice.
    TITLE IV—TRANSPARENCY AND PROGRAM INTEGRITY
    Subtitle A—Limitation on Medicare Exception to the Prohibition on Certain
    Physician Referrals for Hospitals
    Sec. 4001. Limitation on Medicare exception to the prohibition on certain physician referrals for hospitals.
    Subtitle B—Physician Ownership and Other Transparency
    Sec. 4101. Transparency reports and reporting of physician ownership or investment interests.
    Sec. 4102. Disclosure requirements for in-office ancillary services exception to the prohibition on physician self-referral for certain imaging services.
    Sec. 4103. Prescription drug sample transparency.
    Subtitle C—Nursing Home Transparency and Improvement
    PART I—IMPROVING TRANSPARENCY OF INFORMATION
    Sec. 4201. Required disclosure of ownership and additional disclosable parties
    information.
    Sec. 4202. Accountability requirements for skilled nursing facilities and nursing facilities.
    Sec. 4203. Nursing home compare Medicare website.
    Sec. 4204. Reporting of expenditures.
    Sec. 4205. Standardized complaint form.
    Sec. 4206. Ensuring staffing accountability.
    Sec. 4207. GAO study and report on Five-Star Quality Rating System.
    PART II—TARGETING ENFORCEMENT
    Sec. 4211. Civil money penalties.
    Sec. 4212. National independent monitor pilot program.
    Sec. 4213. Notification of facility closure.
    Sec. 4214. National demonstration projects on culture change and use of information technology in nursing homes.
    PART III—IMPROVING STAFF TRAINING
    Sec. 4221. Dementia and abuse prevention training.
    Subtitle D—Nationwide Program for National and State Background Checks
    on Direct Patient Access Employees of Long-term Care Facilities and Providers
    Sec. 4301. Nationwide program for National and State background checks on
    direct patient access employees of long-term care facilities and providers.
    Subtitle E—Pharmacy Benefit Managers
    Sec. 4401. Pharmacy benefit managers transparency requirements.
    TITLE V—FRAUD, WASTE, AND ABUSE
    Subtitle A—Medicare and Medicaid
    Sec. 5001. Provider screening and other enrollment requirements under Medicare and Medicaid.
    Sec. 5002. Enhanced Medicare and Medicaid program integrity provisions.
    Sec. 5003. Elimination of duplication between the Healthcare Integrity and
    Protection Data Bank and the National Practitioner Data Bank.
    Sec. 5004. Maximum period for submission of Medicare claims reduced to not
    more than 12 months.
    Sec. 5005. Physicians who order items or services required to be Medicare enrolled physicians or eligible professionals.
    Sec. 5006. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse.
    Sec. 5007. Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical
    equipment under Medicare.
    Sec. 5008. Enhanced penalties.
    Sec. 5009. Medicare self-referral disclosure protocol.
    Sec. 5010. Adjustments to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program.
    Sec. 5011. Expansion of the Recovery Audit Contractor (RAC) program.
    Subtitle B—Additional Medicaid Provisions
    Sec. 5101. Termination of provider participation under Medicaid if terminated
    under Medicare or other State plan.
    Sec. 5102. Medicaid exclusion from participation relating to certain ownership,
    control, and management affiliations.
    Sec. 5103. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid.
    Sec. 5104. Requirement to report expanded set of data elements under MMIS
    to detect fraud and abuse.
    Sec. 5105. Prohibition on payments to institutions or entities located outside of the United States.
    Sec. 5106. Overpayments.
    Sec. 5107. Enhanced funding for program integrity activities.
    Sec. 5108. Mandatory State use of national correct coding initiative.
    Sec. 5109. General effective date.
    TITLE VI—REVENUE PROVISIONS
    Subtitle A—Revenue Offset Provisions
    Sec. 6001. Excise tax on high cost employer-sponsored health coverage.
    Sec. 6002. Inclusion of cost of employer-sponsored health coverage on W–2.
    Sec. 6003. Distributions for medicine qualified only if for prescribed drug or insulin.
    Sec. 6004. Increase in additional tax on distributions from HSAs not used for
    qualified medical expenses.
    Sec. 6005. Limitation on health flexible spending arrangements under cafeteria
    plans.
    Sec. 6006. Expansion of information reporting requirements.
    Sec. 6007. Additional requirements for charitable hospitals.
    Sec. 6008. Imposition of annual fee on branded prescription pharmaceutical
    manufacturers and importers.
    Sec. 6009. Imposition of annual fee on medical device manufacturers and importers.
    Sec. 6010. Imposition of annual fee on health insurance providers.
    Sec. 6011. Study and report of effect on veterans health care.
    Sec. 6012. Elimination of deduction for expenses allocable to Medicare Part D
    subsidy.
    Sec. 6013. Modification of itemized deduction for medical expenses.
    Sec. 6014. Limitation on excessive remuneration paid by certain health insurance
    providers.
    Subtitle B—Other Provisions
    Sec. 6021. Exclusion of health benefits provided by Indian tribal governments.
    Sec. 6022. Establishment of simple cafeteria plans for small businesses.
    Sec. 6023. Qualifying therapeutic discovery project credit.

  4. Of course, with the new bill, we’ll need new cost “scoring” from the CBO, not that the cost analysis of the previous bill was reliable. But in that cost scoring, will the CBO take everything into account. Buried near the end of this New York Times article is something interesting:

    The Finance Committee approved a detailed outline of a sweeping health care bill last week. Mr. Baucus formally introduced the bill, a 1,502-page document, on Monday.

    The Senate is debating a separate bill to prevent deep cuts in Medicare payments to doctors. The bill would not offset any of the costs, estimated at $247 billion over the next 10 years.

    Senator Lamar Alexander of Tennessee, the No. 3 Republican in the Senate, said: “Of course, we need to fix doctors’ reimbursement. But it needs to be paid for. We can’t just add a quarter-trillion dollars to the national debt.”

    Democrats said the bill simply recognized political reality. In recent years, they said, Congress has repeatedly stepped in to prevent cuts in Medicare payments to doctors, and it is likely to do so in the future.

    Now, if CBO is to price out the new bill, but the Medicare correction isn’t included, how does CBO accurately score the bill, especially if the separate correction bill hasn’t been passed, and its actual numbers are unknown? $247 billion is rather a lot of money, and I’d say that its passage wouldn’t exactly be “revenue neutral,” but if it isn’t passed — the Congress makes this kind of fix every year to the Sustainable Growth Formula, because they have to — then physicians will have to do the only economically sensible thing they can: stop treating Medicare patients.

  5. Dana Pico:
    Of course, with the new bill, we’ll need new cost “scoring” from the CBO, not that the cost analysis of the previous bill was reliable.

    I would like to know what Lobbyists put this together. I just don’t see a few “senators” sitting there looking up all the other existing laws that get amended by this one. A few places in the index look interesting and I need to read what they say. Somehow a 1502 page bill stacked up against the House’s 1017 page bill with different priorities in the Senate than the House has got to be a totally convoluted nightmare to wade through.

  6. Also, I’ve written to Sen. Turn Coat Spector several times voicing opposition to this. I saw on FOX News Sunday he indirectly told me to shove it. He really doesn’t seem to have a desire to go back to the Senate.

  7. You’ll like this part, people:

    13 SEC. 6002. INCLUSION OF COST OF EMPLOYER-SPONSORED
    14 HEALTH COVERAGE ON W–2.
    15 (a) IN GENERAL.—Section 6051(a) of the Internal
    16 Revenue Code of 1986 (relating to receipts for employees)
    17 is amended by striking ‘‘and’’ at the end of paragraph
    18 (12), by striking the period at the end of paragraph (13)
    19 and inserting ‘‘, and’’, and by adding after paragraph (13)
    20 the following new paragraph:
    21 ‘‘(14) the aggregate cost (determined under
    22 rules similar to the rules of section 4980B(f)(4)) of
    23 applicable employer-sponsored coverage (as defined
    24 in section 4980I(d)(1)), except that this paragraph
    25 shall not apply to—

    1 ‘‘(A) coverage to which paragraphs (11)
    2 and (12) apply, or
    3 ‘‘(B) the amount of any salary reduction
    4 contributions to a flexible spending arrange
    5 ment (within the meaning of section 125).’’.
    6 (b) EFFECTIVE DATE.—The amendments made by
    7 this section shall apply to taxable years beginning after
    8 December 31, 2009.

    Note that while coverage under the bill would not begin immediately, your employer-sponsored health insurance benefit would become part of your Forms W-2 beginning in 2010.

  8. Dana Pico:
    You’ll like this part, people:

    13 SEC. 6002. INCLUSION OF COST OF EMPLOYER-SPONSORED
    14 HEALTH COVERAGE ON W–2.
    15 (a) IN GENERAL.—Section 6051(a) of the Internal
    16 Revenue Code of 1986 (relating to receipts for employees)
    17 is amended by striking ‘‘and’’ at the end of paragraph
    18 (12), by striking the period at the end of paragraph (13)
    19 and inserting ‘‘, and’’, and by adding after paragraph (13)
    20 the following new paragraph:
    21 ‘‘(14) the aggregate cost (determined under…..

    That’s it. I don’t see Bulk-Us doing all that, nor most of the staff. You need some high powered reasearch to find this arcane stuff.

  9. Perry: Right, Yorkshire, as you said, you are stupid, if you judge a bill by how many pages it has!

    So says the self-anointed arbiter of what is and what’s not a “personal attack” in the DE blogosphere.

    Hypocrite much?

  10. Dana:“… not that the cost analysis [by the CBO] of the previous bill was reliable.”

    On what basis, Dana, do you make that conclusion?

    “…but the Medicare correction isn’t included, ….

    I agree with you on this point. But I have to say, that charges by physician specialists and hospitals are astronomical. I’m sure you noted the charges to your health insurance company for your recent colonoscopy is an example. So I think Medicare could reasonably cut reinbursements. I happen to live in an area heavily populated year round by senior citizens, yet there is no problem obtaining medical care under current Medicare reimbursement schedules. If these are cut, I’m not sure what the outcome here would be. I suspect there is room for more cutting, based on the reimbursement fees I’ve seen for my own health care.

    On the taxing of employer based health insurance premiums, I think we can agree that this is a form of compensation, therefore taxable. That said, it concerns me, because it will hit the middle income folks pretty hard come 2013. Say the employer is contributing $5K. Assuming a middle income employee is, after deductions, is in the 25% tax bracket, we’re talking a tax increase of $1K. That’s a pretty hefty tax increase! This won’t impact me, but I don’t like this additional burden on my middle income employed fellow citizens. I don’t think the final bill will have this tax in it. The public option won’t help this problem. The problem then remains: In the absence of this tax, where will the money come from while retaining revenue neutrality? Other than downsizing the bill greatly, I don’t see any other funding source solution.

    Yorkshire:“OK Dumbass”

    Is it the weather again? Can’t be; the weather was nice and sunny yesterday, today as well!

    Yorkshire, really, I do not understand your heat over this 1500 page bill. No, I did not read it yet, although I had gone through HB3200. Did you read it? I don’t see how reform of an extremely complex issue like health care reform can be legislated with a few paged bill. Just skimming the section titles you listed suggests to me that our Dem Congressional Reps are trying to get all the details covered in their bill.

    On the arcane language style, of course, nothing new, that’s the way it has to be for legal purposes. People go to law school in order to learn this variant of the English language.

    PS: Can’t finish without mentioning the Phillies win last night, 5-4, on a walk-off two RBI hit by Rollins in the bottom of the ninth! Awesome!!! Reminiscent of last years meeting between the two, it was last year game 4 against the Dodgers when pinch hitter . Let us see if the Dodgers can bounce back from a 3-1 game tally against them in this best of 7 series.

  11. Perry seeking absolution sez:
    Yorkshire:“OK Dumbass”

    Is it the weather again? Can’t be; the weather was nice and sunny yesterday, today as well!

    Perry, it’s like this, I have had enough of your insults. I can’t seem to go anywhere in this blogosphere without the Left constantly throwing insults. It’s as if the Left is not interested in the “civil” discourse they seek, but domination.

    As far as health care,I am extremely happy with the plan I have. I pay a premium for it, but I must do that for the situation I’m in. Everything I hear in this debate, the Left’s approach to this is to take this away, or tax me to death. I abhor Government entering my private life to tell me what I consider a private decision, I can’t have it, or tax it out of my reach. In short, their solution is let me die. If you want a future where the Government dictates to you what you can have have, or not have, Fidel has a place for you in Cuba. If Government run health care isn’t a leftward Lurch, than I don’t what is. If you believe this is Utopia, then there isn’t much hope in convincing you otherwise.

  12. On the taxing of employer based health insurance premiums, I think we can agree that this is a form of compensation, therefore taxable. That said, it concerns me, because it will hit the middle income folks pretty hard come 2013. Say the employer is contributing $5K. Assuming a middle income employee is, after deductions, is in the 25% tax bracket, we’re talking a tax increase of $1K. That’s a pretty hefty tax increase!

    Flush! That’s the sound of Obama’s “I won’t raise taxes on anyone making under $250k” campaign promise going right down the toilet.

  13. PS: Can’t finish without mentioning the Phillies win last night, 5-4, on a walk-off two RBI hit by Rollins in the bottom of the ninth! Awesome!!!

    Well, at least the Yankees lost as well. I’m still hoping for an all LA World Series.

  14. Eric:
    Flush! That’s the sound of Obama’s “I won’t raise taxes on anyone making under $250k” campaign promise going right down the toilet.

    Eric, I think BO was confused when he made that promise. It was broken in a NY second as soon as he got into office.

  15. Where’s the insult, Yorkshire? You need to point that out to me.

    Disagreement on some issues does not constitute an insult!

    Yorkshire:“In short, their solution is let me die.”

    Since we do not yet have a bill, your statement then qualifies as a preemptive strike, and hopefully a gross exaggeration.

  16. Yorkshire: “Perry, it’s like this, I have had enough of your insults. I can’t seem to go anywhere in this blogosphere without the Left constantly throwing insults. It’s as if the Left is not interested in the “civil” discourse they seek, but domination.”

    Yorkshire, was that highlighted remark meant to be ironic?

    Because of course you know ….

  17. Yorkshire:“Eric, I think BO was confused when he made that promise. It was broken in a NY second as soon as he got into office.”

    I am assuming your income is under $250K, Yorkshire. Tell us what additional tax you will have to pay under Obama? Answer: There is none, so your statement is false, so far! So we have another preemptive strike by Yorkshire!

  18. DNW:
    Yorkshire: “Perry, it’s like this, I have had enough of your insults. I can’t seem to go anywhere in this blogosphere without the Left constantly throwing insults. It’s as if the Left is not interested in the “civil” discourse they seek, but domination.”

    Yorkshire, was that highlighted remark meant to be ironic?

    Because of course you know ….

    Yes I do. :-)

  19. Perry:
    Yorkshire:“Eric, I think BO was confused when he made that promise. It was broken in a NY second as soon as he got into office.”

    I am assuming your income is under $250K, Yorkshire. Tell us what additional tax you will have to pay under Obama? Answer: There is none, so your statement is false, so far! So we have another preemptive strike by Yorkshire!

    How quick you forget. Right after inaugaration, the cigerette tax was raised by congress, and BO signed it. Now if you can show me where people making over $250K are the only ones buying cigarettes, you got me. But I know you can’t. Now you can start making excuses for the Chosen One.

  20. Perry wrote:

    “DNW, the ultimate interpretation is in the mind of the reader, as you well know!”

    It’s easy enough to ask Yorkshire if he was being ironic or not.

    Because, as a generalization, the statement ” … the Left is not interested in the “civil” discourse they [purportedly?] seek, but domination. “, is true enough and probably comes as no surprise to many people.

  21. Yorkshire:“…the cigerette tax was raised by congress, and BO signed it.”

    Stop twisting, Yorkshire. You know well that Obama’s commitment was about income taxes, as his policy was to raise income taxes on those making >$250K, not on those < $250K. Now this might change if the health reform bill requires employees to pay income taxes on health insurance premiums paid by their employers. I am opposed to that, even though it has no impact on me, but may impact those like yourself at a time when you don’t need that; I also do not want Obama to break his campaign commitment.

    DNW: In our system, the party in power does dominate, whether Repub or Dem, so your point is moot!

  22. Perry:
    Yorkshire:“…the cigerette tax was raised by congress, and BO signed it.”

    Stop twisting, Yorkshire.

    BO’s Promise:
    PROMISE:
    “I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes” (September 12, 2008, Dover, NH)

    Perry, can you twist “NOT ANY OF YOUR TAXES”. A tax is a tax is a tax. If it walks like a duck, quacks like a duck, and it’s a duck. I guess raising cigarettes taxes was a “fee”

  23. Obama’s campaign commitment on taxes is right here: “Obama, by contrast [to McCain], favors allowing the tax cuts to expire as scheduled for Americans earning more than $250,000 a year. He would raise taxes on capital gains and dividends, but has also promised tax breaks for low and middle-income Americans.”

    Clearly, Yorkshire, Obama was talking about income taxes, just based on his dividing line of $250K. Certainly he was not talking about cigarette taxes, or excise taxes, or estate taxes, or FICA, or ….

    Where did your quote come from? To me it sounds like some wingnut misquoting him purposely.

  24. Perry:

    Where did your quote come from? To me it sounds like some wingnut misquoting him purposely.

    Here’s a part of the google search. As usual Perry, when it doesn’t fit your predetermined answer, you are in Denial.

    Obama Knew Cap-and-Trade Would Hike Income Taxes 15% Breaking His …
    Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”(September 12, 2008, Dover, NH). [Transcript] [Video clip] …
    capwiz.com/atr/issues/alert/?alertid=14061256 – Cached – Similar

    FS: Terminator 2 HD DVD German Steelbook – High-Def Digest Forums
    3 posts – 1 author – Last post: 29 May
    Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” (Barack Obama, September 12, 2008, Dover,
    forums.highdefdigest.com/…/85995-fs-terminator-2-hd-dvd-german-steelbook.html – Cached – Similar
    Collateral BD – Danish Import? – 29 Jun 2009
    Used Logitech Harmony 1000 Universal Remote Control F/S? – 8 May 2009
    St Patricks Day sale/Code? – 11 Mar 2009
    Mad Men: Season Two / July 7th? – 5 Mar 2009

    More results from forums.highdefdigest.com »

    Recent Posts
    29 Jun 2009 … Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes” (September 12, 2008, Dover, NH)
    pinkelephantpundit.com/2009/06/29/read-my-lips-take-2/ – Cached – Similar

    Obama’s First 50 Days: Devastating to Taxpayers | Reuters
    10 Mar 2009 … Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes” (September 12, 2008, Dover, NH
    http://www.reuters.com/…/idUS235282+10-Mar-2009+PRN20090310 – Cached – Similar

    The Weekly Standard
    5 Feb 2009 … Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes” (Barack Obama, September 12, 2008, Dover, …
    http://www.weeklystandard.com/…/obama_breaks_ethics_pledge_and.asp – Cached – Similar

    House Dem Healthcare Tax Hike
    Breaks Obama’s Tax Pledge
    Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” (Barack Obama, September 12, 2008, Dover, NH)
    http://www.atr.org/house-dem-healthcare-tax-hikebr-breaks-a3533 – Cached – Similar

  25. Perry asked:

    Dana:“… not that the cost analysis [by the CBO] of the previous bill was reliable.”

    On what basis, Dana, do you make that conclusion?

    On the basis of the medicare Part D estimates, the Iraq war cost projections, on a whole history of projections for costs made before a bill is passed, which somehow, some way, seem to be significantly underestimated after the bill is passed.

    “…but the Medicare correction isn’t included, ….

    I agree with you on this point. But I have to say, that charges by physician specialists and hospitals are astronomical. I’m sure you noted the charges to your health insurance company for your recent colonoscopy is an example. So I think Medicare could reasonably cut reinbursements.

    Perry, you’ve seen the data before, how Medicare underpays hospitals for what Medicare patients actually cost to treat. I had the story here, along with this chart:

    Hospitals have a negative margin of 9.4% on Medicare patients, and wind up with a bare 3.8% operating margin in total. Somehow I don’t see a total 3.8% operating margin as “astronomical.” You can get almost that much just by putting your money in a savings account.

  26. Dana Pico:
    On the basis of the medicare Part D estimates, the Iraq war cost projections, on a whole history of projections for costs made before a bill is passed, which somehow, some way, seem to be significantly underestimated after the bill is passed.

    As I said on another thread it’s as simple as seeing that Past Performance is a great indicator of future performance.

    A great example is if you borrowed some money from me that you promised to pay me on the 15th of every month for a year, and with a favorable rate. Every month you are two or three days late, but you eventually pay me back. If you ask for another loan, what indicator have you given me that you would pay on time – NONE!

  27. One of the problems with the “official estimates” of how much a new program will cost is the fact that you can’t know if and by how much the estimates are in error until the new program is passed and put into practice. By then, if the estimates are very wrong, it’s too late to do anything about it.

    One thing our friends on the left have realized: they just need something to be passed which obligates the federal government to guarantee everyone health care. Then, if the first program doesn’t work, they can “fix” it, but they don’t have to worry about the plan just being eliminated; by then, it’ll have a large dependent class.

  28. Dana:“One of the problems with the “official estimates” of how much a new program will cost is the fact that you can’t know if and by how much the estimates are in error until the new program is passed and put into practice. By then, if the estimates are very wrong, it’s too late to do anything about it.”

    I agree with you about the CBO prediction accuracy. However, if the estimates are “very wrong”, Congress can undo or adjust the enabling legislation, at any time.

    On the chart that you reposted, I find it difficult to draw firm conclusions without more details. However, the real question involves the future, i.e., how this table rearranges with the final health care reform bill, the contents of which we do not yet know, but let me make some predictions:

    1. Mandating insurance, covering more people, will increase “commercial” and reduce “other gov’t and self pay”, thus increasing the “total” operating margin.
    2. Removing pre-existing conditions requirements and disallowing insurance drops will also increase “commercial” and reduce “other gov’t and self pay”, thus increasing “total” operating margin.
    3. A robust public option will decrease premium costs, thus redirecting money from private insurance company profits to providers, thus reducing net operating costs of providers.
    4. Encouraging preventative medicine will reduce overall medical costs across the board.
    5. Enabling end-of-life consultations will reduce overall medical costs by eliminating extraordinary care for people who don’t want it, like myself. Currently, however, this provision has been removed from the bill, to due the “death panels” paranoia from the Right.

    The fact that health care providers, like doctors and hospitals, are behind health insurance reform strengthens my points. The only organized group opposed are, take a guess, yes, the self-serving private insurance companies.

    Now, Dana, won’t you support health insurance / health care reform?

  29. I just went through the first 50+ pages of this monster. I agree with Conyers that you need two, or three lawyers to understand this. But what I understood right away, this bill amends the Social Security Act.

  30. I am assuming your income is under $250K, Yorkshire. Tell us what additional tax you will have to pay under Obama?

    Don’t forget gasoline taxes went up with the Porkapalooza bill. Perry will try to say that’s not an income tax, but it certainly feels like one.

  31. Sharon:
    I am assuming your income is under $250K, Yorkshire. Tell us what additional tax you will have to pay under Obama?

    Don’t forget gasoline taxes went up with the Porkapalooza bill. Perry will try to say that’s not an income tax, but it certainly feels like one.

    Under my plan, no family making less than $250,000 a year will see any form of tax increase . Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes” (September 12, 2008, Dover, NH)

  32. “I just went through the first 50+ pages of this monster. I agree with Conyers that you need two, or three lawyers to understand this. But what I understood right away, this bill amends the Social Security Act”

    As Sharon can no doubt tell you, The Social Security Act and the “Medicare” Title XVIII of the Social Security Act, is the ultimate cover for the constitutionality of these plans.

    What one sees is the equivalent of an inference, piled on a surmise, on an assumption, that a law allows …

    Like the Social Security Act that it amended, the 1965 Medicare program was ostensibly a vehicle for reducing dependency in old age. In reality, both laws were dependency-shifting rather than dependency-reducing: mandated dependence of the elderly on the federal government and taxpayers replaced potential dependence on family and charity. This paper investigates how and why Medicare became law and considers what the observed pattern of institutional change implies for America’s future …

    For more than 50 years before the 1965 enactment of Medicare, the American people repeatedly rejected the idea of government-mandated health insurance….

    Governmental advocacy of compulsory health insurance was in no way hindered by these developments: government officials proceeded as if the original statutory language had been retained. The Social Security Act signed into law on August 14, 1935, empowered the Social Security Board (SSB) to study “related” areas, and on August 15, 1935, Roosevelt appointed an Interdepartmental Committee to Coordinate Health and Welfare Activities to pursue the health insurance issue”

  33. I Presidenmt Obama has promised that those of us making less than $250,000 a year will not see any increases in any federal taxes, perhaps he should read the Baucus Bill, starting on page 194:

    16 Subtitle D—Shared Responsibility
    17 PART I—INDIVIDUAL RESPONSIBILITY
    18 SEC. 1301. EXCISE TAX ON INDIVIDUALS WITHOUT ESSEN19
    TIAL HEALTH BENEFITS COVERAGE
    .
    20 (a) IN GENERAL.—Subtitle D of the Internal Rev21
    enue Code of 1986 is amended by adding at the end the
    22 following new chapter:
    23 ‘‘CHAPTER 48—MAINTENANCE OF
    24 ESSENTIAL HEALTH BENEFITS COVERAGE
    ‘‘Sec. 5000A. Failure to maintain essential health benefits coverage.

    1 ‘‘SEC. 5000A. FAILURE TO MAINTAIN ESSENTIAL HEALTH
    2 BENEFITS COVERAGE.
    3 ‘‘(a) REQUIREMENT TO MAINTAIN ESSENTIAL
    4 HEALTH BENEFITS COVERAGE.—If an individual is an
    5 applicable individual for any month beginning after June
    6 30, 2013, the individual is required to be covered by essen
    7 tial health benefits coverage for such month.
    8 ‘‘(b) IMPOSITION OF TAX.—
    9 ‘‘(1) IN GENERAL.—If an applicable individual
    10 fails to meet the requirement of subsection (a) for
    11 1 or more months during any calendar year begin
    12 ning after 2013, then, except as provided in sub
    13 section (d), there is hereby imposed a tax with re
    14 spect to the individual in the amount determined
    15 under subsection (c).
    16 ‘‘(2) INCLUSION WITH INCOME TAX RETURN.—
    17 Any tax imposed by this section with respect to any
    18 month shall be included with a taxpayer’s return of
    19 tax imposed by chapter 1 for the taxable year which
    20 includes such month.
    21 ‘‘(3) LIABILITY FOR TAX.—If an individual with
    22 respect to whom tax is imposed by this section for
    23 any month—
    24 ‘‘(A) is a dependent (as defined in section
    25 152) of another taxpayer for the other tax

    1 payer’s taxable year including such month, such
    2 other taxpayer shall be liable for such tax, or
    3 ‘‘(B) files a joint return for the taxable
    4 year including such month, such individual and
    5 the spouse of such individual shall be jointly lia6
    ble for such tax.
    7 ‘‘(c) AMOUNT OF TAX.—
    8 ‘‘(1) IN GENERAL.—The tax determined under
    9 this subsection for any month with respect to any in
    10 dividual is an amount equal to 1?12 of the applicable
    11 dollar amount for the calendar year.

    I went ahead and boldfaced the word tax wherever it appeared; the Baucus Bill isn’t afraid to call non-compliance penalties a tax.

    And, of course, it has to be a tax. If it were a penalty, then the government would have to go through due process of law to enforce the penalty, a process in which the burden of proof would be on the government.

    But, as you know, if the Infernal Revenue Service says that you owe a particular amount in tax, you owe it, period, and the only way to get out of it is to challenge the government in court, and the burden of proof is on you, not the government.

  34. Perry asks:

    Now, Dana, won’t you support health insurance / health care reform?

    No, never. It is neither the government’s responsibility nor the government’s business to tell me whether I should have health insurance.

    Mandating insurance, covering more people, will increase “commercial” and reduce “other gov’t and self pay”, thus increasing the “total” operating margin.

    It makes perfect senae that this would be the case, but that it might make sense does not mean that it is or should be the government’s responsibility to force it.

    Removing pre-existing conditions requirements and disallowing insurance drops will also increase “commercial” and reduce “other gov’t and self pay”, thus increasing “total” operating margin.

    It would also reduce margins for the insurance companies. In a plan that is (supposedly) based on the commercial insurance companies, imposing provisions which lessen their profitability means that some will go out of business.

    A robust public option will decrease premium costs, thus redirecting money from private insurance company profits to providers, thus reducing net operating costs of providers.

    Same response. For the system to be based on the commercial insurance companies means that they have to be allowed to make a profit, so that they can survive.

    Encouraging preventative medicine will reduce overall medical costs across the board.

    This is an unproven assumption, one which may not be true. Example: my routine dental cleanings occur every six months. If I don’t get them, I might have a tooth or four rot away, and have to be extracted. But the cost of pulling four teeth every six years is far less than the twelve scheduled cleanings that I’d have in those six years.

    Enabling end-of-life consultations will reduce overall medical costs by eliminating extraordinary care for people who don’t want it, like myself. Currently, however, this provision has been removed from the bill, due to the “death panels” paranoia from the Right.

    Some of us, including me, believed that those consultations would become mandatory, and that they would be used to encourage people for take such actions to “reduce overall medical costs.” Personally, it is my belief that, eventually, the default position of saving lives would be replaced with the legal assumption that the elderly do not want “extraordinary care,” unless they specifically opt for it, rather than the other way around.

  35. From Dana’s excerpt:
    ‘‘(a) REQUIREMENT TO MAINTAIN ESSENTIAL
    4 HEALTH BENEFITS COVERAGE.—If an individual is an
    5 applicable individual for any month beginning after June
    6 30, 2013, the individual is required to be covered by essential health benefits coverage for such month.
    8 ‘‘(b) IMPOSITION OF TAX.—
    9 ‘‘(1) IN GENERAL.—If an applicable individual
    10 fails to meet the requirement of subsection (a) for
    11 1 or more months during any calendar year begin
    12 ning after 2013, then, except as provided in sub
    13 section (d), there is hereby imposed a tax with re
    14 spect to the individual in the amount determined
    15 under subsection (c).

    I have a funny (not in haha mode) idea, why shouldn’t the writers of this monster say group, or all, and not individual. It’s the imposition on one at the forgiveness of most. One can’t say General Welfare when it attacks individuals.

  36. Dana, you have your opinion to support your position, I have mine to support my position. That’s the way it goes. But I do have to call you on your straw man about the consultations, as stated in your last paragraph.

    These consultations were set up to be voluntary, between each of us and our doctor of choice, to be paid for by our insurance (less deductibles and copay of course). I do not envision any doctor who would “encourage people” to opt out of extraordinary care. The doctor is there to present the options and answer questions.

    Of course, this discussion is moot, because paranoia caused that to be removed from the Baucus Bill, an illustration of how weak-kneed some of our politicians are.

    I hope this provision gets reinserted!

  37. Dana in a response to Perry:
    P: Encouraging preventative medicine will reduce overall medical costs across the board.

    D: This is an unproven assumption, one which may not be true. Example: my routine dental cleanings occur every six months. If I don’t get them, I might have a tooth or four rot away, and have to be extracted. But the cost of pulling four teeth every six years is far less than the twelve scheduled cleanings that I’d have in those six years.

    Today, the ACS said screening wasn’t needed that much. Strange that it comes out now in the middle of the debate. A conclusion for me, if Healthcare passes, the gummint has a reason to limit these and cut back costs. For years we’ve been told over and over the screening was necessary, now it’s not all of a sudden?

  38. Encouraging preventative medicine will reduce overall medical costs across the board.

    Actually, this isn’t really true. The purpose of preventative medicine is to, well, prevent some unpleasant outcome. But there’s no way to know, for example, which women will get breast cancer or which men will have prostate cancer. We can make certain predictions based on factors such as genetics, but there’s no way to know exactly which persons will get certain diseases.

    This is, for example, it is recommended that any woman over 40 gets a mammogram every year. But we know that 12.7% of women get breast cancer in the U.S. every year. For them, the expense of mammograms are justified. But what about the other 87.3% of women, the ones who won’t? For them, it is another unnecessary expense, one that insurance companies cover and that we all pay for. Yet another example of why medical costs have skyrocketed.

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