Pelosi's Health Care Plan Facts and Details Round 3

We'll be updating you with new finds from the Pelosi health care bill this weekend so stay tuned! Here are some of our latest finds:

-- Page 1793: There is a Davis-Bacon expansion in the Indian Health Service titles. Right now, Davis-Bacon applies only to facilities directly constructed by the IHS, but the language below would extend that to tribes who construct their own facilities under a self-determination contract. 

-- FYI: The Democrats cut nearly $55 billion from total spending on their new (mandatory) public health investment fund – not by reducing overall spending levels, but by deleting the spending amounts in the second five years. Instead of $88.7 billion in funding, CBO scored the bill as providing under $34 billion in funding.  That presumes, of course, a program funded with $9 billion in mandatory spending in Fiscal Year 2015 will disappear entirely the next year. 

 -- Page 1076: State Medicaid programs now required to cover juvenile inmates after their time in jail. States must retain coverage for juveniles enrolled in Medicaid “immediately before becoming an inmate of a public institution,” and maintain such coverage after the inmate’s release “unless and until there is a determination that the individual is no longer eligible to be so enrolled.”

 SEC. 1729. PRESERVING MEDICAID COVERAGE FOR

10 YOUTHS UPON RELEASE FROM PUBLIC INSTI11

TUTIONS.

12 Section 1902(a) of the Social Security Act (42 U.S.C.

13 1396a), as amended by section 1631(b) and 1703(a), is

14 amended—

15 (1) by striking ‘‘and’’ at the end of paragraph

16 (74);

17 (2) by striking the period at the end of para18

graph (75) and inserting ‘‘; and’’; and

19 (3) by inserting after paragraph (75) the fol20

lowing new paragraph:

21 ‘‘(76) provide that in the case of any youth who

22 is 18 years of age or younger, was enrolled for med23

ical assistance under the State plan immediately be24

fore becoming an inmate of a public institution, is

25 18 years of age or younger upon release from such

1 institution, and is eligible for such medical assist2

ance under the State plan at the time of release

3 from such institution—

4 ‘‘(A) during the period such youth is incar5

cerated in a public institution, the State shall

6 not terminate eligibility for medical assistance

7 under the State plan for such youth;

8 ‘‘(B) during the period such youth is incar9

cerated in a public institution, the State shall

10 establish a process that ensures—

11 ‘‘(i) that the State does not claim fed12

eral financial participation for services that

13 are provided to such youth and that are

14 excluded under subsection 1905(a)(28)(A);

15 and

16 ‘‘(ii) that the youth receives medical

17 assistance for which federal participation is

18 available under this title;

19 ‘‘(C) on or before the date such youth is

20 released from such institution, the State shall

21 ensure that such youth is enrolled for medical

22 assistance under this title, unless and until

23 there is a determination that the individual is

24 no longer eligible to be so enrolled; and

1 ‘‘(D) the State shall ensure that enroll2

ment under subparagraph (C) will be completed

3 before such date so that the youth can access

4 medical assistance under this title immediately

5 upon leaving the institution.’’

-- Page 872: Includes language regulating the qualifications of the food services director at all nursing homes receiving reimbursement under Medicare and Medicaid. 

Language here:

(a) MEDICARE.—Section 1819(b)(4)(A) of the Social

7 Security Act (42 U.S.C. 1395i–3(b)(4)(A)) is amended by

8 adding at the end the following: ‘‘With respect to meeting

9 the staffing requirement imposed by the Secretary to carry

10 out clause (iv), the full-time director of food services of

11 the facility, if not a qualified dietitian (as defined in sec12

tion 483.35(a)(2) of title 42, Code of Federal Regulations,

13 as in effect as of the date of the enactment of this sen14

tence), shall be a Certified Dietary Manager meeting the

15 requirements of the Certifying Board for Dietary Man16

agers, or a Dietetic Technician, Registered meeting the

17 requirements of the Commission on Dietetic Registration

18 or have equivalent military, academic, or other qualifica19

tions (as specified by the Secretary).’’.

-- Pages 502-520: Here, the bill sets up an Institute of Medicine study on “high-value” health care, and requires the Institute to recommend – and HHS to implement – changes to Medicare policy reflecting the report.  Page 510 gives the Secretary blanket waiver authority to implement these changes, unless Congress passed a joint resolution of disapproval blocking them.  Because the changes would go into effect unless Congress acts before May 2012, it would effectively require a 2/3 majority to enact a joint resolution of disapproval – since it’s highly unlikely a President Obama would sign a resolution undermining his Administration’s own work.

Most troubling is the lack of anti-rationing provisions throughout this section.  In other words, bureaucrats on the IOM and/or HHS could decide “high-value” health care means denying patients effective but expensive treatments, and put their policies into law – unless a 2/3 majority of both houses of Congress stopped them.  (Remember too Obama’s own words on rationing in his NYT interview: “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here….There is going to have to be a very difficult democratic conversation that takes place.”)

Page 57: The Democrats amended the reinsurance program, which provides $10 billion in federal funds to employers who cover their retirees age 55-64, to ensure that State/municipal health plans and multiemployer plans were eligible for funding. Those specific references were not in HR 3200.  In other words, the Democrats want to make sure that AFSCME and the big multiemployer union plans get their share of the $10 billion in goodies being given away.

-- Page 106: Durable medical equipment now added to the list of mandatory benefits in the coverage all Americans must buy.  In other words, we're spending $1.3 trillion on health care so people can go around doing this.

-- Page 216: The bill includes a new clause prohibiting a federal bailout of the government-run health plan (see below).  Of course, Fannie Mae and Freddie Mac weren't going to get a federal bailout -- until they did.  Does anyone believe that a government-run plan which all experts agree would enroll millions of people would be allowed to fail?

Here's the language:

(3) N

O BAILOUTS.—In no case shall the public

14

health insurance option receive any Federal funds

15

for purposes of insolvency in any manner similar to

16

the manner in which entities receive Federal funding

17

under the Troubled Assets Relief Program of the

18

Secretary of the Treasury.