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What to Civilly Ask Your Congressperson about Obamacare (Parts 5&6 of 7)

Original post made by Concerned Pleasanton Resident on Aug 5, 2009

July 30, 2009
What To Ask Your Congressperson About Obamacare (Part 5 of 7)
Lee Cary
Here's the 5th installment in a series of questions you can ask your member of the House of Representatives concerning H.R. 3200 – also known as Obamacare.

The entire bill can be read here. This website will help you find ways to contact your congressperson's office.

If your Representative is undecided or favors Obamacare, call their DC office and ask for someone knowledgeable about the bill. Ask questions, and then considering entering what you hear in the comment section of American Thinker.

Question 16: Section 431, Disclosures To Carry Out Health Insurance Exchange Subsidies, amends section 6130 of the IRS Code of 1986 with language that enables the Health Choices Commissioner [in a previous installment of this series referred to as the "Commish"] access, via written request to the Secretary of the Treasury [Timmy Geithner], to taxpayer records including: "(i) taxpayer identity information with respect to such taxpayer; (ii) the filing status of such taxpayer; (iii) the modified adjusted gross income of such taxpayer; (iv) the number of dependents of the taxpayer; (v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof)"

SO, with my tax information available within the enormous bureaucracy required to stand-up "America's Health Choices Act of 2009" how long before this information becomes available to operatives of the political party in power at the time? And, when can we expect affluent citizens to be denied government healthcare payment because their net worth is identified as beyond a certain level? Oh, and by the way, just how many more government employees will be hired to staff Obamacare? And, of what government workers' union are they likely to become members?

Question 17: (Tracking through this one will hurt, but it'll pay off - at the very end.) The Obamacare bill makes amendments to the Social Security Act (SSA), thereby requiring the reader to toggle back-and-forth between the two bills, as well as the IRS Code. Here goes:

SSA, Section 1848, Subsection (j) reads as follows:
"(1) Category.—For services furnished before January 1, 1998, the term 'category' means, with respect to physicians' services, surgical services (as defined by the Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)), and all other physicians' services. The Secretary shall define surgical services and publish such definitions in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians.

(2) Fee schedule area.—The term 'fee schedule area' means a locality used under section 1842(b) for purposes of computing payment amounts for physicians' services.

(3) Physicians' services.—The term 'physicians' services' includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(00)(2)), (2)(R) (with respect to services described in subparagraphs (B), (C), and (D) of section 1861(pp)(1)), (2)(S), (2)(W), 2(AA), (3), (4), (13) (14) (with respect to services described in section 1861(nn)(2)), and (15) of section 1861(s) (other than clinical diagnostic laboratory tests and, except for purposes of subsections (a)(3), (g), and (h) such other items and services as the Secretary may specify).

(4) Practice expenses.—The term 'practice expenses' includes all expenses for furnishing physicians' services, excluding malpractice expenses, physician compensation, and other physician fringe benefits."

Now, the pending House version of the healthcare deform, oops, reform bill proposes (in Section 1121, pages 241-244) to add a 5th paragraph to the SSA that reads as follows:

"(5) Service Categories.-For services furnished on or about January 1,2009, each of the following categories of physicians' services (as defined in paragraph (3)) shall be treated as a separate 'service category' (A) Evaluation and management services that are procedure codes (for services covered under the title for – (i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009 and as subsequently modified by the Secretary); and (ii) preventative services (as defined in section 1861(iii) for which payment is made under this section. (B) All other services not described in subparagraph (A). Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service."

[Here, as elsewhere in life, the devil is in the details – sometimes the last detail.]

SO, as the incomes of physicians who specialize are brought, by this bill, into income equivalency with general practitioners (AKA family practice or primary care physicians), how will that impact the incentive for med students to specialize by undertaking years of additional training, often incurring substantial additional medical school debt and deferred income? Do primary care physicians represent a disproportionate percentage of the physicians that supports this bill?



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July 31, 2009
What To Ask Your Congressperson About Obamacare (Part 6 of 7)
Lee Cary
If you've been tracking with this series, you're learning, along with me, that H.R.3200, also know as Obamacare, isn't a "reform" of America's health care system - it's a nearly complete government takeover.

If your Representative is undecided, or favors Obamacare, call their DC office and ask to speak to someone knowledgeable about the bill. Ask questions. You're entitled to answers. This bill represents over a trillion dollars in taxpayers' money.

Question 18: Section 1121, Sustainable Growth Rate Reform, Subsection (c), Limitation On Physicians' Services Included in Target Growth Rate Computation To Services covered Under Physician Fee Schedule, stipulates a change in the language of the Social Security Act in section 1848(f)(4)(A) which today reads as follows:

"(A) Services included in physicians' services.-The term 'physicians' services' includes other items and services (such as clinical diagnostic laboratory tests and radiology services) specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee."

Obamacare proposes to change the language in the SSA bill to the following:

"(A) Services included in physicians' services.-The term 'physicians' services' includes other items and services for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services), but does not include services furnished to a Medicare+Choice plan enrollee."

Social Security Act 1842(b)(18)(C) reads: "A practitioner described in this subparagraph is any of the following: (i) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)). (ii) A certified registered nurse anesthetist (as defined in section 1861(bb)(2)). (iii) A certified nurse-midwife (as defined in section 1861(gg)(2)). (iv) A clinical social worker (as defined in section 1861(hh)(1)). (v) A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)). (vi) A registered dietitian or nutrition professional."

And, SSA Section 1861(p) refers to: "The term 'outpatient physical therapy services' means physical therapy services furnished by a provider of services, a clinic, rehabilitation agency, or a public health agency, or by others under an arrangement with, and under the supervision of, such provider, clinic, rehabilitation agency, or public health agency to an individual as an outpatient..."

So what's the change? Well, it looks like the physician services covered in the existing SSA is downgraded by the definition of "practitioner" as meaning one of the non-physician specialists in the SSA section 1842(b)(18)(C) list above.
SO, is the sustaining growth rate cut in costs outlined in Section 1121(c) of the Obamacare bill gained by reducing physician services for seniors and low income persons who need it the most?
Question 19: Section 1122, Misvalued Codes Under The Physicians Fee Schedule, offers a revision of SSA Sec. 1848 which includes adding this language:

"(i) In General.-The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b).

(ii) Components And Elements Of Work.-The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include furnishing a service and my include validation of the pre, post, and intra-service components of work."
SO, Obamacare is going to measure how much stress a physician is under and quantify their technical skill in order to pay accordingly? How's that work? (Particularly since only one "practicing physician" is required to be on the plan's board chaired by the Surgeon General.) Is the government going to put some sort of stress meter on the doc's wrist and require them to download readings to a central stress-monitoring data base (CSDB)?

Question 20: Section 1145, Treatment Of Certain Cancer Hospitals, proposes to add a paragraph (18) to section 1833(t) of the Social Security Act. The addition pertains to specialized cancer hospitals. It reads:

"(18) Authorization Of Adjustment For Cancer Hospitals.- (A) Study.-The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection as determined appropriate by the Secretary).

(B) Authorization Of Adjustment.-Insofar as the Secretary determines under paragraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011."

So, what's 1886(d)(1)(B)(v) about? [WARNING: Skip this next part if you're not into the minutia of understanding cancer treatment options and go straight to the next "SO,".] Here's how that section reads in the Social Security Act:

"(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause, is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer,

(II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1814(b), that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before the date of the enactment of this subclause), that as of the date of the enactment of this subclause, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or

(III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998, that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1814(b), that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of the date of the enactment of this subclause, is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E); and, in accordance with regulations of the Secretary, does not include a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital (as defined by the Secretary). A hospital that was classified by the Secretary on or before September 30, 1995, as a hospital described in clause (iv) shall continue to be so classified notwithstanding that it is located in the same building as, or on the same campus as, another hospital."
SO, what impact will Obamacare have on hospitals across the country that specialize in cancer treatments? (If the knee-jerk answer is "none"...) Well, Section 1145, which proposes to add language to the Social Security Act, seems to indicate that when their specialized care is more expensive than "other hospitals" furnishing cancer treatment, their costs may not be covered by Obamacare. So what's the expected impact on those hospitals and their cancer patients?

If you Congressperson conducts open meetings during the recess and you attend, it's not necessary, obviously, to take these particular questions along with you. But it would be smart to take some documented question. If the member of Congress is likewise smart, he or she will have their staff person along who's most knowledgeable of the bill in order to answer the more technical questions - those beyond the range of "Can I keep my doctor?" And, "Is the government going to tell me when to die?"

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Comments (1)

Posted by Cholo, a resident of Livermore
on Aug 5, 2009 at 11:37 am

The gummint will not tell you when to die. However, I will...DROP DEAD!

the prophet...Cholo


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