Zatera Ul

I skimmed some of the House version, and “There are a lot of things in this bill that I don’t understand.” [--obscure reference to a Gordon Korman book]

Some of the things I did understand I found quite amusing:

P. 21, on mandated coverage for children:

Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

Where do you get well child care for a 21-year-old?!

P. 50, on prohibiting discrimination in distribution of health care services:

Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

But what doesn’t affect your health? Race: relevant to health care needs, not extraneous. Gender: not extraneous. Age: not extraneous. BMI: not extraneous. Religion: probably not extraneous (see below). So discrimination is out, except when it’s not.

P. 167 is where the section on tax penalties for individuals not having health insurance starts. If you renounce your citizenship can you avoid the penalty?:

NONRESIDENT ALIENS.—Subsection (a) [tax penalty for no health coverage] shall not apply to any individual who is a nonresident alien.

P. 170; from this I predict mass conversions to Christian Science if thus bill is passed:

RELIGIOUS CONSCIENCE EXEMPTION.—‘‘(A) IN GENERAL.—Subsection (a) [tax penalty for no health coverage] shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section….

Religious exemptions must be applied for.

General observation: this bill would definitely create a bunch of government jobs.

Other things were rather alarming:

P. 16: Existing health insurance plans to be grandfathered out–no new enrollees except new dependents, no changes to plans and limited changes to premiums.

P. 100: Children without coverage will be automatically enrolled in Medicaid:

(1) COVERAGE FOR CERTAIN NEWBORNS.—(A) IN GENERAL.—In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed—(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and (ii) to have elected to enroll in Medicaid through the application of paragraph (3).

(B) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.—In
the case of a child described in subparagraph (A) who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains
such coverage or the State otherwise makes a determination of the child’s eligibility for medical assistance under its Medicaid plan pursuant to section 1943(c)(1) of the Social Security Act) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B) of such Act.

It goes on to say that others who are eligible for Medicaid and lack other coverage will automatically be enrolled also.

P. 124: drafting doctors to treat public insurance patients:

ESTABLISHMENT OF A PROVIDER NETWORK.—Health care providers participating under Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary.

P. 124, particularly scary limitations on review of provider payment rates:

LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

P. 776, requirement to apply for medical assistance

‘‘(3) APPLICATION FOR MEDICAL ASSISTANCE.—In the case of an individual described in subsection (a) who is determined by a qualified entity to be presumptively eligible for medical assistance under a State plan, the individual shall apply for medical assistance by not later than the last day of the month following the month during which the determination is made.

P. 844, home visit program for families deemed “at risk”:

‘‘(v) provide parents with—‘‘(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners); ‘‘(II) knowledge of realistic expectations of age-appropriate child behaviors; ‘‘(III) knowledge of health and wellness issues for children and parents; ‘‘(IV) modeling, consulting, and coaching on parenting practices; ‘‘(V) skills to interact with their child to enhance age-appropriate development; ‘‘(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and ‘‘(VII) activities designed to help parents become full partners in the education of their children….

Free parenting coaching from the government–oh yay! Funding starts at $50 million a year, and participation is voluntary. For now.

P. 993, school-based health clinics (SBHCs); this goes way beyond having a school nurse with a little office where a sick kid can lie down for a minute:

ICES.—The term ‘comprehensive primary health services’ means the core services offered by SBHCs, which shall include the following: ‘‘(A) PHYSICAL.—Comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions and referrals to, and follow-up for, specialty care. ‘‘(B) MENTAL HEALTH.—Mental health assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs. ‘‘(C) OPTIONAL SERVICES.—Additional services, which may include oral health, social, and age-appropriate health education services, including nutritional counseling.

Naturally, they are starting with the schools with a lot of “at-risk” kids first. Is an increase in the number of urban homeschoolers coming?

Too tired now to look up the pages, but there’s a very lenient definition of freestanding birth centers (”you can have a home birth, as long as you have it at someone else’s house” was my impression), and maybe? a suggestion that private health plans cover birth center births. But later on, there is a requirement to develop “best practices” protocols for various medical fields, including obstetrics.

Finally, on p. 1001, the National Medical Device Registry. ALL UR PACEMAKER ARE BELONG TO US!

General observation: there’s no way they can pay for all that they promise in this with the payment rates that they are establishing in it.