2009
things you should know…
about the health care bill the House just passed.
• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a “qualified plan” covers and how much you’ll be legally required to pay for it. That’s like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.
• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.
• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients. (Scary!)
• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what’s called a “medical home.”
The medical home is this decade’s version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to “disseminate this approach rapidly on a national basis.”
• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
• Sec. 303 (pp. 167-168) makes it clear that, although the “qualified plan” is not yet designed, it will be of the “one size fits all” variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.
• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of “medical items and services.” (This will likely result in huge changes, to who receives what level of care!)
• Sec. 399V (p. 1422) provides for grants to community “entities” with no required qualifications except having “documented community activity and experience with community healthcare workers” to “educate, guide, and provide experiential learning opportunities” aimed at drug abuse, poor nutrition, smoking and obesity. “Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program.”
• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should “give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population.” And secondary-school grants should go to schools “graduating students from disadvantaged backgrounds including racial and ethnic minorities.” (Basically, continued affirmative action for training medical professionals.)
