Universal Health Care for America

[Guest Colleen]

Page 158 of the health care bill states:

 

"The only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act)."

 

The provision goes on: "The term 'Member of Congress' means any member of the House of Representatives or the Senate... The term 'congressional staff' means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC."

[Guest American Thinker]

This exemption will apply similarly to believers in Islam, which considers health insurance - and, for that matter, any form of risk insurance - to be haraam (forbidden). Amish will also be exempt.

[Guest ACC]

Exemptions from the coverage requirement include those whose required contribution to employer-sponsored insurance exceeds 8% of household income, religious reasons, hardship, short coverage gaps, persons with income below the federal tax return filing level, and those residing outside of the country.

 

The law requires states to establish insurance exchanges. The states will not insure benefits, but will act as coverage coordinators for commercial carriers. States may offer their own exchange or group together and form multistate exchanges. Beginning in 2014, refundable tax credits will be available for purchasing insurance through a state exchange, for individuals and families whose income is up to four times the federal poverty level (currently, up to $43,420 for individuals and $88,200 for families), provided the individuals are not eligible for other adequate coverage such as Medicare or an affordable and adequate employer-sponsored plan. The amount of the credit is determined on a sliding scale. The credit amount is determined and will be paid by the IRS in advance, directly to the insurer to obtain coverage through the state exchange. The individual pays the difference in the cost of coverage, through payroll deduction for employed persons. Beginning immediately, "cost-sharing subsidies" will be available to help low income persons by reducing out of pocket limits on a sliding scale based on income relative to the poverty line. HHS will notify the plan that the person is eligible for a reduction in plan costs. These credits and subsidies will not count as income for purposes of disqualifying or reducing other federal program benefits, nor state or local programs which are financed at all with federal funds. In addition to other penalties, a person who negligently provides incorrect information in order to qualify for a credit or subsidy is subject to a penalty of up to $25,000 per year.

[Guest ShameOnUs]

This is the source of contention from an article Senator Grassley wrote on March 22, 2010.

 

Grassley says health care reform should apply to President Obama, top administration officials

 

Senator Chuck Grassley said he will offer an amendment during Senate debate on the health care reconciliation bill this week to apply the reform legislation to the President, Vice President, cabinet members and top White House staff.

 

 

“It’s pretty unbelieveable that the President and his closest advisors remain untouched by the reforms they pushed for the rest of the country. In other words, President Obama’s health care reform won’t apply to President Obama,” Grassley said. “Last December, the effort to apply any new law to administration political leaders was rejected by the Senate Majority Leader. But there’s no justification for the double standard, and I’ll continue to work to establish fairness.”

 

 

The Senate legislation passed last night by the House of Representatives includes an amendment Grassley sponsored and got adopted by the Finance Committee last fall to have members of Congress and their staffs get their health insurance through the same health insurance exchanges where health plans for the general public would be available. During the closed-door negotiations on the bill late last year, the Senate Majority Leader carved out Senate committee and leadership staff from this requirement.

 

 

Subsequently, Grassley and Senator Tom Coburn attempted to offer another amendment to restore the requirement during Senate debate on the health care bill, but the Senate Majority Leader would not let their amendment to fix this loophole even come up for a vote. In addition to Senate committee and leadership staff, the amendment Grassley and Coburn filed during the Senate debate would have made the President, the Vice President, top White House staff and cabinet members all get their health insurance through the newly created exchanges. It would not have applied to federal employees in the civil service.

 

 

Grassley said, “It’s only fair and logical that top administration officials, who fought so hard for passage of this overhaul of America’s health care system, experience it themselves. If it’s as good as promised, they’ll know it first-hand. If there are problems, they’ll be able to really understand them, as they should.”

 

 

Grassley said the motivation for his amendments is simple: public officials who make the laws or lead efforts to have laws changed should live under those laws.

 

 

“This is the same principle that motivated me to pursue legislation over 20 years ago to apply civil rights, labor and employment laws to Congress,” Grassley said. Before President Clinton signed into law Grassley’s long-sought Congressional Accountability Act of 1995, Congress had routinely exempted itself.

 

 

The Congressional Accountability Act made Congress subject to 12 laws, including the Age Discrimination in Employment Act of 1967, the Americans with Disabilities Act of 1990, Title VII of the Civil Rights Act of 1964, the Employee Polygraph Protection Act of 1988, the Fair Labor Standards Act of 1938, the Family and Medical Leave Act of 1993, the Federal Service Labor-Management Relations Statute, the Occupational Safety and Health Act of 1970, the Rehabilitation Act of 1973, the Veteran’s Employment and Reemployment Rights at Chapter 43 of Title 38 of the U.S. Code, and the Worker Adjustment and Retraining Notification Act of 1989.

 

 

Today, Grassley is working to make sure Congress lives up to the same standards it imposes on others with legislation such as his Congressional Whistleblower Protection Act.

[Guest Bombastic]

Angela Braly was paid over Ten Million dollars last year while upping the premiums for 25 percent of California's health insurance policy holders?

She is a greedy person, at best, is what it appears to be on the outside...

[Guest Tim McManus]

According to sources the company WellPoint had pledged in 2007 to spend $30 million over three years to help those who lack health coverage, but its tax records and website show it gave only $6.2 million. The company disputes that.

 

MS BRALY: Any comment??

[Guest ALWAYSRED]

More and more truths are seeping out from this legislation:

 

The Effects Of Health Reform on the Federal Budget

 

The underlying law and the subsequent reconciliation act that modified it will generate changes in direct spending and revenue that will reduce federal deficits by $143 billion (-$15 billion in 2019).

 

The health reform legislation will lead to some increases in discretionary spending:

 

Spending necessary for agencies to implement the legislation: $10 billion to $20 billion over 2010-2019 period for the IRS and HHS.

 

Authorizations of appropriations for other programs: At least $50 billion during 2010-2019, but CBO did not complete estimates of all of the amounts. Some or all of those amounts may not be appropriated.

 

Cost estimates focus on the effects of legislation on the unified (total) budget.

 

The health reform legislation improves cash flow in the HI trust fund by more than $400 billion over 10 years. Higher balances in the fund will give the government legal authority to pay Medicare benefits longer, but most of the money will pay for new programs and will not enhance the government’s economic ability to pay Medicare benefits. (There is a much smaller effect of this sort on Social Security.)

 

The legislation establishes a voluntary federal program for long-term care insurance (CLASS). The program will reduce budget deficits by $70 billion during 2010-2019 but eventually will increase deficits.

 

Cost estimates do not include any effects of legislation on overall output, which could go in either direction.

The health reform legislation raises effective tax rates for some people, through tax increases and income-based subsidies for health insurance.

 

The legislation makes it easier for people to get health insurance after switching jobs or without having a job.

 

Reduces the growth rate of Medicare spending (per beneficiary, adjusting for overall inflation) from about 4 percent per year for the past two decades to about 2 percent per year for the next two decades. It is unclear whether such a reduction can be achieved, and, if so, whether it would be through greater efficiencies in the delivery of health care or through reductions in access to care or the quality of care.

 

Indexes exchange subsidies at a lower rate after 2018.

 

Establishes a tax on insurance plans with relatively high premiums in 2018 and (beginning in 2020) indexes the tax thresholds to general inflation.

 

Some analysts argue that the legislation hampers future deficit reduction by using spending cuts and extra revenues to pay for a new entitlement rather than existing entitlements.

 

CBO and JCT estimate that the health legislation will reduce federal budget deficits during the next decade and in the following decade.

 

http://www.cbo.gov/ftpdocs/114xx/doc11439/WHCC_Presentation-4-12-10.pdf

[Guest AlwaysRed]

According to sources the company WellPoint had pledged in 2007 to spend $30 million over three years to help those who lack health coverage, but its tax records and website show it gave only $6.2 million. The company disputes that.

 

MS BRALY: Any comment??

 

She is probably Democrat

[Guest Literati]

Wow. How are the Democrats going to explain this?

 

http://www.usnews.co...tough-sell.html

 

Democratic Leadership and Staff Are Exempt From Obamacare: The Democratic leadership and committee staff will be exempt from the healthcare bill they just wrote and passed. Politico reports, "The healthcare reform bill signed into law by President Barack Obama Tuesday requires Members of Congress and their office staffs to buy insurance through the state-run exchanges it creates--but it may exempt staffers who work for congressional committees or for party leaders in the House and Senate." Republicans have already introduced legislation to repeal this exemption.

 

Read this one

 

CONGRESSIONAL DISTRIBUTION MEMORANDUM

April 2, 2010

 

From: Jennifer A. Staman

Todd B. Tatelman

Legislative Attorneys

American Law Division

Ida Brudnick

 

Analyst on the Congress

Government and Finance Division

Subject: Analysis of § 1312(d)(3)(D) of Pub. L. No. 111-148, The Patient Protection and Affordable Care Act, and its Potential Impact on Members of Congress and Congressional Staff

 

This memorandum provides an analysis of several legal and practical issues raised by the passage of §1312( d )( 3 )( D ) of Pub. L. No. 111-148, The Patient Protection and Affordable Care Act (PPACA), which

relates to health plans for Members of Congress and congressional staff.

 

Current law, as discussed in more detail below, provides Members of Congress and all congressional staff with access to the FEHBP. FEHBP is administered and operated by the Office of Personnel Management (OPM), an executive branch entity.19 As drafted, § 1312( d )( 3 )( D ) appears to remove Members of Congress and congressional staff, as defined by the subsection, from FEHBP and, therefore, arguably from any health insurance provided under the rules, administration, and guidance of OPM. Section 1312(d)(3)(D), however, does not provide for any specific entity to replace OPM for interpretation and/or implementation purposes. This omission, whether intentional or inadvertent, raises questions regarding interpretation and implementation that cannot be definitively resolved by CRS. The statute does not appear to be self-executing, but rather seems to require an administrating or implementing authority that is not specifically provided for by the statutory text. Of the possible entities that might arguably be responsible, it is possible to include the Committee on House Administration, the Chief Administrative Officer of the House, the Secretary of the Senate, Senate Rules and Administration Committee, or some non-congressional entity such as OPM or the Department of Health and Human Services. Regardless of whether an entity assumes responsibility for interpretation and implementation, it remains possible that any interpretive and implementation decisions could be adopted via changes to the internal rules of each House of Congress respectively.

 

Applying the plain meaning canon to the definition of "Member of Congress," which, as used in §

1312( d )( 3 )( D )( ii )( I ), reads "any Member of the House of Representatives or the Senate," it appears possible to argue that it is limited to those Members of the House of Representatives and Senate in the constitutional sense articulated in Article I of the Constitution, as amended by the Seventeenth Amendment. All other participants in the House of Representatives, including the Resident Commissioner of Puerto Rico, the Delegates of Guam, American Samoa, the U.S. Virgin Islands, the Northern Mariana Islands, the District of Columbia are not considered Members for Article I purposes, as they are not elected by the people of a state and, therefore, it could be argued that under this interpretation they are not included by this definition.

 

Reading the definition in § 1312( d )( 3 )( D )( ii )( I ) to exclude Delegates and the Resident Commissioner can be further supported by the fact that on numerous occasions Congress has specifically defined the term "Member of Congress" or "Member of the House of Representatives" to specifically include the Resident Commissioner of Puerto Rico, the Delegates of Guam, American Samoa, the U.S. Virgin Islands, the Northern Mariana Islands, and the District of Columbia. For example, in 18 U.S.C. § 202( d )( 2 ), which defines "Member of Congress" for the purposes of the federal criminal bribery and conflict of interest

statutes, the definition specifically includes "a Representative in, or a Delegate or Resident Commissioner to, the House of Representatives."23 Nearly identical language is used to define the term "Member of Congress" for purposes of Title 5 of the United States Code, as well as to define "Member of the House of Representatives" for purposes of other federal statutes. The Supreme Court has recognized that the failure by Congress to use terms of art or specific statutory language that is normally used for certain purposes can be evidence that Congress intended a different result to apply.25 In other words, the failure of Congress to specifically include the Delegates and Resident Commissioner in § 1312 may be interpreted by a reviewing court as evidence that Congress expressly intended to exclude those officials from the provision's coverage.

 

On the other hand, however, the rules and precedents of the House have increasingly treated Delegates and the Resident Commissioner as the equivalent of Members regarding their rights and privileges, with the exception of the right to vote on the floor. In all other respects, they are essentially equal under House Rules as well as current laws related to pay and benefits. Additionally, while distinctions with respect to staffing allowances previously existed, they were eliminated at least 25 years ago.

 

"Congressional Staff"

 

Turning to the application of § 1312 to congressional staff members, it should first be noted that CRS has been unable to locate any previous use of the phrase "official office of a Member of Congress" in statute or appropriations laws. It should also be noted that Members of the House are provided with a Member's Representational Allowance (MRA) to support their official and representational duties to the districts from which they were elected. Likewise, Senators receive an amount from the Senators' Official Personnel and Office Expense Account (SOPOEA) to support their duties. It appears possible to argue that the statute's use of the phrase "official office of a Member of Congress in the definition of "congressional staff" in § 1312( d )( 3 )( D )( ii )( II ) refers to Member's personal offices and, therefore, arguably excludes other employees that a Member may utilize for other purposes. In other words, employees who are solely paid for through MRA or SOPOEA appropriations would appear to be covered by this language.

 

The inclusion of committee staff, joint committee staff as well as potentially those staff employed by leadership offices including, but not limited to, the Speaker of the House, Majority Leader of the Senate, Minority Leader of the House, Minority Leader of the Senate, as well as the Whip offices in both the House and Senate appears to be less clear. While it is possible to argue that Members of Congress are the final hiring authority and certification from a Member is required for disbursement of funds in committee and leadership offices, the phrase "official office" could be seen to only encompass employees in the personal offices of Members paid for through the appropriations account given to Senators and Representatives to operate their offices. For instance, although Members who serve as committee chairman or ranking members may have staff affiliated with their service on a given committee, and while the Member may have control over hiring, promotion, and termination, those staff are paid by the funds provided for committees and not for the MRA.

[Guest Literati]

Alternatively, it may be argued that § 1312( d )( 3 )( D )( ii )( II ) can be interpreted as encompassing more than a Member's personal staff. If the implementing authority relies solely on who the hiring authority is, rather than on the source of the funding, it appears possible that committee staff and leadership staff could be included among the staff covered by the provision. For example, the Senate Rules have previously been used to demonstrate the relationship or authority of Senators over staff outside of his or her office in at least one instance. Senate Rule XXXVII (relating to conflict of interest), states:

 

For purposes of this rule—

( a ) a Senator or the Vice President is the supervisor of his administrative, clerical, or other assistants;

( b ) a Senator who is the chairman of a committee is the supervisor of the professional, clerical, or other assistants to the committee except that minority staff members shall be under the supervision of the ranking minority Senator on the committee;

( c ) a Senator who is a chairman of a subcommittee which has its own staff and financial authorization is the supervisor of the professional, clerical, or other assistants to the subcommittee except that minority staff members shall be under the supervision of the ranking minority Senator on the subcommittee;

( d ) the President pro tempore is the supervisor of the Secretary of the Senate, Sergeant at Arms and Doorkeeper, the Chaplain, the Legislative Counsel, and the employees of the Office of the Legislative Counsel;

( e ) the Secretary of the Senate is the supervisor of the employees of his office;

( f ) the Sergeant at Arms and Doorkeeper is the supervisor of the employees of his office;

( g ) the Majority and Minority Leaders and the Majority and Minority Whips are the supervisors of the research, clerical, or other assistants assigned to their respective offices;

( h ) the Majority Leader is the supervisor of the Secretary for the Majority and the Secretary for the Majority is the supervisor of the employees of his office; and

( i ) the Minority Leader is the supervisor of the Secretary for the Minority and the Secretary for the Minority is the supervisor of the employees of his office.

 

Existing language regarding the role of the committee chair in both the House and Senate Rules and handbooks could also be instructive, since they indicate that the chair has authority over the committee budget, serves as the employing authority, and determines the terms and conditions of staff. While not directly hired by Members, staff in other administrative, legal, and legislative support offices are also accountable to the membership in each chamber. For instance, pursuant to House Rule II, the Clerk, Sergeant-at-Arms, Chief Administrative Officer, and Chaplain are elected at the beginning of each Congress by the House and may be removed by the House or by the Speaker. In addition, other positions, including the Inspector General, Historian, director of the Office of Interparliamentary Affairs, Legislative Counsel, Parliamentarian, Law Revision Counsel, and General Counsel are appointed by the Speaker.

 

Moreover, in the Senate, the Secretary of the Senate, Sergeant-at-Arms, and Chaplain are elected

positions, while additional officials, including the Senate Legislative Counsel, Senate Legal Counsel and Deputy Counsel are appointed by the President pro tempore.

 

In sum, the impact on congressional staff not directly affiliated with a Member's individual office appears unclear. The applicability may hinge on any determination regarding whether an employee in an official office is dependent on a source of appropriation, hiring authority, or accountability to the parent chamber.

[Guest Literati]

Shared Staff

 

In addition to potential questions of definition, any potential differences in benefits systems may present administrative challenges given the possibility of mobility among staff across these offices. A more narrow definition may also raise questions about whether certain categories of employees, described below, are covered under this provision.

 

For example, one potential issue with proposing different standards for employees paid through Member office accounts and employees paid through other House and Senate accounts arises from the use of shared staff. Although the House and Senate have different rules regarding shared staff, both chambers allow types of shared staffing arrangements that could result in an employee being both on the payroll of a Member office and another type of office.

 

Contractors, Fellows, Annuitants, Detailees, and Consultants

 

The applicability of this provision to staff who are employed under other arrangements may also be unclear. The potential applicability may be dependent on the source of funds providing for the staff assistance, the type of employing office, the nature of the duties performed, the duration of the affiliation, or other guidelines or rules established by the committees with jurisdiction over employment within the House and Senate (including the Committee on House Administration and the Senate Committee on Rules and Administration, respectively) or through an adoption of changes to the House and Senate Rules.

 

The Committee on House Administration has established guidelines for categories of employees who may serve on a temporary basis or be paid from a source other than the House of Representatives. Three of these types of employees (contractors,34 fellows,35 and annuitants36) may be employed by both Member and committee offices, while two (detailees37 and consultants38) may only be hired by committees. The Senate may also enlist the assistance of detailees and fellows, subject to rules, applicable law, and guidelines established by the Senate Committee on Rules and Administration.

[Guest Literati]

Continued Availability of FEHBP as a "Grandfathered Plan"

 

FEHBP is the largest employer-sponsored health insurance program in the United States, covering over 8 million individuals. Currently, those eligible to enroll in FEHBP include current federal employees, Members of Congress, congressional employees, the President, annuitants, and eligible family members. One important question raised by § 1312( d )( 3 )( D ) is whether Members of Congress and congressional staff may continue to participate in FEHBP as a "grandfathered plan" under the authority provided in § 1251 of PPACA. Section 1251( a ) states that:

 

[N]othing in this Act (or an amendment made by this Act) shall be construed to require that an

individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.

 

Based on the language of §1312( d )( 3 )( D ) and § 1251( a ), it is difficult to predict which provision a court would find controlling for individuals who are currently participating in FEHBP.

 

In examining the statutory language at issue, a court may apply the plain meaning canon to § 1251( a ) of PPACA. As the section specifies, nothing in this Act (or an amendment made by this Act) must be construed to require that an individual terminate coverage under a group health plan or health insurance coverage. It appears that under a plain meaning interpretation, a court could find that by using the words "nothing in this Act," Congress created no exception to this provision, even with the language included under § 1312( d )( 3 )( D ). Further, under another canon of statutory construction, courts may assume the language Congress employs, including additions and omissions to a particular statute, is intentional. Accordingly, if Congress had wanted to make an exception for § 1312(d)(3)(D) under § 1251, one may argue that Congress could have said so.

[Guest DC Government Worker]

The office of personal management has stated nothing on this. But, changes will be made to our health plan next year.

 

On March 23, 2010, President Obama signed into law the “Patient Protection and Affordable Care Act,” Public Law 111-148. While some aspects of this law will not take effect until 2014, there are several major provisions that become effective before that time.

 

Among those is the coverage of a dependent until age 26. The effective date of this provision is the first day of the plan year that is six months following enactment of the law. For the Federal Employees Health Benefits (FEHB) Program, that means January 1, 2011.

 

The Office of Personnel Management (OPM) will take the necessary actions to comply with the new law by this effective date. We will provide additional information in the near future about the changes to FEHB plans for the 2011 plan year occurring as a result of passage of the PPACA so that employees and retirees have the information in time for the Open Season, which begins in November.

[Guest Sarah]

That is a relief. At least I can stick with my current FEHBP plan and see how this whole thing rides out.

[Guest Literati]

Hold your jets. I am not done yet with the CBO statement.

 

Conversely, as provided under § 1312( d )( 3 )( D ), “notwithstanding any other provision of law,” the only health plans that may be made available to Members of Congress and congressional staff are the plans that are specified by the section. With regard to this phrase, the plain meaning seems a bit harder to ascertain. Congress sometimes seeks to underscore the primacy of a statutory directive by stating that it is to apply “notwithstanding” the provisions of another, specified statute or class of statutes. Courts take into account this expressed intent to override the provisions specified in a "notwithstanding" clause, but when the clause purports to override “any other provision of law,” its preclusive scope often is unclear.

One court, for example, ruled that a directive to proceed with timber sale contracts "notwithstanding any other provision of law" meant only “notwithstanding any provision of environmental law," and did not relieve the Forest Service from complying with federal contracting law requirements governing such matters as non-discrimination, small business set-asides, and export restrictions.45 As the Supreme Court articulated, “[w]e have repeatedly held that the phrase ‘notwithstanding any other law’ is not always construed literally ... and does not require the agency to disregard all otherwise applicable laws." Nevertheless, while there are cases that have given full measure to “any other provision of law," the

provision may be ignored if there is a clear and unambiguous statement of an underlying directive. However, it is hard to say whether § 1251 provides such a statement.

 

It may be possible to make a reasonable argument that § 1312( d )( 3 )( D ) would trump the application of § 1251. If a court were to evaluate § 1312( d )( 3 )( D ) and § 1251( a ) as conflicting, a court could rely on a canon of statutory construction that provides, in essence, that "where one statute deals with a subject in general terms, and another deals with a part of the same subject in a more detailed way, the two should be harmonized if possible." However, "if there is any conflict the latter (more specialized) will prevail, regardless of whether it was passed prior to the general statute, unless it appears that the legislature intended to make the general act controlling." Applying this canon, one could argue that § 1312( d )( 3 )( D ) would override application of § 1251( a ), as § 1312( d )( 3 )( D ) deals specifically with available health coverage for Members of Congress and congressional staff. On the other hand, a court could also find that these statutes may be read in concert with each other, in that § 1312( d )( 3 )( D ) only applies to new Members of Congress and congressional staff, and § 1251( a ) would apply to existing ones participating in FEHBP.

 

One may also argue that to allow Members and congressional staff to stay on FEHBP would frustrate congressional intent. While CRS was not able to find much discussion surrounding the intent of the provision, as noted by Senator Grassley, the idea behind offering a similar amendment that limited the health coverage available to Members and staff was “to require that Members of Congress and congressional staff get their employer-based health insurance through the same exchanges as … constituents." Thus, allowing current Members of Congress and congressional staff to stay in FEHBP seems contrary to this idea. However, it should be noted that if a reviewing court finds that the language in § 1251 can be interpreted under the plain meaning rule, it may choose to disregard this statement of congressional intent.

[Guest Consumer Watchdog]

The enactment of broad health reform into law is, as you know, only the start of providing health coverage to all Americans at a fair price. Not only must the White House and Congress close loopholes in the newly enacted law, but the White House must also strongly repel efforts already under way by insurers and other corporate interests to undermine Department of Health and Human Services regulations while they are being written. . . .

 

Key questions left unanswered in the legislation—including the scope of health benefits that insurers must provide under the new law—will be addressed over the next months and years by federal regulators. Congress must stand ready to continuously clarify and strengthen the law against efforts to nullify its broad and progressive intent. . . .

 

Consumers will brook no excuses for failure by the White House or Congress to strongly defend newly won consumer protections, fill dangerous loopholes in the new law, and ward off an onslaught of well-funded lobbyists.”

 

The ten loopholes and problem areas are (see letter at link above for more details):

 

* Lack of Insurer Rate Regulation. The federal law fails to adequately limit what insurers can charge American families and business owners for coverage, even though tens of millions of Americans are required to purchase private health insurance policies. Without the strongest possible review and prior approval of health insurance rates insurers will be able to raise rates nearly without limit and use rate-setting as a vehicle for continuing to cherry-pick the healthiest customers.

 

* Weakening of benefits. Pre-emption of stronger state benefit requirements by so-called Nationwide and Multi-state plans will threaten the survivability of the state Exchanges and eliminate key health and consumer protections in many states. This is a “race to the bottom” provision that may allow insurers to sell highly profitable bare-bones policies under the guise of cutting costs. Consumers who fall seriously ill would suffer the consequences.

 

* States Rights to Innovate. Under the current law, states must wait until 2017 for waivers from the federal government to use federal Medicaid, Medicare, tax subsidies and other funds to support state alternatives to the private insurance market, whether that be by adopting a state single-payer model or a state "public option." If the federal government will require all Americans to purchase private insurance by 2014 or face tax fines, then by 2014 the federal government must also give states the right to use their share of federal funds to support alternate, state-based health reform.

 

* Medicare Advantage pushback. Private, for-profit Medicare Advantage systems will spend hundreds of millions of dollars on glossy marketing to attract a higher percentage of healthier seniors into such plans. The result could be a lobbying coup that prevents cuts in Medicare Advantage overpayments, cripples efforts to stabilize Medicare costs and may even push traditional Medicare into an economic death spiral.

 

* Pharmaceutical price spiral. Pharmaceutical companies’ large and unwarranted recent price increases on heavily used drugs have already eliminated any cost savings from an industry promise to “reduce” Medicare drug prices by $8 billion a year. Further Congressional action is needed to allow direct bargaining for drugs by Medicare, which is the only way to steadily curb drug prices.

 

* Continued rescission. The federal law allows insurers to define the terms of future coverage rescissions when customers fall seriously ill in the fine print of their policies. The law limits rescission of health policies to instances of fraud or “intentional misrepresentation,” however no new regulatory oversight of rescission is provided to ensure that omissions or errors are indeed fraudulent or intentional, rather than innocent mistakes.

 

* No legal accountability for insurers that deny care. Patients who have health coverage paid for in part or full by employers cannot hold insurers legally accountable for denying medically necessary treatments.

 

* Definition of medical expenses. Consumer Watchdog has called on the Obama Administration and the Department of Health and Human Services (“HHS”) to probe insurance giant WellPoint Inc. in light of a message to its investors describing how WellPoint would simply re-label administrative costs as “medical care” in response to the new health reform law. HHS must narrowly define what constitutes medical care to block gaming of the new medical loss ratio requirement by health insurers.

 

* Inadequate Federal Fallback. Consumer Watchdog advocates for frontline state enforcement with strong federal fallback if states fail to act. States are the local cops on the beat and can respond faster to local threats and with greater knowledge of the local market. But there should be pathways for federal regulators to become fully aware of the failure of state fraud enforcement through public intervenor groups and reporting requirements that tip federal regulators to local inaction.

 

* Sick kids. The ink was hardly dry on the health reform law when the insurance industry started saying that no matter what Congress thought it passed and no matter what President Obama said, they did not have provide coverage to sick children right away. The main private insurer lobbying group, Americans Health Insurance Plans, has since said it will not fight the new coverage of previously excluded children and conditions, but the provision must also be clearly stated in regulations implementing the law.

 

http://www.consumerwatchdog.org/patients/articles/?storyId=33691

[Guest John]

In a move sure to please the "no" voters on this bill insurance companies announced that even though they were no longer able to deny coverage to children with pre-existing conditions, they could now deny coverage to "children in general."

Nice.

[Guest Literati]

Final part of the CBO memo:

 

Applicability of FEHBP to New Members and Covered Congressional Staff

 

The language of § 1312( d )( 3 )( D ) specifies what "health plans" the federal government may make available to Members of Congress and congressional staff. The definition of health plan, as provided under § 1301( b )( 1 ) of PPACA, means a group health plan or health insurance coverage as defined under § 2791 of the Public Health Service Act (PHSA). Under this section of the PHSA, it appears that FEHBP would likely be considered a "health plan." However, in light of the fact that FEHBP is an existing program established under the Federal Employee Health Benefits Act, the program was not created by PPACA or an amendment made by the Act, and FEHBP would not be an option in a state's exchange; therefore, it would appear that, at least for new Members and staff, this provision does not allow the federal government to make FEHBP "available" to them.

[Guest LAW]

Senator Jim Webb (D-VA) secured full protection of military health care for service members, veterans and their families when the U.S. Senate unanimously approved the TRICARE Affirmation Act, S. 3148. Webb’s legislation explicitly states in law that TRICARE and Department of Defense (DOD) nonappropriated fund (NAF) health plans meet the minimum essential coverage standard for individual health insurance required by the recently enacted health care reform law.

 

Webb Bill Passes, Protecting TRICARE for Military Service Members, Veterans and Families

 

Supported by Leading Service Organizations, Measure Heads to President’s Desk

 

April 13, 2010

 

Webb’s bipartisan legislation, which was cosponsored by 65 members of the Senate, mirrors the successful legislation of House Armed Services Committee Chairman Ike Skelton (D-MO). The bill now heads to the President’s desk to be signed into law.

 

“Following months of confusion surrounding military health care programs, we can now definitively tell our service members and their families today that their health care is secure,” said Senator Webb, who serves as chairman of the Personnel Subcommittee of the Senate Committee on Armed Services. “Thanks to the strong support of our nation’s leading military and veterans organizations, we will be able to write into law that the coverage provided by TRICARE and other military health programs meets the minimal essential coverage required under the new health care reform law.”

 

Continued Webb: “As one who grew up in the military, served as a Marine in Vietnam and spent five years in the Pentagon, I know the special obligation we have to provide our military service members, their families, and our veterans with the very finest health care coverage available. Today, we can tell them that we’ve continued to make good on that promise.”

 

Success of Senator Webb’s TRICARE Affirmation Act was received with strong praise today from numerous military service organizations, including the Veterans of Foreign Wars (VFW), the Military Officers Association of America (MOAA), the National Association for Uniformed Services (NAUS), and the Air Force Association (AFA).

 

“This is a great victory for military families,” said Thomas J. Tradewell Sr., National Commander of the Veterans of Foreign Wars of the U.S. “Senator Webb is a true military champion, and along with House Armed Services Committee Chairman Ike Skelton (D-Mo.), the VFW is most grateful for their leadership to recognize and protect all military TRICARE programs under the national healthcare law.”

 

“We’re very grateful for Sen. Webb’s leadership in ensuring the law explicitly states that TRICARE meets coverage requirements under the new national health reform legislation,” said VADM Norb Ryan, Jr. (US Navy-Ret), President of the Military Officers Association of America. “MOAA accepts assurances that there was no danger of it being considered otherwise, but the lack of statutory clarity was a source of concern to many. We appreciate Sen. Webb’s initiative in establishing that clarity beyond any doubt.”

 

“The National Association for Uniformed Services (NAUS) congratulates Senator Webb on his success in the passage of legislation that explicitly states in law that TRICARE meets requirements under the new health care bill,” said Major General William M. Matz, Jr. (US Army-Ret), President of NAUS. “The men and women who serve our country in uniform deserve complete assurance that their earned health care benefits are fully protected and this legislation will do just that. On behalf of our more than 180,000 NAUS members and supporters, I thank you for your leadership to see this fundamental responsibility is fulfilled.”

 

“We appreciate Senator Webb’s commitment to preserving TRICARE for all those who have earned this important benefit through their patriotic service,” said Mike Dunn, President of AFA. “The TRICARE Affirmation Act reinforces our national commitment to care for our veterans and their families.”

 

TRICARE, TRICARE for Life, and the DOD nonappropriated fund (NAF) provide health coverage to members of the military and their families, military retirees and their families, and employees of U.S. military post/base exchanges and other nonappropriated fund activities. Beneficiaries of TRICARE for Life and military veterans’ health care programs also satisfy requirements for individual health insurance under the health care reform bill and will not be required to purchase additional coverage.

[Guest John]

Our military deserves the best care available due to their (sometimes "ultimate") sacrifices.

That being said, while I appreciate all the back-patting going on, TRICARE was never in any danger due to the health care legislation - to me it's like congratulating a senator for his continued support for having the 4th of July remain a federal holiday - was there any real danger of the 4th of July holiday being discontinued?

Just my 2 cents...

[Guest HUMAN]

Well!! In about two weeks I will be going thru MAJOR SURGERY and there is a great likelihood that I won’t live through it.

 

With a shortfall of 44 thousand doctors, with the healthcare bill being law, it must be changed.

 

For if not? There will be many folks where I am headed "6 feet under".

 

It doesn't get anymore real than this.

[Guest Soldier of God]

May God bless you and guide your surgeons with wisdom and skill. Father grant Human's illness be removed, so that he may be restored to soundness of health. Through Jesus Christ. Amen.

[Guest Human]

Thanks. You know Soldier; I really wished that the democrats did this Bill which is now law RIGHT.

 

Not the way it is now. In all frankness; I hope I get to live long enough to see it done right.

That would really be a miracle.

 

I don't want anything else in politics.

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May God bless you and guide your surgeons with wisdom and skill. Father grant Human's illness be removed, so that he may be restored to soundness of health. Through Jesus Christ. Amen.

[Guest LAW]

I too hope your surgery goes well. Here is a recent statement of the President about visitation rights.

 

Presidential Memorandum - Hospital Visitation

MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES

 

SUBJECT: Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies

 

There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital. In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean -- a loved one to be there for us, as we would be there for them.

 

Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides -- whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.

 

For all of these Americans, the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real onsequences. It means that doctors and nurses do not always have the best information about patients' medications and medical histories and that friends and certain family members are unable to serve as intermediaries to help communicate patients' needs. It means that a stressful and at times terrifying experience for patients is senselessly compounded by indignity and unfairness. And it means that all too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall.

 

Many States have taken steps to try to put an end to these problems. North Carolina recently amended its Patients' Bill of Rights to give each patient "the right to designate visitors who shall receive the same visitation privileges as the patient's immediate family members, regardless of whether the visitors are legally related to the patient" -- a right that applies in every hospital in the State. Delaware, Nebraska, and Minnesota have adopted similar laws.

 

My Administration can expand on these important steps to ensure that patients can receive compassionate care and equal treatment during their hospital stays. By this memorandum, I request that you take the following steps:

 

1. Initiate appropriate rulemaking, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national

origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient's care or treatment.

 

2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations.

 

3. Provide additional recommendations to me, within 180 days of the date of this memorandum, on actions the Department of Health and Human Services can take to address hospital visitation, medical decisionmaking, or other health care issues that affect LGBT patients and their families.

 

This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

 

You are hereby authorized and directed to publish this memorandum in the Federal Register.

 

BARACK OBAMA

[Guest Justice]

With the creation of the registry, every new RFID will be documented and entered into a system which was created solely to keep tabs on it.

 

Revelation 13:16-17

16 He also forced everyone, small and great, rich and poor, free and slave, to receive a mark on his right hand or on his forehead, 17 so that no one could buy or sell unless he had the mark, which is the name of the beast or the number of his name.

 

The individual micro-chipping of Americans is not currently and explicitly laid out in OBAMACARE, but could become a very real possibility under the guise of protection and “delivery of efficient and affordable healthcare”. If this were allowed in the future, it would not only fly in the face of the Constitution, but God, the natural law, and each and every individual right that has been recognized since the beginning of time.

 

Read the language of these sections here:

http://en.wikisource.org/wiki/H.R._3200/Division_C/Title_V/Subtitle_C (§2521 OBAMACARE)

http://www.law.cornell.edu/uscode/21/usc_sec_21_00000360—i000-.html (21 U.S.C. 360i)

http://usjf.net/?p=1492#more-1492