Posted on 03/18/2010 7:06:08 AM PDT by ohioWfan
February 19, 2010
Analysis of the Patient Protection & Affordability Act
HR 3590
• Transfer significant regulatory authority from states to the federal government
• Significant changes in the national health insurance markets
• Dramatically alters the financing and content of employer-provided and individual health insurance
• Significantly changes Medicare / Medicaid
• Changes how hospitals, doctors, and other medical professionals are paid and how care is delivered
• Mandates purchase of insurance
• CBO* estimates up to 10 million Americans will no longer be covered by their employers for health insurance (given the bill’s incentives for employers to discontinue job-based coverage – independent estimates are higher)
*CBO – Congressional Budget Office
• Contains over 12 new taxes
• Reduces Medicare payments $493 billion over 10 years through payment reductions for Medicare Advantage, hospitals, home health and nursing homes
• Provides federal funding for abortion
• CMS’ Office of the Actuary projects increased healthcare spending – $234 billion between 2010 and 2019.
• Actual cost of 1st 10 years* - $2,500,000,000,000 (assuming both full funding and spending)
• Begins cuts and new taxes immediately, but delays new programs for 4 to 5 years
*Senator Baucus, Backgrounder, No. 2353, 12/18/09 – The Heritage Foundation
Individual Mandate
• Forces or mandates Americans to buy a commodity: health insurance
• Anyone failing to obtain insurance will pay a tax penalty of $750 per family member and $375 per child to a maximum of $2,250 (President’s Plan $695 and $325 and maximum of $2,040)
Employer Mandate
• Requires companies with more than 50 employees to offer health plans to full-time employees or pay a tax of $750 per employee (President’s Proposal $2,000/employee)
• Since the penalty is much cheaper than providing health insurance, many employers are likely to opt out and pay the penalty (President’s Proposal doesn’t change this)
• The federal government would determine benefits provided under health insurance plans (sets up four benefit levels – Bronze 60%, Silver 70%, Gold 80%, Platinum 90% of cost of benefits; also Catastrophic plan for those under 30 years of age; out of pocket limits)
• Will effectively result in nationalized health insurance system or a public plan
• 40% excise tax on “high value” healthcare plans of $8,500 or more for an individual and $23,000 or more for a family ($149.1 billion) (President’s Proposal $10,200 and $27,500 and effective from 2013 to 2018)
• .5% increase in the payroll tax on earnings above $200,000 for individuals and $250,000 joint return ($53.8 billion) (President’s Proposal adds 2.9% assessment)
• Changes in health savings accounts, medical spending accounts, flexible spending accounts, and health reimbursement arrangements ($5 billion)
• $2,500 cap on flexible spending accounts ($14.6 billion)
• Increase from 10 to 20% on the penalty for early non-qualified HSA withdrawals ($1.3 billion)
• Tax on branded drugs ($22.2 billion) (President’s Proposal increase to $33 billion, but delay 1 year)
• Annual tax on health insurers ($60.4 billion) (President’s Proposal delays until 2014)
• Tax on companies that manufacture or import medical devices ($19.3 billion)
• .5% excise tax on cosmetic surgery ($5.8 billion)
• Increase in the floor of the medical expenses deduction from 7.5% of adjusted gross income to 10% ($15.2 billion)
• Elimination of Medicare Part D* deduction ($5.4 billion) (President’s Proposal delays)
• $500,000 cap on the tax deduction for the salaries of employees of health insurance companies ($.6 billion)
• Mandate on companies with more than 50 employees to provide health coverage or pay $750 penalty per employee for those who obtain coverage through the insurance exchange ($36 billion) (President’s Proposal $2,000/employee)
* Prescription drugs
• Expands Medicaid eligibility to 133% of the federal poverty level with premium and cost sharing credits to 400% of the federal poverty level
• Increases the federal government’s control
• Legal immigrants immediately eligible for new federal subsidies for welfare and Medicaid (currently they have to wait five years)
1) Value based purchasing (payment modifier providing reduced payments to physicians and hospitals based on quality care vs. cost – plan is to add nursing homes, home health, and ambulatory surgery centers within 2-3 years)
2) Payment adjustment for conditions acquired in hospitals (ex. blood incompatibility, falls, catheter-associated urinary tract infection, etc.)
3) Hospital readmissions reduction program (reduce payments to account for “excess” readmissions – high dollar and high volume)
4) Revisions in home health care and hospice payments (reduction in annual market basket updates and as mentioned earlier will include hospitals, nursing homes, and other Medicare providers)
5) Adjustment to Medicare DSH payments (DSH – Disproportionate Share Hospital; add-on payment applied to the DRG adjusted base payment rate for hospitals that treat a high percentage of low income patients)
6) Reduction in technical component reimbursement on single session imaging from 25% to 50% (for example CT of head and CT of chest)
1) Reasonable break time for nursing mothers for 1 year after child’s birth and requires room other than bathroom
2) Nevada Wage Index Guarantee (nothing below 1.0)
3) Louisiana Purchase ($300,000,000 for Louisiana)
4) Corn Husker Kickback – permanent exemption from the state share of Medicaid expansion for Nebraska, meaning rest of country pays (President’s Proposal eliminates and adds significant additional Federal financing to all States for expansion of Medicaid)
5) No limitation on assisted suicide
6) No limitation to the withholding of medical treatment or medical care
7) No limitation to the withholding or withdrawing of nutrition or hydration
8) Non-profit hospitals required to complete a community health needs assessment annually
9) Mandatory review of community benefit activities once every 3 years (federal audit)
10) Annual report on level of charity care
11) Dependent coverage for children up to age 26
12) Tax on indoor tanning services (10%)
Invitees:
9 Senators (5 Democrats, 4 Republicans)
12 Congressmen (7 Democrats, 5 Republicans)
Each invited Senator and Congressman can designate an additional 4 members to attend plus 1 staff member
• Medical Tort Reform - savings $500 billion per Decade
• Portability
• Patient/physician choice
• Tax reform of health insurance
• Align incentives and payments for physicians and hospitals
• Open insurance competition across state lines
• Personal Responsibility – Financially and Health Behaviors
........*70% of healthcare costs are a direct result of behavior
........*74% of all costs confined to 4 chronic conditions – cardiovascular disease, cancer, diabetes, and obesity
........*Safeway model or auto insurance model – Savings nationally of $550 billion (Safeway employees
…….. are given freedom of choice but if they choose healthy lifestyles, they are rewarded with significant
……..reductions in premium share and co-pay (Senate Bill reduces ability of companies to reward healthy behavior)
........*Major predictable expenses funded by savings and credit
........*Catastrophic care funded by insurance
........*Improved HSA’s, which allow the individual to withdraw money for any purpose without penalty once
…….. the funds exceed a ceiling established for each age and dollars remaining upon death are reimbursed through inheritance
Assume:
• 22 year old single employee $30,000 annual salary
• Marries at 28
• 2 children supported for 20 years
• Retires at 65
• Dies at 80
• Insurance premiums, Medicare taxes and premiums, and out of pocket costs will grow 3%/year
• Earnings grow 3%/year
Results:
By retirement, annual salary $107,000
*September 2009 Article by David Goldhill in The Atlantic
Over lifetime worker + employer together will have paid $1.77 million for healthcare.
If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care?
The proposals passed by the Senate and House are not acceptable and not affordable. We need to let our legislators know that we need real reform and reduced government interference. As Healthcare Professionals, we need to continue to do all we can to continue to provide cost effective expert care.
Continue to Call and Write Your Legislators – It Does Make A Difference. This is still very important because there are discussions underway to break up heathcare reform into multiple bills. We all need to stay engaged.
He presented this to hospital personnel and other health care professionals after reading every page of both bills (and Obama's "proposal," and there is information in it that may be useful to FReepers in this debate.
I hope it proves useful in giving added information to those of us who have not read these monstrosities.
PING!
Special thanks to mkjessup for encouraging me to post this presentation to FR.
And I can testify that it was painful even to watch him go through piles of papers with his highlighter night after night!
We both know exactly what the motivation is here - to destroy America. Period.
I just wanted to add something ... Yep, that’s what is going on, the destruction of America as we know it.
And all the procedural spats we are seeing is what the Constitution is all about ‘procedure’.
Exactly. It’s all smoke and mirrors to try to hide the real agenda.
This is from a 2007 contact list of congressional aides. Some might not be there any longer, but worth a try. The ones on the one post are senate aides, a few have bounced back, it’s worth the effort to clog up their email system along with the phones, and 1/3rd of these senators are up for re-election.
Contact congressional aides.
http://www.freerepublic.com/focus/f-news/1857768/posts
U.S. Senate switchboard: (202) 224-3121
U.S. House switchboard: (202) 225-3121
White House comments: (202) 456-1111
Find your House Rep.: http://www.house.gov/writerep
Find your US Senators: http://www.senate.gov/general/contact_information/senators_cfm.cfm
Toll free to the US Senate:
1-800-882-2005. (Spanish number)
1-800-417-7666. (English number)
Courtesy of a pro-amnesty group, no less!!
Defeat Obamacare call list: List now contains the new MAYBES culled from FR posts. Be sure to call KNOWN RINOS too.THEY ARE ANSWERING THEIR LOCAL NUMBERS
Here is one of the ones Rush gave out on the radio that I’m calling. So far it’s been busy but I’m going to burn it up till I get to tell my congress critter to vote NO!
Join me?..... 1-877-762-8762
Good idea from the bloggers at Hillbuzz:
http://hillbuzz.org/2010/03/17/action-items-march-17th-2010/
They offer specifics and links on how to put pressure on Dem DONORS, who have private numbers for legislators who may have taken their phones off the hook.
Congress may not want to hear from us, but they’ll listen to the money men.
KEEP THE CALLS UP! DC OFFICE LOCAL OFFICE
CODE RED Contact list http://www.nrcc.org/CodeRed/targets/
Remember they are all being offered BRIBES for their votes.
Ask them how much their bribe price is.
The National Republican Congressional Committee has published a target list on health care. In addition to continuing to contact the five Tennessee Democrat Congressmen, you can go http://www.votervoice.net/link/clickthrough/ext/94697.aspx to contact some of these targets. Much of the talk following Obama’s announcement has focused on how to defeat this second bill through reconciliation, but that is misleading because the first step to defeating Obamacare is not by concentrating on defeating the “fixer” bill but by defeating the Senate bill in the House when it goes to the floor for an up-or-down vote on Thursday, March 18th.
New FLIPPERS
Dennis Kucinish, Lakewood 216)228-8850, Fax (216)228-6465,
Parma. 440)845-2707, Fax (440)845-2743, DC (202)225-5871
Fax (202)225-5745
James Oberstar (202) 225-6211, Duluth (218) 727-7474, Chisholm (218) 254-5761, Brainerd (218) 828-4400, North Branch, (651) 277-1234
Gabrielle Giffords (202) 225-2542 (520) 881-3588 AZ 8th District
Rep. Lincoln Davis 202-225-6831 Columbia office: 931-490-8699
Rep. Jim Cooper 202-225-4311 Nashville office: 615-736-5295
Rep. Bart Gordon 202-225-4231 Murfreesboro office: 615-896-1986
John Tanner (202) 225-4714, Union City, (731) 885-7070, Jackson Phone: (731) 423-4848, Millington (901) 873-5690 TN (MAYBE)
Rep. Steve Cohen 202-225-3265 Memphis office: 901-544-4131
Harry Mitchell (202) 225-2190 (480) 946-2411 AZ 5th District
Ann Kirkpatrick (202) 225-2315 (928) 226-6914 AZ 1st District
Jerry McNerney (202) 225-1947 925-833-0643 CA 11th District
John Salazar 202-225-4761 970-245-7107 CO 3rd District
Jim Himes (202) 225-5541 (866) 453-0028 CT 4th District
Alan Grayson (202) 225-2176 (407) 841-1757 FL 8th District
Bill Foster (202) 225-2976 630-406-1114 IL 14th District
Baron Hill 202 225 5315 812 288 3999 IN 9th District
Mark Schauer (202) 225-6276 (517) 780-9075 MI 7th District
Gary Peters (202) 225-5802 (248) 273-4227 MI 9th District
Dina Titus (202) 225-3252 702-256-DINA (3462) NV 3rd District
Carol Shea-Porter (202) 225-5456 (603) 743-4813 NH 1st District
Tim Bishop (202) 225-3826 (631) 696-6500 NY 1st District
John Hall (202) 225-5441 (845) 225-3641 x49371 NY 19th District
Bill Owens (202) 225-4611 (315) 782-3150 NY 23rd District
James Matheson Toll-Free Number 1 (877) 677-9743 (202) 225-3011Mike Arcuri (202)225-3665 (315)793-8146 NY 24th District
Dan Maffei (202) 225-3701 (315) 423-5657 NY 25th District
Earl Pomeroy (202) 225-2611 (701) 224-0355 ND At-Large District
Steven Driehaus (202) 225-2216 (513) 684-2723 OH 1st District
Mary Jo Kilroy (202) 225-2015 (614) 294-2196 OH 15th District
Zach Space (202) 225-6265 (330) 364-4300 OH 18th District
Kathy Dahlkemper (202) 225-5406 (814) 456-2038 PA 3rd District
Patrick Murphy (202) 225-4276 (215) 826-1963 PA 8th District
Christopher Carney (202) 225-3731 (570) 585-9988 PA 10th District
Paul Kanjorski (202) 225-6511 (570) 825-2200 PA 11th District
John Spratt (202) 225-5501 (803)327-1114 SC 5th District
Tom Perriello (202) 225-4711 (276) 656-2291 VA 5th District
Alan Mollohan (202) 225-4172 (304) 623-4422 WVA 1st District
Nick Rahall (202) 225-3452 (304) 252-5000 WVA 3rd District
Steve Kagen (202) 225-5665 (920) 437-1954 WI 8th District
Bart Stupak (202) 225 4735 MI (MAYBE)
Brian Baird (202) 225-3536, Vancouver, (360) 695-6292. Olympia, (360) 352-9768, (MAYBE)
senator mark begich (202) 224-3004 toll free. (877) 501 - 6275 just became a MAYBE
Jason Altmire 202-225-2565, Aliquippa, 724-378-0928,
Natrona Heights, 724-226-1304 (MAYBE)
On the Bubble (Major developments from the “yes” and “no” columns in the House)
http://www.freerepublic.com/focus/news/2467046/posts
Congressional Dems on Twitter
http://www.arrghpaine.com/congressional-dems-on-twitter
And here are toll-free numbers we can use to call any Senators or Reps.
At the first number below you must wait through a tape recording urging you to tell your Rep or Senator to vote “yes” for the health care bill. Just hang on and when the recording is over, you will get the Capitol operator. Just ask for your Rep or Senator’s office. Then you will either talk to an aid or have the chance to leave a message for him/her to vote NO on the health care bill.
When you use the second number and the Capitol operator comes on, just ask for your Rep or Senator’s office. Every time I use this number I get the Rep or Senator’s answer machine, so it may be set up that way all the time...to go to their answer machine. Either way you can leave a message to vote NO on the health care bill!
We need to use these toll free numbers that have been set up for the health care/ BO supporters and illegals to use! After all they are FREE!
1-866-220-0044, 1-866-338-1015, 877-851-6437, 877-210-5351
The democrats have an awfully bizarre idea that health care is a “right” we’re forced to buy.
May be of interest to some of your ping lists.
I don’t want to be an American anymore.
You might want to add Rep. John Boccieri (D), Ohio 16th to your list
Voted Yes on Stupak, NO on Health Care.
Contact info - DC office (202) 225-3876 - Fax - (202) 225-3059
Local # - (330) 489-4414, Local Fax - (330) 489-4448
Bizzare is a nice word for their “idea.”
IT MUST NOT PASS!!
I applaud you and your husbands efforts. I am a physician and I am also giving public talks against 0bamacare. I believe that the illegal “receoncilation” process facilitated by the Slaughter rule contains even worse provisions than the Senate bill. The mandate penalties in the reconciled bill are percentage based on income and would be much higher than the flat Senate $750/2250 penalties. There is also a more overt provision for a public option.
We should also explore the silver lining if 0bamacare is passed and after rules come out. There are exemptions for religious objectors, undocumented immigrants, hardship cases, Indian tribes. I believe that if 0bamacare passes, we must examine these rules, create organizations that allow persons to claim exemptions and challenge this legislation on this basis.
http://www.atr.org/comprehensive-list-tax-hikes-government-health-a4658
Thanks for the added input and the link. We need to continue to work together on this.
Congress might still try and force their own wishes on us, but it would make it a lot harder...
(great info. here, BTW - thanks! that's a "print and save"...!)
I'm glad you found this useful. That's the idea. :)
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