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Summary, comments on 383-page amendment to ObamaCare (HR 3590)

Senator Harry Reid (D-NV) filed this 383-page amendment to ObamaCare (HR 3590), which includes provisions used to buy the votes of various Senate Demcrats. I’ve summarized and commented on most sections of the amendment  and published all of the controversial abortion section  Publish all of the abortion section below. Also, I summarized and commented on some parts of the original Senate bill, S 1796, on October 19.

• Gun owners won’t have disclose their legal ownership or possession or storage of guns, ammunition. Thus, the government and insurers can’t collect information that would let them charge gun owners higher premiums because they own and possess guns. p. 5.

• Price controls placed on insurers, ensuring they’ll offer only profitable products. p. 9.

• Requires insurers to rebate premiums on a pro rata basis if the ratio of the amount of premium revenue expended by the insurer on administrative costs exceeds 15% to 20%. Watch customer service departments close. p. 9.

• Hospitals annually must publish standard rates by DRG. These are phony rates because they’re deeply discounted for insurers, Medicare, Medicaid. p. 12.

• Insurers required to set up appeals process for patients whose claims have been denied. Increases hated administrative costs. Protects patients. Reduces coverage denials, raises premiums. p. 13.

• Hospitals’ ERs will get paid even if out of network. p. 16. This seems to keep hospital ERs in the primary care business, but now they’ll be better paid. 

• Protects pediatric care docs vs. family practitioners and other primary care docs. p. 19.

• OB/GYNs will get paid. p. 20.

• Creates Medical Data centers that will report market rates on the Internet for medical services and geographic differences in those rates.The centers can’t be controlled by providers or payers and can’t compel insurers to provide data. This is an attempt to reduce variations in rates in rural and metro areas. Good luck with that. p. 23.

• Sec. 2709. Coverage for individuals particiapating in approved clinical trials. Medical researchers and institutions are protected. p. 27.

• Sec. 1253. Annual report on self-insured plans. Due a year for enactment, the report would give policy makers better info about self-insured health plans. Democrats would like to regulate them more. Conservatives want employers out of the health insurance business. p. 34.

• Sec.1254. Study of large group market. Congress is blindly deforming health insurance markets. This provision proves it. p. 35.

• Sec. 10104. Amendments to subtitle D. This is a provision that requires health insurers to cover home care or a provision designed to regulate what home care providers can be covered by insurers and what they are paid. The Secretary of DHHS will decide who can be a “qualified” home health provider and what they can be paid. Micro management and distortion of the markets run rampant. p. 36.

Sec. 1303. Special rules. Abortion. p. 38.

‘‘SEC. 1303. SPECIAL RULES.

‘‘(a) STATE OPT-OUT OF ABORTION COVERAGE.— ‘‘(1) IN GENERAL.—A State may elect to pro- hibit abortion coverage in qualified health plans of- fered through an Exchange in such State if such State enacts a law to provide for such prohibition. ‘‘(2) TERMINATION OF OPT OUT.—A State may repeal a law described in paragraph (1) and provide for the offering of such services through the Ex-

change.

‘‘(b) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERVICES.—

‘‘(1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES.—

‘‘(A) IN GENERAL.—Notwithstanding any other provision of this title (or any amendment made by this title)—

‘‘(i) nothing in this title (or any amendment made by this title), shall beBAI09R08 S.L.C. 39

1 construed to require a qualified health plan 2 to provide coverage of services described in 3 subparagraph (B)(i) or (B)(ii) as part of 4 its essential health benefits for any plan 5 year; and

6 ‘‘(ii) subject to subsection (a), the 7 issuer of a qualified health plan shall de- 8 termine whether or not the plan provides 9 coverage of services described in subpara-

10 graph (B)(i) or (B)(ii) as part of such ben- 11 efits for the plan year. 12 ‘‘(B) ABORTION SERVICES.— 13 ‘‘(i) ABORTIONS FOR WHICH PUBLIC 14 FUNDING IS PROHIBITED.—The services 15 described in this clause are abortions for 16 which the expenditure of Federal funds ap- 17 propriated for the Department of Health 18 and Human Services is not permitted, 19 based on the law as in effect as of the date 20 that is 6 months before the beginning of 21 the plan year involved.

22 ‘‘(ii) ABORTIONS FOR WHICH PUBLIC 23 FUNDING IS ALLOWED.—The services de- 24 scribed in this clause are abortions for 25 which the expenditure of Federal funds ap-

BAI09R08 S.L.C. 40

1 propriated for the Department of Health 2 and Human Services is permitted, based 3 on the law as in effect as of the date that 4 is 6 months before the beginning of the 5 plan year involved.

6 ‘‘(2) PROHIBITION ON THE USE OF FEDERAL 7 FUNDS.— 8 ‘‘(A) IN GENERAL.—If a qualified health 9 plan provides coverage of services described in

10 paragraph (1)(B)(i), the issuer of the plan shall 11 not use any amount attributable to any of the 12 following for purposes of paying for such serv- 13 ices:

14 15 16 17 18 19 20 21 22 23 24 25

‘‘(i) The credit under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance pay- ment of the credit under section 1412 of the Patient Protection and Affordable Care Act).

‘‘(ii) Any cost-sharing reduction under section 1402 of thePatient Protection and Affordable Care Act (and the amount (if any) of the advance payment of the reduc- tion under section 1412 of the Patient Protection and Affordable Care Act).

BAI09R08 S.L.C. 41

1 ‘‘(B) ESTABLISHMENT OF ALLOCATION AC- 2 COUNTS.—In the case of a plan to which sub- 3 paragraph (A) applies, the issuer of the plan 4 shall—

5 ‘‘(i) collect from each enrollee in the 6 plan (without regard to the enrollee’s age, 7 sex, or family status) a separate payment 8 for each of the following:

9 ‘‘(I) an amount equal to the por- 10 tion of the premium to be paid di- 11 rectly by the enrollee for coverage 12 under the plan of services other than 13 services described in paragraph 14 (1)(B)(i) (after reduction for credits 15 and cost-sharing reductions described 16 in subparagraph (A)); and

17 ‘‘(II) an amount equal to the ac- 18 tuarial value of the coverage of serv- 19 ices described in paragraph (1)(B)(i), 20 and

21 ‘‘(ii) shall deposit all such separate 22 payments into separate allocation accounts 23 as provided in subparagraph (C). 24 In the case of an enrollee whose premium for 25 coverage under the plan is paid through em-

BAI09R08 S.L.C. 42

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

ployee payroll deposit, the separate payments required under this subparagraph shall each be paid by a separate deposit.

‘‘(C) SEGREGATION OF FUNDS.— ‘‘(i) IN GENERAL.—The issuer of a

plan to which subparagraph (A) applies shall establish allocation accounts de- scribed in clause (ii) for enrollees receiving amounts described in subparagraph (A).

‘‘(ii) ALLOCATION ACCOUNTS.—The issuer of a plan to which subparagraph (A) applies shall deposit—

‘‘(I) all payments described in subparagraph (B)(i)(I) into a separate account that consists solely of such payments and that is used exclusively to pay for services other than services described in paragraph (1)(B)(i); and

‘‘(II) all payments described in subparagraph (B)(i)(II) into a sepa- rate account that consists solely of such payments and that is used exclu- sively to pay for services described in paragraph (1)(B)(i).

‘‘(D) ACTUARIAL VALUE.—

BAI09R08 S.L.C. 43

1 ‘‘(i) IN GENERAL.—The issuer of a 2 qualified health plan shall estimate the 3 basic per enrollee, per month cost, deter- 4 mined on an average actuarial basis, for 5 including coverage under the qualified 6 health plan of the services described in 7 paragraph (1)(B)(i).

8 ‘‘(ii) CONSIDERATIONS.—In making

9 such estimate, the issuer— 10 ‘‘(I) may take into account the 11 impact on overall costs of the inclu- 12 sion of such coverage, but may not 13 take into account any cost reduction 14 estimated to result from such services, 15 including prenatal care, delivery, or 16 postnatal care; 17 ‘‘(II) shall estimate such costs as 18 if such coverage were included for the 19 entire population covered; and 20 ‘‘(III) may not estimate such a 21 cost at less than $1 per enrollee, per 22 month. 23 ‘‘(E) ENSURING COMPLIANCE WITH SEG- 24 REGATION REQUIREMENTS.—

BAI09R08 S.L.C. 44

1 ‘‘(i) IN GENERAL.—Subject to clause 2 (ii), State health insurance commissioners 3 shall ensure that health plans comply with 4 the segregation requirements in this sub- 5 section through the segregation of plan 6 funds in accordance with applicable provi- 7 sions of generally accepted accounting re- 8 quirements, circulars on funds manage- 9 ment of the Office of Management and

10 Budget, and guidance on accounting of the 11 Government Accountability Office. 12 ‘‘(ii) CLARIFICATION.—Nothing in 13 clause (i) shall prohibit the right of an in- 14 dividual or health plan to appeal such ac- 15 tion in courts of competent jurisdiction.

16 ‘‘(3) RULES RELATING TO NOTICE.— 17 ‘‘(A) NOTICE.—A qualified health plan 18 that provides for coverage of the services de- 19 scribed in paragraph (1)(B)(i) shall provide a 20 notice to enrollees, only as part of the summary 21 of benefits and coverage explanation, at the 22 time of enrollment, of such coverage. 23 ‘‘(B) RULES RELATING TO PAYMENTS.— 24 The notice described in subparagraph (A), any 25 advertising used by the issuer with respect to

BAI09R08 S.L.C. 45

1 the plan, any information provided by the Ex- 2 change, and any other information specified by 3 the Secretary shall provide information only 4 with respect to the total amount of the com- 5 bined payments for services described in para- 6 graph (1)(B)(i) and other services covered by 7 the plan.

8 ‘‘(4) NO DISCRIMINATION ON BASIS OF PROVI-

9 SION OF ABORTION.—No qualified health plan of- 10 fered through an Exchange may discriminate against 11 any individual health care provider or health care fa- 12 cility because of its unwillingness to provide, pay for, 13 provide coverage of, or refer for abortions

14 ‘‘(c) APPLICATION OF STATE AND FEDERAL LAWS 15 REGARDING ABORTION.— 16 ‘‘(1) NO PREEMPTION OF STATE LAWS REGARD- 17 ING ABORTION.—Nothing in this Act shall be con- 18 strued to preempt or otherwise have any effect on 19 State laws regarding the prohibition of (or require- 20 ment of) coverage, funding, or procedural require- 21 ments on abortions, including parental notification 22 or consent for the performance of an abortion on a 23 minor.

24 ‘‘(2) NO EFFECT ON FEDERAL LAWS REGARD- 25 ING ABORTION.—

BAI09R08 S.L.C. 46

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

‘‘(A) IN GENERAL.—Nothing in this Act shall be construed to have any effect on Federal laws regarding—

‘‘(i) conscience protection;

‘‘(ii) willingness or refusal to provide abortion; and

‘‘(iii) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to pro- vide or participate in training to provide abortion.

‘‘(3) NO EFFECT ON FEDERAL CIVIL RIGHTS LAW.—Nothing in this subsection shall alter the rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.

• Sec. 1334. Multi-state plans. Director of the Office of Personnel Management shall contract with health insurers that want to sell insurance across state lines. Small office would become huge bureacracy subject to intensive lobbying by insurers, members of Congress and others. Should draw a lot of big  campaign contributions for the president and influential members of Congress. Annual contracts mean perpetual negotiations. Protects Kaiser and not-for-profit Blues. The Director designs the plans, which means they’ll include costly coverage mandates. p. 54.

• Under 1334, States may impose additional expensive coverage mandates, which will ensure that providers who sponsor those mandates will continue to make nice profits. But, this is neat, the cost of state mandates won’t be covered by the feds. For subsidized individual insureds, the states must pay for the additional mandates. Should keep states from adding mandates. p. 59.

• Under 1334, only three or four big national insurers like Aetna, Humana, UnitedHealth, Wellpoint  and Cigna would be able to compete across state lines. This is because national plans would have to cover 60% of the states in the first year they offered multi-state plans, 70% in the second year, 85% in the third and 100% thereafter. The goal here, I think, is to pretend to allow insurers to sell across state lines but to make it so difficult that few if any will ever try. p. 61. 

• Sec. 10105. Amendments to subtitle E. Changes sections of the Internal Revenue Code. Taxes. I’ll leave it to others to figure this out. p. 64.

• Section 10106. Amendments to subtitle F. This looks like an attempt to show that the act would be Constitutional under the 10th Amendment and contains a lot of questionable propaganda desgined to show Congressional intent when an if the act is challenge in court. p. 67.

• Penalties or fines for individuals who don’t buy insurance. Fines as a percentage of household income: 2014, .5%; 2015, 1%; After 2015, 2%. Since health insurance is still a bargain for consumers, costing most more than 5% of household income, this is an invitation to freeride and game the system. p. 73.

• Large employers are discouraged from making new employes wait for health insurance coverage. Nice way to discourage hiring. p. 76

• Sec. 1562. Requires a GAO study of the rate of denial of coverage and enrollment by health insurers and group health plans. There are a lot of myths out there. p.77.

• Sec. 1563. Small business procurement. p. 79.

• Sec. 10108. Free Choice Vouchers. Employers would give vouchers to workers. Workers would use to buy health insurance insurance on state health insurance exchanges. This means employers wouldn’t select insurers, workers would. That would be a good change. p.80.

• Indexing of the 8% of payroll cost of health insurance after 2014 means that health insurance costs are expected to rise and that the cost of health premiums to employers will rise well above 8% over time. p. 87.

• Section 10109. Development of standards for financial and administrative transactions. Instructs the Secretary to establish and maintain administrative standards and to facilitate “crosswalk” from ICD-9 to ICD-10 coding used by providers seeking payments. p. 90. 

• Subtitle B, Part I—Medicaid and CHIP. 

Sec. 10201. Amendments to the Social Security Act. Makes provisions requiring insurers to cover family dependents and foster children under 26 effective in 2014 instead of 2019. Or it could mean 2015 instead of 2020. It’s not clear here. Makes other provisions effective  April 1, 2010 instead of Jan. 1 2011. Watch for clarification. p. 93.

Reid buys votes from Ben Nelson beginning on page 96. 

• Sec. 10202. Incentives for states to offer home and community-based services as a long-term care alternative to nursing homes. Looks like an unfunded mandate on states. Wonder whose vote this buys? Nursing home companies will fight to change this down the road. How will seniors’ groups and advocacy groups for the disabled respond? Generally, keeping people out of nursing homes looks like a good idea until you’re the home-bound care giver who’s expected to lift a 200-pound patient every time he or she falls. Some special interests are being taken care (hospitals, home health agencies, some medical equipment and supply companies, the states) of and gored (family care givers, nursing homes, hospices?) here. p. 111.

More spending. Sec. 10203. Extension of funding for CHIP through fiscal year 2015, etc. p. 120.

• Part II–Support for pregnant and parenting teens and women. More spending. p. 132.

• Sec. 10212. Establishment of $25 billion per fiscal year 2010-2019 pregnancy assistance fund. Looks like a subsidy for colleges, universities, high schools and community centers. Patients probably won’t see any of this money. Can you spell f-r-a-u-d and a-b-u-s-e? p. 134.

• Sec. 10221. Indian health care improvement. Indian health historically has been under funded. Do tribes that own casinos get more money? Who put this in the bill? Ah, it’s for the dentists! p. 144.

• Sec. 10301. Plans for a value-based purchasing program for ambulatory surgical centers. Looks like the hospitals are trying to impose expensive administrative burdens on their competitors, the surgery centers. It also looks like a senator, employee or family memberhad a bad experience at a surgery center and is trying to get even. Who sponsored this?  p. 146.

• Sec. 10302. Revision to national strategy for quality improvement in health care. Technical stuff. p. 148. 

• Sec. 10303. Development of outcome measures. The technology here, I think, is about as good as in global warming and green technology. Think Climategate. p. 149.

• Sec. 10305. Data collection; public reporting. Better data certainly is needed. p. 152.

• Sec. 10306. Improvements under the center for Medicare and Medicaid innovation. Oxymoron alert!

p. 154.

• Sec. 10307. Improvements to the Medicare shared services program. Designed to reduce payments to providers, I think. Trying to turn large health care providers into risk-taking insurers. p. 156.

• Sec. 10308. Revisions to national pilot program on payment bundling. Years ago, we published an article on payment bundling in Health Care Strategic Management by Walter Unger. Not sure it would work. Note the term, “continuing care hospitals,” defined on p. 161. They used to be called “integrated health care systems (1990s) or vertically integrated care (1960s, 1970s, 1980s). The concept hasn’t worked very well because of differing payment schemes for various levels of care. Does it make sense to impose acute care overhead on a home care business. And how do you get the docs to participate? Harder than it looks. p. 159.

• Sec. 103010. Repeal of physician payment update. Sneaky way to cut about $250 billion out of the bill and shift it into the defense act that was just sent to the president. p. 161.

• Sec. 10311. Revisions to extension of ambulance add-ons. Looks like the cost of the bill is being cut a bit by delaying the expansion of subsidies for rural ambulance services. p. 162. 

• Sec. 10312. Certain payment rules for long-term care hospital services and moratorium on the establishment of certain hospitals and facilities. Extends moratorium on building new facilities to five years from four. Specialty hospitals and psychiartric hospitals lose to budget cutters, I think. p. 163.

• Sec. 10313. Revisions to the extension for the rural community hospital demonstration program. Was this for Ben Nelson? p. 164.

• SEC 10314. Adjustment to low-volume hospital provision. Defines qualifying low-volume as 1,600 discharges instead of 1,500. p. 167. 

• Sec. 10315. Revisions to home care provisions. Requires study due March 1, 2014 of home health agency services to low-income Medicare beneficiaries in medically underserved areas. Aim is to revise payment system to save government money, maybe to improve services. Spends $500 million over five years on demonstration projects. p. 167.

• Sec. 10317. Revisions to extension of section 508 hospital provisions. Special interest get more money for certain hospitals. Technical stuff. p. 174.

• Sec. 10319. Revisions to market basket adjustments. Lobbyists for providers get paid back for their contributions. p. 177.

• Independent Medicare Advisory Board becomes Independent Payment Advisory Board (IPAB). The advisory boards, otherwise known as “death panels”, will advise on payments by private providers as well as by Medicare. p. 189, line 19.

• Sec. 10322. Quality reporting for psychiatric hospitals. p. 190.

• Sec. 10323. Medicare coverage for individuals exposed to environmental health hazards. Mary Landrieu gets her $300 million for New Orleans and Louisiana. This was an expensive vote. p. 193.

• Sec. 2009. Program for early detection of certain medical conditions related to environmental health hazards. More for Mary. p. 203.

• Funding Sec. 2009. $23 million for fiscal 2010 through 2014; $20 million for each 5-fiscal year period thereafter. p. 207.

• Sec. 10324. Protections for frontier states (a state in which at least 50% of counties are frontier counties that have less than 6 residents per sq mile, i.e., Neb.). More money for Kent Conrad’s and Byron Dorgan’s North Dakota. Sets wage index floor for rural hospitals in the state, thereby upping their Medicare, Medicaid and other government program revenues. p. 208.

• Floor on area wage adjustment factor for hospital outpatient dept. services in frontier states. Money for Fargo hospitals, etc. p. 210.

• Floor for practice expense index for services furnished in frontier states. Takes care of Neb. docs, other clinicians. p. 211.

• Sec. 10325. Revision to skilled nursing facility prospective payment system. Delays new regs for the industry. p. 212.

• Sec. 10326. Pilot testing pay for performance programs for certain Medicare providers. By Jan. 1, 2016, Secretary shall conduct a separate pilot program to test the implementation of a value-based purchasing program. Coveres psych hospitals, long-term care hospitals, rehab hospitals, PPS (prospective payment system)-exempt cancer hospitals, hospice programs. Prospective payments by DRGs have failed to contain Medicare’s costs since they were first implemented in 1984. PPS has totally failed and distorted health care markets while failing to contain costs or expenditures. If a rate setting scheme fails, might as well try to see how it will fail again. p. 213, line 14.

• Sec. 10327. Improvements to the physician quality reporting system. Sets up a “Maintenance of Certification Program’ for physicians. If they maintain their certifications, they apparently get paid more. Think of how k-12 teachers game the system by getting masters degrees in online teaching to earn higher pay for teaching music, art or reading in a school. It’s not how well the doctors perform that counts, it’s how well they test. Don’t expect the tests to be that hard. This program could be used to do what I’ve been advocating for years, counter detail the drug companies in an effort to get docs to prescribe cost-effective drugs instead of the latest and most expensive ones. p. 216.

• Sec. 10328. Improvement in Part D medication therapy management (MTM) programs. Disease management, case management and drug prescription adherence management for Medicare/Medicaid beneficiaries on high-cost drugs. This looks like a program intended to get the chronically ill to take their pills and to reduce costly drug interactions. Should improve quality of care and life. Cost effectiveness will depend on the individual patients, their therapists and program managers who will have no financial incentives to save money. p. 221, Line 18.

• Sec. 10329. Developing methodology to assess health plan value. Due 18 months after bill’s enactment. Insurers, providers, regulators all would have input, which means the plan will be dumbed down to the lowest possible levels. That’s the way self-regulation works. p. 224, line 21.

• Sec. 10330. Modernizing computer and data systems of the centers for Medicare & Medicaid services to support improvements in care delivery. Plan due 9 months from enactment, which means implementation would be years away.  Some huge assumptions here, but the software undoubtedly is ancient. p. 225, line 20.

• Sec. 10331. Public reporting of performance information. Develop a Physician Compare Internet website by Jan. 2011. Why hasn’t this been done by now? Because physicians and hospitals don’t want it and probably will find ways to delay it again. p. 226, line 22.

Sec. 10332. Availability of Medicare data for performance measurement. CMS would sell data on individual providers (hospitals, physicians, etc.) to public or private entities qualified to design and run performance measurements that would show how those providers do their jobs. The data would be sold at the government’s cost. Apparently the database, consulting and academic institutions that would do the studies could sell them to providers, payers, patients, government agencies, suppliers, employers, etc.? Like gun owners who don’t want insurers to know they own gun because they don’t want the insurers to charge them higher premiums because they own guns, providers will fight the implementation of this program. This is because they fear the data would be used to cut their incomes and give bureaucrats more power to create practice guidelines and control their incomes. p. 232, line 14.

• Sec. 10333. Community-based collaborative care networks. Gives hospitals, physician groups, clinics, alternative care providers incentives to provide low income patients coordinated care in integrated companies or contractually-linked firms and agencies. Again, this is an attempt to make case management, disease management and vertical integrated providers work in low-income communities. The idea is that if there is coordinated, collaborative care, patients will recover faster and at less cost. So much depends on organizational politics, community dynamics and cooperation by patients. The ideals are great. Not sure about the execution, which is what really counts. If Congress cuts physicians’ pay and cuts Medicare payments to institutions, don’t look for them to be very collaborative. Note that no funds are appropriated in this bill, which keeps the cost of the bill down. p. 237, line 12.

• Sec. 10334. Minority health. The Office of Minority Health would be taken from the Office of Public Health and Science and put in DHHS and would be headed by a deputy assistant secretary for minority health. This office would serve, what, a third of Americans? No funding provided. Keeps cost of the bill artificially low. p. 240, line 19. 

• Sec. 10336. GAO study and report on Medicare beneficiary access to high-quality dialysis services. Due 1 year after enactment. There is a big battle between providers and Medicare over bundled payments, which providers believe would hurt the quality of care for patients on dialysis. Senators obviously want more information. p. 249.

• Subtitle D—provisions relating to Title IV. Sec. 10401. Amendments to subtitle A. Delays effective dates for certain preventive care and wellness programs to 2020 from 2010. Not clear which ones. Did Reid do this to cut the cost of the bill? p. 250, line 20.

• Sec. 10407. Better diabetes care. Catalyst to Better Diabetes Care Act of 2009.  DHHS, CDC create biennial national diabetes Report Card and “to the extent possible, for each state.” Collect statistics, educate physicians on the importance of birth and death certificate data, encourage states to keep better data. p. 254, line 10.

• Sec. 10408. Grants for small businesses (< 100 employes) to provide comprehensive workplace wellness programs. What a waste. Employers should create jobs. Workers should take care of their wellness care out of their own pockets. p. 257, line 15.

• Comprehensive workplace wellness programs. p. 258, line. 9. $200 million funding for fiscal years 2011 through 2015. p. 259, line 21.

• Sec. 402C. Cures acceleration network (CAN). A $500 million program for fiscal 2010 alone. (p. 277, line 3) This is a provision for the biological drug industry that AARP opposed. It would award grants and contracts by NIH to developers of high need cures. Funding for basic research through commercialization of products. Effectively tells FDA to stop delaying new products with cya reviews. Creates CAN advisory board. This appears to be a very big deal for one or more senators who has clout. p. 261.

Sec. 10410. Centers of Excellence for Depresssion. $1.25 billion over 10 years for the creation of up to 20 depression centers and extensive research depression and preventive services aimed at low income populations. A big win for the mental health industry, medical researchers and one or more senators who is very concerned about the illnesses involved. Wonder who they are? p. 277, line 12.

• Sec. 10411. Programs relating to congental heart disease. p. 289, line 9.

• Sec. 10413. Young women’s breast health awareness and support of young women diagnosed with breast cancer. $35 billion program over 5 years.  Young Women’s Breast Health Education and Awareness Requires Learning Young Act of 2009. Could this be in the bill to get Senators Barbara Boxer (D-CA) and Patty Murray (D-WA), the two pro-choice senators who were negotiating with Sen. Nelson through Reid and Schumer, to give a little on abortion? Could it? p. 294, line 8.

• Sec. 5104 Interagency task force to assess and improve access to health care in the state of Alaska. p. 302, line 18.

• Sec. 5316 Demonstration grants for family nurse practitioner training programs. p. 305, line 18.

• Sec. 399V-3. National diabetes prevention program. p. 310, line 20.

• Sec. 5606. State grants to health care providers who provide services to a high percentage of medically underserved populations or other special populations. This probably is for Schumer and other big city Senators. p. 318, line 17.

• Subpart I—Medical training generally

• Sec. 749B. Rural physician training grants. $16 million—$4 million a year fiscal years 2010 through 2013. p. 318, line 21.

• Sec. 768. Preventive medicine and public health training grant program. $43 million for fy 2011 “and such sums as may be necessary for each of the fiscal years 2012 through 2015. Keeps cost of bill down. p. 323, line 14.

• Sec. 10502. Infrastructure to expand access to care. $100 million construction grant or debt service for a public research university that contains sole public academic medical and dental school. Which one? I don’t think Colorado. It has new school. p. 329, line 14.

• Sec. 10503. Community health centers and the national health service corps fund. $7 billion over 5 years for Sen. Sanders. And another $1.52 billion for National  Health Service Corps over fy ‘11 through ‘15. p. 329, line 21.

• Sec. 10504. Demonstration project to provide access to affordable care. p. 331, line 21.

• Sec. 10601. Revisions to limitation on Medicare exception to the prohibition on certain physcian referrals for hospitals. p. 332, line 20.

• Sec. 10602. Clarifications to patient-centered outcomes research. p. 333, line 11.

• Sec. 10605. Certain other providers permitted to conduct face to face encounter for home health services. Nurse practictioners and clinical nurse specialists as well as certified nurse midwifes given access to this business. p. 336, line 5.

• Sec. 10606. Health care fraud enforcement. Stiffens penalties. Gives investigators new subpoena powers to access institutions under investigation. p. 337, line 3.

• Sec. 10607. State demonstration programs to evaluate alternatives to current medical tort litigation. $50 million for reports due in 2016.  Weak effort to deflect Republican demands for medical malpractice tort reforms. p. 344, line 5. 

• Sec. 10608. Extension of medical malpractice coverage to free clinics. Extends protection to officers, boards. Effective upon enactment. p. 358, line 16.

• Sec. 10609. Labeling changes. Technical stuff for drug industry. p. 359, line 3.

• Section 10901. Modifications to excise tax on high cost employer-sponsored health coveratge. p. 362, line 5.

• Longshore workers treated as employees engaged in high-risk professions. p. 359, line 9.Exempts longshoremen from high-cost insurance tax includes certain additiona excepted benefits. p. 359, line 18.

• Sec. 10902. Inflation adjustment of limitation on health flexible spending arrangements under cafeteria plans. A Ben Nelson item. p. 363, line 4.

• Sec. 10903. Modification of limitation on charges by charitable hospitals. Technical changes from “the lowest amounts charged” to “the amounts generally billed.” Probably allows these hospitals to bill more. p. 364, line 12.

• Modification of annual fee on medical device manufacturers and importers. Looks like it reduces tax burden on companies based in Minnesota, Indiana and New Jersey. p. 364, line 22.

• Sec. 10905. Modification of annual fee on health insurance providers. Looks like it reduces tax liabilities of very small insurers.  p. 365, line 10.

• Exemption from annual fee on health insurance for certain nonprofit entities. Sen. Nelson and Sen. Carl Levin (D-MI) protect the tax-exempt Blue Cross monopolies in their states. Getting a lot of media attention. p. 367, line 6.

• Sec. 10906. Modifications to additional hospital insurance tax on high-income taxpayers. Increases FICA and SECA taxes (Medicare payroll taxes paid by small employers) to 0.9% from 0.5%??? Soak the rich? p. 372, line 13.

• Sec. 10907. Excise tax on indoor tanning serices in lieu of elective cosmetic medical procedures. Imposes 10% tax on tanning services fees. Effective July 1, 2010. Designed to discourage cancer-causing service? Will it put them out of business? p. 373, line 3.

• Sec. 10908. Exclusion for assistance provided to participants in state student loan repayment programs for certain health professionals. National Health Service Corps loan repayment program and certain state loan repayment programs. p. 375, line 8. 

• Sec. 10909. Expansion of adoption credit and adoption assistant programs. Increases credits to $13,170 from $10,000. p. 376, line 7. 

4:31 p.m., mst. This project took about 8 hours over 2 days. 

Christmas party time. Will write some stories based on this effort later.

5,550 words.

Posted by Donald E. L. Johnson on 12/19/2009 at 09:55 AM

Health insuranceHealth Insurance Reform

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