health insurance

HR 3200 – A Line by Line Analysis

Posted on by tomdaly

Here is a line-by-line analysis of HR 3200 currently under consideration in the House of Representatives.  This analysis was prepared by the Liberty Council and, like all parties to this discussion, they have their point of view.

I give anyone who reads this resolution credit.  I just hope our representatives are in that number BEFORE making their vote!

Pg 22 of the HC Bill MANDATES the Government will audit the books of ALL EMPLOYERS that self insure!!

Pg 29 lines 4-16 in the HC Bill – YOUR HEALTH CARE IS RATIONED!!!

Pg 30 Sec 123 of HC Bill – THERE WILL BE A GOVERNMENT COMMITTEE that decides what treatments/benefits you get

Pg 42 of HC Bill – The Health Choices Commissioner will choose your benefits for you. You have no choice!

Pg 50 Section 152 in HC Bill – HC will be provided to ALL non-U.S. citizens, illegal or otherwise

Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Health Care Card will be issued!

Pg 59 HC Bill lines 21-24 Government will have direct access to your banks accounts for electronic funds transfer.

(NOTE FROM RJ-This really does mean they can take your money at any time. Who will have this authority?—a government bureaucrat.)

Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in unions and community organizations (ACORN).

Pg 72 Lines 8-14 Government is creating a Health Care Exchange to bring private health care plans under government control.

Pg 84 Sec 203 HC Bill – Government mandates ALL benefit packages for private health care plans in the Exchange

Pg 85 Line 7 HC Bill – Specs for of Benefit Levels for Plans = The government will ration your health care!

Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services.

Pg 95 HC Bill Lines 8-18 The government will use groups i.e., ACORN & AmeriCorps to sign up individuals for government Health Care Plan

Pg 85 Line 7 HC Bill – Specs of Ben Levels 4 Plans. #AARP members – Your health care WILL be rationed

Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individual will be automatically enrolled in Medicaid. No choice.

Pg 124 lines 24-25 HC No company can sue the government on price fixing. No “judicial review” against government monopoly.

Pg 127 Lines 1-16 HC Bill – Doctors/ #AMA – The government will tell YOU what you can make.

Pg 145 Line 15-17 An employer MUST auto enroll employees into public opt plan. NO CHOICE

Pg 126 Lines 22-25 Employers MUST pay for health care for part-time employees AND their families.

Pg 149 Lines 16-24 ANY Employer w/ payroll 400k and above who does not prov. pub opt. pays 8% tax on all payroll

Pg 150 Lines 9-13 Businesses with payroll between 251k and 400k who do not provide public opt pays 2-6% tax on all payroll

Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable health care according to government will be taxed 2.5% of income.

Pg 170 Lines 1-3 Any NONRESIDENT Alien is exempt from individual taxes (Americans will pay).

Pg 195 Officers & employees of HC Admin (GOVT) will have access to ALL Americans’ financial and personal records.

Pg 203 Line 14-15 HC – “The tax imposed under this section shall not be treated as tax.” Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid.  Seniors, low income, poor affected.

Pg 241 Line 6-8 HC Bill – Doctors, it does not matter what specialty you have, you’ll all be paid the same.

Pg 253 Line 10-18 Government sets value of doctors’ time, prof judg, etc. Literally value of humans.

Pg 265 Sec 1131Government mandates and controls productivity for private health care industries.

Pg 268 Sec 1141 Federal Government regulates rental and purchase of power-driven wheelchairs.

Pg 272 SEC. 1145. Treatment of certain cancer hospitals – Cancer patients – welcome to rationing!

(RJ-NOTE: Much cancer treatment will not work unless implemented early, but the waiting time just to see a specialist will likely be months when this plan is implemented. As you can see in this bill, the option of the health care bureaucrat is to deny treatment to those they deem not likely to be helped by it. Watch the cancer death rate skyrocket.)

Page 280 Sec 1151 The government will penalize hospitals for what government deems preventable readmissions. (Incentives for hospital to not treat and release.)

Pg 298 Lines 9-11 Doctors that treat a patient during initial admission that results in a readmission-Government will penalize you.

Pg 317 L 13-20 PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25, 1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.

pg 321 2-13 Hospitals have opportunity to apply for exception, BUT community input required. Can you say ACORN?!!

Pg335 L 16-25 Pg 336-339 – Government mandates establishment of outcome based measures. Health Care the way they want. Rationing.

Pg 341 Lines 3-9 Government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. Forcing people into Government plan.

Pg 354 Sec 1177 – Government will RESTRICT enrollment of special needs people!

Pg 379 Sec 1191 Government creates more bureaucracy – Tele-health Advisory Committee. Health care by phone/Internet?

Pg 425 Lines 4-12 Government mandates Advance [Death] Care Planning Consult. Think Senior Citizens end of life.

Pg 425 Lines 17-19 Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!

Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death.

Pg 427 Lines 15-24 Government mandates program for orders for end of life. The government has a say in how your life ends.

Pg 429 Lines 1-9 An “adv. care planning consult” will be used frequently as patient’s health deteriorates.

Pg 429 Lines 10-12 “adv. care consultation” may include an ORDER for end of life plans. AN ORDER from Government.

Pg 429 Lines 13-25 – The government will specify which doctors can write an end of life order.

PG 430 Lines 11-15 The government will decide what level of treatment you will have at end of life.

(NOTE FROM RJ: The above really does give the government the authority to determine who lives and dies, and when. A government bureaucrat really will be making this decision for you and your loved ones.)

Pg 469 – Community Based Home Medical Services=Non-profit orgs. Hello, ACORN Medical Services here!!?

Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment to a community-based org. Like ACORN?

Pg 489 Sec 1308 The government will cover Marriage and Family therapy. They will insert government into your marriage.

Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.

PG 502 Sec 1181 Center for Comparative Effectiveness Research Established. – Hello Big Brother – Literally.

Pg 503 Lines 13-19 Government will build registries and data networks from YOUR electronic medical records.

Pg 503 lines 21-25 Government may secure data directly from any department or agency of the U.S., including your data.

Pg 504 Lines 6-10 The “Center” will collect data both published and unpublished (that means public and your private info).

PG 506 Lines 19-21 The Center will recommend policies that would allow for public access of data.

PG 518 Lines 21-25 The Commission will have input from Health Care consumer reps – Can you say unions and ACORN?

PG 524 18-22 Comparative Effectiveness Research Trust Fund set up. More taxes for ALL.

PG 621 Lines 20-25 Government will define what quality means in health care. Since when does government know about quality?

Pg 622 Lines 2-9 To pay for the Quality Standards, government will transfer money from other government Trust Funds. More Taxes.

PG 624 “Quality” measures shall be designed to assess outcomes and functional status of patients.

PG 624 “Quality” measures shall be designed to profile you including race, age, gender, place of residence, etc.

Pg 628 Sec 1443 Government will give “Multi-Stake Holders” Pre-Rule Making input into Selection of “Quality” Measures.

Pg 630 9-24/631 1-9 Those multi-stake holder groups include unions and groups like ACORN deciding health care quality.

Pg 632 Lines 14-25 The Government may implement any “Quality measure” of health care services as they see fit.

PG 633 14-25/ 634 1-9 The Secretary may issue non-endorsed “Quality Measures” for Physician Services and Dialysis Services.

Pg 635 to 653 Physicians Payments Sunshine Provision – Government wants to shine sunlight on doctor but not government.

Pg 654-659 Public Reporting on Health Care-Associated Infections – Looks okay.

PG 660-671 Doctors in Residency – Government will tell you where your residency will be, thus where you’ll live.

Pg 676-686 Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.

Pg 686-700 Increased Funding to Fight Waste, Fraud, and Abuse. You mean like the government with an $18 million website?

(NOTE FROM RJ—Can you actually imagine empowering the government to fight waste, fraud, and abuse????)

PGs 701-704 Sec 1619 If your part of health care plan isn’t in Government Health Care Exchange but you qualify for Federal aid, no payment.

PG 705-709 SEC. 1128 If Secretary gets complaints (ACORN) on health care provider or supplier, government can do background check.

PG 711 Lines 8-14 The Secretary has broad powers to deny health care providers/ suppliers admittance into Health Care Exchange. Your doctor could be thrown out of business.

Pg 719-720 Sec 1637 ANY Doctor who orders durable medical equipment or home medical services MUST be enrolled in Medicare.

PG 722 Sec 1639 Government MANDATES doctors must have face-to-face with patient to certify patient for Home Health Services.

PG 724 23-25 PG 725 1-5 The same government certifications will apply to Medicaid and CHIP (your kids).

PG 724 Lines 16-22 Government reserves right to apply face-to-face certification for patient to ANY other health care service.

Pg 735 lines 16-25 For law enforcement, proposes the Secretary-HHS will give Attorney General access to ALL data.

PG 740-757 Government sets guidelines for subsidizing the uninsured (That’s your tax dollars people).

Pg 757-762 Federal Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)

Pg 763 1-8 No DS/EA hospitals will be paid unless they provide services without regard to national origin.

Pg 765 Sec 1711 Government will require Preventative Services including vaccines. (Choice?)

Pg 768 Sec 1713 Government – Nurse Home Visitation Services (Hello union paybacks).

Pg 769 11-14 Nurse Home Visit Services include economic self-sufficiency, employ adv, school-readiness.

Pg 769 3-5 Nurse Home Visit Services – “increasing birth intervals between pregnancies.” Government ABORTIONS anyone?

Pg 770 SEC 1714 Federal Government mandates eligibility for State Family Planning Services. Abortion and State Sovereign.

(NOTE FROM RJ—Can you believe that in America you will be told how many children you can have, and when? Does this mean we can expect the government to impose mandatory abortions? How else can this be interpreted?)

Pg 789-797 Government will set, mandate drug prices, controlling which drugs brought to market. Bye innovation.

Pgs 797-800 SEC. 1744 PAYMENTS for graduate medical education. The government will now control doctors’ educations.

PG 801 Sec 1751 The government will decide which health care conditions will be paid. Say RATION!

Pg 810 SEC. 1759. Billing Agents, clearinghouses, etc. req. to register. Government takes over private payment system.

Pg 820-824 Sec 1801 Government will identify individuals ineligible for subsidies. Will access all personal financial information.

Pg 824-829 SEC. 1802. Government sets up Comparative Effectiveness Research Trust Fund. Another tax black hole.

PG 829-833 Government will impose a fee on ALL private health insurance plans including self-insured to pay for Trust Fund!

PG 835 11-13 fees imposed by government for Trust Fund shall be treated as if they were taxes.

Pg 838-840 Government will design and implement Home Visitation Program for families with young kids and families expecting kids.

PG 844-845 This Home Visitation Program includes government coming into your house and telling you how to parent!!!

(NOTE FROM RJ—If you think this sounds like “Big Brother” actually coming into our homes, we really need to think about what comes after Big Brother. The scenario being set up by the government to control people through this, with the technology now available, is beyond what the science fiction horror works about this could conceive of.)

Pg 859 Government will establish a Public Health Fund at a cost of $88,800,000,000. Yes that’s billion.

Pg 865 The government will MANDATE the establishment of a National Health Service Corps.

PG 865 to 876 The NHS Corps is a program where doctors perform mandatory health care for two years for part loan repayment.

PG 876-892 The government takes over the education of our medical students and doctors.

PG 898 The government will establish a Public Health Workforce Corps to ensure supply of public health prof.

PG 898 The Public Health Workforce Corps shall consist of civilian employees of the U.S. as Secretary deems.

PG 898 The Public Health Workforce Corps shall consist of officers of Regular and Reserve Corps of Service.

PG 900 The Public Health Workforce Corps includes veterinarians.

PG 901 The Public Health Workforce Corps WILL include commissioned Regular and Reserve Officers. HC Draft?

PG 910 The government will develop, build, and run Public Health Training Centers.

PG 913-914 Government starts a health care affirmative action program thru guise of diversity scholarships.

PG 915 SEC. 2251. Government MANDDATES Cultural and linguistic competency training for health care professionals.

Pg 932 The Government will establish Preventative and Wellness Trust fund- initial cost of $30,800,000,000 billion.

PG 935 21-22 Government will identify specific goals & objectives for prevention & wellness activities. Control YOU!!

PG 936 Government will develop “Healthy People and National Public Health Performance Standards” Tell me what to eat?

(NOTE FROM RJ—This is no joke—the government will be able to actually mandate what you can eat or not eat. This could be helpful for some, but do we want the government doing it? What is the most fat and out of shape entity on the planet? The Federal Government. What kind of shape do you think the bureaucrats will be in who mandate such for everyone else?)

PG 942 Lines 22-25 More government? Offices of Surgeon General -Public Health Svc, Minority Health, Women’s Health

PG 950- 980 BIG GOVERNMENT core pub health infrastructure including workforce capacity, lab systems, health info sys, etc.

PG 993 Government will establish school based health clinics. Your kids won’t have a chance.

PG 994 School Based Health Clinic will be integrated into the school environment. Say government brainwash!

PG 1001 The government will establish a National Medical Device Registry. Will you be tracked?

Are You Kidding?

Posted on by tomdaly

I am shocked and astounded to think that the Federal Government is even thinking of eliminating some very popular, long standing tax-advantaged saving and spending vehicles – FSAs and HRAs – as a way to pay for a government health plan.  See ARTICLE.

In my opinion, this is insane for a couple of reasons that come to mind.

1.  Theses tax advantaged vehicles are the ONLY health care related programs, created by the government, which are actually effective tools for both encouraging and rewarding active engagement by consumers in the purchase of their own health care.  Individuals who use these types of vehicles have an incentive to manage their costs.  Since overall health is most impacted by many individual lifestyle decisions, this is where the incentive NEEDS to be.

2.  No new tax or elimination of an existing tax break will EVER be enough to “pay” for a public health plan that lacks incentive for consumer engagement.  Nothing that is free, including medical services, is ever truly appreciated or valued appropriately.  With the goverment in a role of managing the cost of care, rationing is an inevitability.  Just look to any of the Universal Healthcare systems we emulate around the world.

Take a look at the Medicare website to get a glimpse into what may be an all too near future – indecipherable choices without clear and competent assistance through the maze.  I hope someone wakes up soon!

See my previous post – My Fix for Health Care – in less than 250 words.

My Fix for Health Care – in less than 250 words!

Posted on by tomdaly

I haven’t run the numbers on how to pay for this yet (emulating all of my current political heroes).  But, I have come up with a relatively simple “Universal Coverage” proposal that does not completely abandon our free-market system and the patient service and treatment innovation that system encourages.  Here is a quick summary:

  • Wellness Benefits – Age appropriate diagnostic screenings as well as regular physical exams for all paid at 100%.
  • Calendar Year Deductible – Single and Family annual deductible resets each January 1st to 5% of previous year’s reported income.  (i.e. – Individual who earned $26,000 in 2008 would have a $1,300 deductible in 2009, Family who earned $128,000 would have a family deductible of  $6,400).
  • Provider Charges – Publish Medicare fee schedule online for complete transparency of pricing.  Patient is responsible for paying 10% above Medicare negotiated provider fees for care.
  • Coinsurance – After the single or family deductible is satisfied, patient is responsible for 20% of approved charges.
  • Calendar Year Out-of-Pocket Maximum – Single and Family annual out-of-pocket maximum (combination of all deductible and coinsurance expense) is 10% of  previous year’s income.
  • Health Savings Accounts – Allow covered individuals to fund and deduct from income up to their annual out-of-pocket maximum.

This plan, though it would obviously shift exposure for medical expenses to higher income earners, does so WHILE establishing a base level of care and an annual worst-case scenario tied to earnings (“catastrophic” coverage is somewhat subjective and relative to financial means).  HSAs and insurance company supplements can be tools to manage costs.  Everyone has an incentive to adopt a healthier lifestyle.

5 Tips for Stretching Employer’s Healthcare Dollar:

Posted on by tomdaly


With many industries now beginning to feel the impact of the current recession, it has become more important than ever for employers and their employees to get the most value possible from their healthcare dollar.  Here are 5 tips for stretching these dollars:

1. Give Options – Employer groups of just about all sizes could benefit from providing their employees with choices of health insurance plans. Bottom line is all health insurance choices are expensive. However, since most employers pay a percentage of employee premium, lower cost alternatives are lower cost for employers and their employees. Employees who are given a choice, may just take that choice electing to bear some risk themselves which, if unrealized, results in lower cost for all.

2. Offer High Deductible Plans – When evaluating your plan options, do not overlook qualified high deductible plans. Though these plans may seem like they are too much for average employees to digest or budget for, they are valuable for a segment of most employee populations. Employees are more capable of evaluating these alternatives than employers think – particularly employees who are engaged in the process and aware of their funding alternatives.

3. Flexible Spending Accounts – These plans have been around for a number of years. However, even with relatively recent expansions in eligible expenses, extension of grace period and an general increase in member responsibility from current health plans, average FSA usage is still low. These types of plans offer employers an extremely low cost way to help their employees increase their spending power for what could be a large part of their family expenses.

4. Health Reimbursement Arrangements – HRAs are tools employers can use to directly reimburse a large number of eligible healthcare expenses that their employees incur. The values of HRAs are their flexibility of design (employers can define reimbursable expenses) and their unfunded liability status. An unfunded liability (essentially a promise to an employee) is only paid when the expense is incurred. Though this approach bears some risk, the risk can be defined and budgeted. In addition, it can be funded at least in part by premium savings and any cost of a reimbursement is not a premium expense that will be subject to a rate increase each year.

5. Communicate – None of the things I have mentioned here can be accomplished without a well thought out, ongoing communication plan. These concepts are not the most riveting conversation topics. However, as the dollars (premium, copays, deductibles, etc.) rise, interest in the topics tend to rise as well. Giving employees both access to information and the tools they need to combat escalating healthcare costs are essential to building a benefit plan with the maximum perceived value.

HSAs, FSAs, HRAs, HDHPs, CDHPs. . .

Posted on by tomdaly

This is the second in a great series of videos (most of which I will post) produced by Stay Smart Stay Healthy.  Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry. Their goal: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.

Who Moved My Benefits? Change in the Employee Benefits Industry

Posted on by tomdaly

Written – November 3, 2003

Anyone whose life is touched by Employee Benefits—employers, employees, and brokers—has been forced to deal with a tremendous amount of change in the last few years.

Group health insurance premiums are increasing across the country at a rate of 14-20 percent. Carriers are either exiting markets or pricing themselves out of consideration, leaving only a handful of fully insured options for employers to consider. The managed care, copay approach is giving way to higher deductible defined contribution plans. Reinsurance markets have tightened as varying HIPAA interpretations have drastically restricted the flow of information. Human resources staffs are being inundated by changes in federal and state legislation, complicating the administration of benefit plans and adding to potential liability of non-compliance. And, employees are being asked to make more and more decisions about things they understand less and less.

Basically, the “Cheese” has moved, and we are all still stuck in the “Maze.”

Rather than hope for the old days to return, here are some “Handwritings on the Wall” so employers and brokers can adapt and thrive in the face of these changes.

Follow the money
The money employers and their employees pay for benefits will generally flow to the following areas:
1) employee claims,
2) insurance (shifting the risk of excessive claims to a third party),
3) administration of claims and bills, and
4) a fee or commission to the broker/consultant who helped put it all together.

On average, employee claims are responsible for 70 percent or more of total plan costs. Employers that manage these costs have the best opportunity to control their own.

Understanding this, more and more employers and brokers are aggressively targeting claims expenses by developing extensive corporate wellness programs. These programs vary in size and scope from one employer to the next. However, many wellness providers are able to illustrate hard returns on the investments employers make in their programs.

Regardless of the degree and approach, it is important for employers and their brokers to develop a strategy to address this issue proactively.

Make the intangible tangible
Employers offer benefits so that they can attract and retain good employees. Because employee benefits are intangible, employers must create a tangible value for their employees by communicating and administering their benefit plans effectively.

Some ways employers and brokers successfully communicate the value of benefits are personalized enrollment materials, compensation statements, and benefit Web sites. However, none of these offerings are as effective as person-to-person benefit plan communication and personal customer service to resolve claims or administrative issues.

Employees don’t understand and don’t want to understand the inner workings of claims processing and network discounts. These procedures are confusing enough to the people who deal with them every day. Employees who are using their lunch breaks to try to figure out a bill that is “Not a Bill” will inevitably blame their benefit plan for their frustration—eliminating any tangible value associated with the plan.

You want to buy value, provide value
When employers “follow the money,” they become aware that some percentage of the money they spend on employee benefits is for professional assistance through this process.

If it is important to choose a valuable benefit plan, it is equally important to choose a valuable broker to analyze, negotiate, and communicate these plans. For this reason, the carrier evaluation and selection should be made separately from the broker evaluation and selection.

Here are a few areas to consider when assessing the value of a broker/consultant.
• Carrier Market Access.
• Industry Knowledge and Experience.
• Client References.
• Administrative Services Provided.
• Out-Sourced Services.
• Benefits Communication Capabilities.

Once an employer selects a broker, benefit plans can be designed collaboratively and rates and provisions negotiated with the strength of a unified voice.

Seeing the “Handwriting on the Wall” about the Employee Benefits industry cannot guarantee that we will find our “Cheese.” It can only focus our attention and our efforts where they can make the most tangible impact—making the “Cheese” we are always searching for seem easier to find.

Tom Daly is the co-founder and managing principal of Hartwig Moss Benefits (www.hm-b.com), a full-service employee benefits consulting firm in New Orleans.