America’s Affordable Health Choices Act of 2009
The bill is a 1,017 page document broken out in three Divisions:
1. Division A – Affordable Health Care Choices
2. Division B – Medicare and Medicaid Improvements
3. Division C – Public Health and Workforce Development
Division A – Affordable Health Care Choices (pages 4-215) This division creates a Health Insurance Exchange (HIE) with a public health insurance option along with private insurance plans.
The government will determine what is a qualifying plan (section (202 (d)(2)). You must be covered under a qualifying plan on January 1, 2013 or you will be automatically enrolled in the public plan (Div.A Title I Subtitle A Section 102 (a)(1)(A) page 16 lines 11-16).
There are NO new enrollees in private health plans after January 1, 2013 (Div. A Title I Subtitle A Section 102 (a)(1)(A) page 16 lines 11-16).
There is an out for the government to deny all private plans from qualifying after 2018 (Div.A Title I Subtitle A Section 102 (b)(1)(A) page 17 lines 13-19).
The government can disqualify any plan for not adhering to the American Recovery and Reinvestment Act of 2009, the Employee Retirement Income Security Act of 1974 or any other reason the Commissioner sees fit ((Div.A Title I Subtitle A Section 102 (b)(1)(B) page 18 lines 13-17).
There will be a Health Benefits Advisory Committee made up of 26 members and chaired by the Surgeon General. Of the 26 members, 17 are appointed by the President. There might not be one single Medical Doctor (Div.A Title I Subtitle A Section 123 (a)(3)(A-C) and (4) pages 31-32 lines 1-25 and 1-10).
There is a statement that the government has the right to conduct examinations and audits of Qualifying Health Benefit Plans (QHBP) and recoup the costs involved (Div.A Title I Subtitle E Section 142 (b)(2)(B) page 43 lines 13-1. Nothing in the paragraph stipulates how infrequent these audits need to be. Therefore, the government could run private plans out of business. Once the government disqualifies a plan, you’re in the public plan (Div.A Title I Subtitle E Section 142 (d)(2)(B) page 44 lines 16-22) and (Div.A Title I Subtitle E Section 142 (d)(2)(D) page 45 lines 7-10).
Private Insurers are not allowed to make a profit (Div.A Title I Subtitle F Section 2714 (a) page 54 lines 1-13). This obviously will bankrupt private insurers. Each company must reinsure all retirees, their spouses and dependents (Div.A Title I Subtitle F Section 164 (a)(1) page 65 lines 14-22). This obviously will bankrupt companies.
The government will automatically enroll you in the public plan if you are not in a qualifying health plan (Div.A Title II Subtitle A Section 205 (b)(3)(A) pages 97-98 lines 22-25 and 1-2). I thought this was all about choice.
If you have any sort of family change: marriage; divorce; new child; child completing college and now off of your insurance or move, you are automatically enrolled in the government plan (Div. A Title II Subtitle A Section 205 (b)(2)(B) pages 96-97 lines 24-25 and 1-11).
The public health plan has no dental coverage (Div.A Title II Subtitle B Section 221 (b)(3)(B) page 117 line 9). We’re going to have “English Teeth”
There is a 2.5% tax on all individuals who do not get acceptable coverage (Div.A Title IV Subtitle A Section 59B (a) page 167 line 23). And Obama says there are no new taxes for this.
If your employer elects to not provide coverage, there is an 8% tax on wages (Div.A Title IV Subtitle A Section 412 (a) page 183 lines 17-20). If your current employer pays more than 8% now, what do you think they will do? You’re going on the public plan.
There is a range of taxes (1%-5.4%) for people making over $350,000/year (Div.A Title IV Subtitle D Section 59C (a)(1-3) pages 197-198 lines 21-23 and 1-6). And Obama says there are no new taxes for this.
By 2012, there must be submitted, a study showing the savings, through 2019, generated as a result of the public health care (Div.A Title IV Subtitle D Section 59C (i)(4) page 201 lines 5-11). How could they possible predict this? The date is awfully close to Obama’s next election day.
Division B – Medicare and Medicaid Improvements (pages 215-854) This division discusses all of the changes to Medicare and Medicaid.
The public health plan will be reducing “Durable Medical Equipment” (Div. B Title I Subtitle B Part 2 Section 1131 (e)(1) page 267 lines 7. This means, folks, no more MRIs, CT Scans, etc. The government will arbitrarily adjust “utilization rates” on such equipment so less of them are required (Div. B Title I Subtitle B Part 2 Section 1147 (a)(1)(C) pages 273-274 lines 20-25 and 1-4).
No more specialty hospitals, like cancer treatment centers (Div. B Title I Subtitle B Part 2 Section 1145 (B) page 272 lines 8-25). If these specialty hospitals cannot charge a premium for their services, they will go bankrupt.
The government will ration the amount of time you are allowed in a hospital (Div. B Title I Subtitle C Section 1151 (a)(1) page 280 lines 15-20). Good luck infirm and elderly.
Physicians can no longer have ownership interest in a hospital (Div. B Title I Subtitle C Section 1156 (i)(1)(B) page 317 lines 13-20).
No new hospitals or expansion of existing hospitals (Div. B Title I Subtitle C Section 1156 (i)(1)(C) page 317 lines 21-25). Obviously, this is of concern and needs no further comment.
If any increase in hospital facilities is allowed, through exception, it can only occur at the main campus (Div. B Title I Subtitle C Section 1156 subsection (i)(2)(D) page 323 lines 15-20). Main campuses are usually located in urban areas forcing money into cities and away from rural populations. There will be studies on how to get you to go back to the cities (Div. B Title I Subtitle C Section 1157 (c)(1)(A) page 329 lines 7-9).
The only way a rural hospital will be allowed to increase their facilities will be after 5 years and only if they are located in a county showing a 150% population growth over the state aggregate population growth; admission rates for the hospital must be greater than other county hospitals; in a state that has less bed capacity than the national average; has a bed occupancy rate more than the state average and other conditions determined by the Secretary (Div. B Title I Subtitle C Section 1156 subsection (i)(2)(E)(i-v) pages 323-325). Seems pretty difficult to get new hospitals built, huh?
The public health plan fully admits there will be a lack of Physicians (Div. B Title I Subtitle C Section 1156 subsection (i)(4) page 326).
Pharmaceutical companies cannot make a profit (Div. B Title I Subtitle D Section 1181 (b)(1) pages 361-362 and Div. B Title VII Subtitle E Section 1742 (a)(1)(C) pages 793-794 lines 5-25 and 1-. Obviously, without profit, there is no further research.
The poor, in order to get benefits without paying for them, can self-report income (Div. B Title II Subtitle A Section 1203 (a)(1) page 390 lines 12-25). No potential for fraud here!
ACORN will be getting grants under public health care (Div. B Title II Subtitle A Section 1222 (a)(2)(B) page 407 lines 5-9). No potential for fraud here!
The elderly will be counseled every five years on end-of-life issues (Div. B Title II Subtitle C Section 1223 (a)(1) pages 424-426). Good bye useless old people.
The state will limit the explanations needed to euthanize you (Div. B Title II Subtitle C Section 1223 (a)(1) pages 426 lines 22-24).
A “practitioner” who will be given the authority to turn your life support off can be a nurse practitioner or a physicians assistant (Div. B Title II Subtitle C Section 1223 (a)(1) page 428 lines 9-10 and page 429 line 13). Good bye useless old people.
The capitol gains on your primary residence will be used to compute your income to determine your Part B income-related premium (Div. B Title II Subtitle A Section 1235 (a) page 437 lines 17-24). Suddenly, you’re rich!
Division C – Public Health and Workforce Development (pages 855-1017) This division is about training of future health care professionals.
Future doctors and/or nurses can no longer pick their specialties. The Secretary will pick their areas of interest based upon “needs” (Div. C Title II Part 2 Section 340H page 869 lines 21-24).
Primary Care Physicians and “Other Healthcare Professionals” will make up 90% of the healthcare workforce (Div. C Title II Part 2 Section 340K pages 874-875 lines 22-24 and 1-2 and Div. C Title II Part 2 Section 2213 pages 877-880 lines 14-25 and 1-23, inclusive).
Quotas are in full effect throughout the bill (Div. C Title II Part 2 Section 2213 (c-d)(1-3)(pages 880- 881 lines 4-23 and 1-7 and page 884 lines 4-10 and page 939 lines 16-19 and page 946 lines 3-5).
There will be funding for “additional health services” at schools (Div. C Title V Subtitle A Section 2501 page 994 lines 11-13). What are the “additional health services”?
Only unionized healthcare entities can train future nurses (Div. C Title V Subtitle D section 2531 page 1008 lines 13-16 and page 1010 lines 4-5).
All state, county and municipal workers are under the public health plan (Div. C Title V Subtitle E section 2541 page 1017 lines 6-19).
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