THE WALL STREET JOURNAL
By BETSY MCCAUGHEY
What the Pelosi Health-Care Bill
Really Says. Here are some important passages in
the 2,000 page legislation.
The health bill that House Speaker Nancy
Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here
are some of the details you need to know.
What the government will require you
to do:
• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your
insurance at work, your employer will have a "grace period" to
switch you to a "qualified plan," meaning a plan designed by
the Secretary of Health and Human Services. If you buy your
own insurance, there's no grace period. You'll have to enroll
in a qualified plan as soon as any term in your contract
changes, such as the co-pay, deductible or benefit. [In other words, you will no longer be able to buy catastrophic health insurance---a right that is a decided economic advantage for the healthy and those who are willing to live with a high deductible plan.]
• Sec. 224 (p. 118) provides that 18 months after the bill
becomes law, the Secretary of Health and Human Services will
decide what a "qualified plan" covers and how much you'll be
legally required to pay for it. That's like a banker telling
you to sign the loan agreement now, then filling in the
interest rate and repayment terms 18 months later.
On Nov. 2, the Congressional Budget Office estimated what the
plans will likely cost. An individual earning $44,000 before
taxes who purchases his own insurance will have to pay a
$5,300 premium and an estimated $2,000 in out-of-pocket
expenses, for a total of $7,300 a year, which is 17% of his
pre-tax income. A family earning $102,100 a year before taxes
will have to pay a $15,000 premium plus an estimated $5,300
out-of-pocket, for a $20,300 total, or 20% of its pre-tax
income. Individuals and families earning less than these
amounts will be eligible for subsidies paid directly to their
insurer. [So much for Obamaster's pledge to not raise taxes on the middle class.]
• Sec. 303 (pp. 167-168) makes it clear that,
although the "qualified plan" is not yet designed, it will be
of the "one size fits all" variety. The bill claims to offer
choice-basic, enhanced and premium levels-but the benefits are
the same. Only the co-pays and deductibles differ. You will
have to enroll in the same plan, whether the government is
paying for it or you and your employer are footing the bill.
• Sec. 59b (pp. 297-299) says that when you file your
taxes, you must include proof that you are in a qualified
plan. If not, you will be fined thousands of dollars.
• Sec. 412 (p. 272) says that employers must provide a
"qualified plan" for their employees and pay 72.5% of the
cost, and a smaller share of family coverage, or incur an 8%
payroll tax. Small businesses, with payrolls from $500,000 to
$750,000, are fined less.
Eviscerating Medicare:
In addition to reducing future Medicare funding
by an estimated $500 billion, the bill fundamentally changes
how Medicare pays doctors and hospitals, permitting the
government to dictate treatment decisions.
• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment
system, in which patients choose which doctors to see and
doctors are paid for each service they provide, toward what's
called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care
provider manages access to costly specialists and diagnostic
tests for a flat monthly fee. The bill specifies that patients
may have to settle for a nurse practitioner rather than a
physician as the primary-care provider. Medical homes begin
with demonstration projects, but the HHS secretary is
authorized to "disseminate this approach rapidly on a national
basis."
A December 2008 Congressional Budget Office
report noted that "medical homes" were likely to resemble the
unpopular gatekeepers of 20 years ago if cost control was a
priority.
• Sec. 1114 (pp. 391-393) replaces
physicians with physician assistants in overseeing care for
hospice patients. [Well, who cares? They're dying anyway.]
• Secs. 1158-1160 (pp. 499-520)
initiates programs to reduce payments for patient care to what
it costs in the lowest cost regions of the country. This will
reduce payments for care (and by implication the standard of
care) for hospital patients in higher cost areas such as
New York and Florida .
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used
by 20% of seniors). Advantage plans have warned this will
result in reductions in optional benefits such as vision and
dental care.
• Sec. 1402 (p. 756) says that the results
of comparative effectiveness research conducted by the
government will be delivered to doctors electronically to
guide their use of "medical items and
services." [In other words, your physician will be monitored to make sure that he or she is not giving "too much" medical care to patients. If a physician orders "too many tests," then quite possibly that person needs to be reigned in---because costs will have to be "contained" according to how much money is available from "the system."]
Questionable Priorities:
While the bill will slash Medicare funding, it
will also direct billions of dollars to numerous inner-city
social work and diversity programs with vague standards of
accountability.
• Sec. 399V (p. 1422) provides for
grants to community "entities" with no required qualifications
except having "documented community activity and experience
with community healthcare workers" to "educate, guide, and
provide experiential learning opportunities" aimed at drug
abuse, poor nutrition, smoking and obesity. "Each community
health worker program receiving funds under the grant will
provide services in the cultural context most appropriate for
the individual served by the program." [This is a "make work" project for "community organizing" groups such as ACORN.]
These programs will "enhance the capacity of individuals to utilize health
services and health related social services under Federal,
State and local programs by assisting individuals in
establishing eligibility . . . and in receiving services and
other benefits" including transportation and translation
services. [i.e., illegals aliens who will be eventually legalized by the Obama administration]
• Sec. 222 (p. 617) provides reimbursement
for culturally and linguistically appropriate services. This
program will train health-care workers to inform Medicare
beneficiaries of their "right" to have an interpreter at all
times and with no co-pays for language services. [i.e., illegals aliens who will be eventually legalized by the Obama administration]
• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and
ethnic preferences in awarding grants for training nurses and
creating secondary-school health science programs. For
example, grants for nursing schools should "give preference to
programs that provide for improving the diversity of new nurse
graduates to reflect changes in the demographics of the
patient population." And secondary-school grants should go to
schools "graduating students from disadvantaged backgrounds
including racial and ethnic minorities." [This is nothing but Affirmative Action education policy on steroids, i.e., reverse racism.]
• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of
newborns who do not otherwise have insurance.
Additional Healthcare Information
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