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What the “Affordable Health Care for America Act,” HR 3962, Actually Says
What does the bill recently passed by the U.S. House of Representatives, HR3962, short-titled the ‘‘Affordable Health Care for America Act,” actually say about major health-care issues? I here pose a few commonsense questions, cite some relevant passages, and offer a few brief comments. (The bill is available at http://docs.house.gov/rules/health/111_ahcaa.pdf.)
This bill is 1,990 pages of mind-numbing legalese. It will reach deeply into federal and state regulations and laws, on a scale that will require years for experts to interpret. It will establish institutions that will be effectively irreversible. It will grant arbitrary powers to bureaucrats, who will have to interpret and enforce its dictates. A full analysis of its impact would require a commentary at least as long as the bill itself. American citizens cannot be expected to read and understand such legislation. But they should be aware that this is the nature of the laws being written by their (alleged) representatives in Washington.
I have only touched on pieces of the bill here. I have not considered the establishment of (1) the “Health Choices Commissioner” and the associated bureaucracy; (2) the “Health Insurance Exchange,” (a government-mandated insurance scheme to control all insurance activity); (3) the so-called “Public Health Insurance Option,” or similar provisions. I have not analyzed the more than one hundred new committees, boards, commissions, and bureaucratic institutions that it establishes (but I have listed them below under the section titled Special Note).
This legislation empowers the executive branch, namely the Secretary of Health and Human Services and a “Health Choices Commissioner,” to write thousands of pages of regulations, and to force Americans to comply with them. For every line in this bill, many pages of regulations will be written. As a result, the bureaucracy will expand, the final cost will be many times more than the original estimates—and the impact on American medicine will be devastating.
The overall result of this bill, if enacted, will be a complete government takeover of the health-care industry. This cannot be prevented by tweaking the language in the bill. The bill must be rejected in full before we can consider proper reforms to American medicine.
In many ways the bill is a convoluted, uncoordinated list of compromises between thousand of legislators, legislative aides, and lobbyists. Yet the bill has two main thrusts, with one central meaning. The first thrust is a massive increase in government power. The second is the total rejection of the free market. The central meaning of both is the repudiation of individual rights. No longer will Americans have the liberty to preserve their own lives in the way they judge best—from now on, they will have to conform to government controls on the most intimate details of their lives.
We may answer one question up front: How will the government pay for all this? By increasing taxes, cutting payments to doctors and other medical professionals, or rationing services—there are no other options. We will all pay for this, whether or not we are enrolled in the government “option”—because none of us may opt out of the taxes levied to finance it, or escape the controls it will breed.
Will the plan punish Americans who do not carry the required insurance, or employers who do not provide it?
What the Bill Says:
SEC. 501. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE (pp. 296–97).
(a) In General.—Subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part:
PART VIII—HEALTH CARE RELATED TAXES
Subpart A—Tax on Individuals Without Acceptable Health Care Coverage
SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.
(a) Tax Imposed— In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
(1) the taxpayer’s modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
SEC. 307. HEALTH INSURANCE EXCHANGE TRUST FUND (pp. 195–96) . . .
(c) Transfers to Trust Fund—
(1) DEDICATED PAYMENTS— There are hereby appropriated to the Trust Fund amounts equivalent to the following:
(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE— The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).
(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE— The amounts received in the Treasury under sections 3111(c) and 3221(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).
(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS— The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).
Evaluation of the Passages:
1. This section amends the Internal Revenue Code. It adds a new category of taxes, to be levied against Americans who do not have “acceptable” health insurance.
2. All Americans will be required to purchase health insurance that is “acceptable” to the government. Anyone caught without acceptable coverage and not in the government plan will pay a special tax of 2.5 percent on top of his existing taxes.
3. The IRS will be a major enforcement mechanism for the plan.
2. Will the plan make private insurance illegal?
What the Bill Says:
SEC. 222. ESSENTIAL BENEFITS PACKAGE DEFINED (pp. 104–7).
(a) In General.— In this division, the term “essential benefits package” means health benefits coverage, consistent with standards adopted under section 224, to ensure the provision of quality health care and financial security, that [here follows a list of insurance services required]. . . .
(A) IN GENERAL.— The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
Evaluation of the Passage:
1. The bill does not explicitly make private insurance illegal. But it does establish federal insurance requirements, enforced by the government, which will make many private plans illegal and will force many out of business.
2. The “minimum actuarial value” required by this bill means that catastrophic insurance policies, insurance plans that cover hospitalization alone, or other such coverage as Americans may elect to purchase for themselves, will not provide a level of coverage acceptable to the government. Americans must purchase more insurance, enroll in the government plan—or face tax penalties.
3. Many other passages in the bill place private insurance under government rules and will prevent Americans from negotiating private health-care coverage as they wish. For instance, section 223 establishes federal categories of insurance, under a new “Health Benefits Advisory Committee,” which will be used to control public and private plans.
Will the plan ration medical care through budgets?
What the Bill Says:
SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS (pp. 441–48) . . .
(1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital. . . .
(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
Evaluation of the Passage:
1. This section applies to Medicare Parts A and B. It is important to understand that the so-called “Public Option” is, in essence, an extended version of Medicare, and that millions of Americans will be enrolled in this plan. The Medicare guidelines written here will apply to the expanded government plan—and ultimately to millions of Americans.
2. The plan uses statistics to judge whether someone may be readmitted to the hospital. A patient will be allowed readmission only if a certain number of people with the same “applicable condition” have been discharged from that hospital. This is rationing, pure and simple.
3. The plan empowers bureaucrats to exercise this power over doctors and hospitals. Item (7) on page 450, for instance, allows bureaucrats to impose sanctions on hospitals whose statistics are determined to be out of line. Item (C), page 462, empowers the bureaucrats to apply “a payment reduction for physicians who treat the patient during the initial admission that results in a readmission.”
4. The bill allows the bureaucrats to define terms such as “excess,” “readmission,” and “applicable condition.” For instance, in the same section:
5) DEFINITIONS.—For purposes of this subsection: . . .
(A) APPLICABLE CONDITION.—The term “applicable condition” means, subject to subparagraph (B), a condition or procedure selected by the Secretary among conditions and procedures for which—
(i) readmissions (as defined in subparagraph (E)) that represent conditions or procedures that are high volume or high expenditures under this title (or other criteria specified by the Secretary) . . .
Evaluation of the Passage:
1. “Applicable conditions” are determined by “the Secretary,” meaning, as always, the bureaucrats. Such passages empower bureaucrats to determine the very meaning of the law. The bill is permeated with such arbitrary, open-ended language.
2. Should doctors treat, say, many people with cancer, this would indicate “high volume” and “high expenditures.” Bureaucrats will then be empowered to prevent other cancer patients from being readmitted, in order to prevent “excess” readmissions and improve the statistics.
3. The plan specifically calls for expansion of the Secretary’s authority to determine what constitutes an “applicable condition.” From the same section:
(B) EXPANSION OF APPLICABLE CONDITIONS.—Beginning with fiscal year 2013, the Secretary shall expand the applicable conditions beyond the 3 conditions for which measures have been endorsed as described in subparagraph (A)(ii)(I) as of the date of the enactment of this subsection to the additional 4 conditions that have been so identified by the Medicare Payment Advisory Commission in its report to Congress in June 2007 and to other conditions and procedures which may include an all-condition measure of readmissions, as determined appropriate by the Secretary. In expanding such applicable conditions, the Secretary shall seek the endorsement described in subparagraph (A)(ii)(I) but may apply such measures without such an endorsement.
Evaluation of the Passage:
1. Such language is typical in this bill. In the end, the power to determine its meaning is left with “the Secretary,” meaning the bureaucrats. This is arbitrary government power—power without definition or limits.
2. It is important to stress that such arbitrary power is open ended—bureaucrats will determine its meaning as they write their regulations.
Will this plan ration care through waiting lists?
What the Bill Says:
SEC. 101. NATIONAL HIGH-RISK POOL PROGRAM (pp. 16–17) . . .
(2) INSUFFICIENT FUNDS— If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.
Evaluation of the Passage:
1. This section establishes a “temporary” “High-Risk Pool” program, which is to operate until the Health Exchanges are established. Meanwhile the Secretary of Health and Human Services will decide who gets care and who goes on a waiting list.
2. This determination will be made on the basis of “aggregate” budget. The bill recognizes that there are only three ways to control the budget: reducing benefits, increasing premiums, or establishing waiting lists. The Secretary’s bureaucrats will control all three.
3. Proponents of the bill will claim that this particular program will be temporary. But this next passage shows that under this plan, waiting lists will become the norm:
SEC. 1734. PREVENTING THE APPLICATION UNDER CHIP OF COVERAGE WAITING PERIODS FOR CERTAIN CHILDREN (p. 1079) . . .
(a) In General.— Section 2102(b)(1) of the Social Security Act (42 U.S.C. 1397bb(b)(1)) is amended. . . . [in part by adding this new paragraph]
(C) DESCRIPTION OF CHILDREN NOT SUBJECT TO WAITING PERIOD— For purposes of this paragraph, a child described in this subparagraph is a child who [here follows a list of requirements for children exempt from waiting lists]
Evaluation of the Passage:
1. This section amends the Social Security Act.
2. The bill specifically excludes certain children from government waiting lists.
3. This exclusion makes clear that proponents of the bill know that there will be government-controlled waiting lists. This is consistent with states and countries (such as Canada and the UK) that have waiting lists reaching into months for diagnostic tests and treatments.
4. This next passage again shows that waiting lists are already planned for the United States:
SEC. 3101. INDIAN HEALTH CARE IMPROVEMENT AMENDED (p. 1636) . . .
SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND (pp. 1724–29) . . .
(f) Report.— By no later than the date that is 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service Unit, including newly recognized or acknowledged Indian Tribes. Such report shall set out . . . [among other requirements]:
(4) an estimate of— . . .
(C) the number of Indians using the Service resources made available to each Service Unit, Indian Tribe or Tribal Organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of resources.
Evaluation of the Passage:
1. This section amends the Indian Health Care Improvement Act.
2. This passage specifically references waiting lists—and excludes certain people from them.
3. The need for government-controlled waiting lists is understood by those who have promoted this plan. Government enforced waiting lists are rationing. Rationing is needed to control the government’s budget.
Will the plan impose special, higher taxes on Americans who earn more than others?
What the Bill Says:
SEC. 551. SURCHARGE ON HIGH INCOME INDIVIDUALS (p. 336–39).
Evaluation of this Section:
1. This section amends the Internal Revenue Code.
2. The title of this section is accurate. This section lays out the surcharges to be levied against Americans who earn more than an arbitrary level—a level determined by the government and adjustable at its whim. This is simple, coercive wealth redistribution—a tax on successful people because they are successful.
3. The section adds this surcharge on top of the existing federal tax rates, and states, “The amendment made by subsection (a) shall not be treated as a change in a rate of tax.”
4. This surcharge will be enforced by the IRS.
6. Will the plan levy special taxes and surcharges on medical devices (such as wheelchairs, walkers, canes, etc.)?
What the Bill Says:
SEC. 552. EXCISE TAX ON MEDICAL DEVICES (p. 339) . . .
(a) In General— Chapter 31 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subchapter:
Subchapter D—Medical Devices . . .
SEC. 4061. MEDICAL DEVICES.
(a) In General— There is hereby imposed on the first taxable sale of any medical device a tax equal to 2.5 percent of the price for which so sold.
Evaluation of this Passage:
1. This section amends the Internal Revenue Code.
2. This section puts a special federal tax on the “first taxable sale” of medical devices such as wheelchairs. This specifically targets medical device manufacturers and applies to sales made directly by those manufacturers. (It is worth noting that this clause was inserted because medical device companies opposed this bill.)
3. The bill will raise the price of such devices by the amount of the tax.
http://www.theobjectivestandard.com/...ca-hr-3962.asp
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