The Obama Medical Rationing Bill
What It Actually Says

by John David Lewis

What does the bill, HR 3200, short-titled “America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.

This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws. I have only touched pieces of the bill here. For instance, I have not considered the establishment of (1) “Health Choices Commissioner” (Section 141); (2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity; (3) a Public Health Insurance Option (Section 221); and similar provisions.

This is the evaluation of someone who is neither a physician nor a legal professional. I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways – but this is too important to ignore.

We may answer one question up front: How will the government will pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services – there are no other options. We will all pay for this, enrolled in the government “option” or not.

(All bold type within the text of the bill is added for emphasis.)

1. Will the plan ration medical care?

This is what the bill says, pages 284–288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:

‘(ii) EXCLUSION OF CERTAIN READMISSIONS. – For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

and, under “Definitions”:

“(A) APPLICABLE CONDITION. – The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .

and:

“(E) READMISSION. – The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

and:

“(6) LIMITATIONS ON REVIEW. – There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of – . . .
“(C) the measures of readmissions . . .

EVALUATION OF THE PASSAGES:

1. This section amends the Social Security Act
2. The government has the power to determine what constitutes an “applicable [medical] condition.”
3. The government has the power to determine who is allowed readmission into a hospital.
4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.
5. This is government rationing, pure, simple, and straight up.
6. There can be no judicial review of decisions made here. The Secretary is above the courts.
7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317–318.

2. Will the plan punish Americans who try to opt out?

What the bill says, pages 167–168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:

“(a) TAX IMPOSED. – In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of –
         (1) the taxpayer’s modified adjusted gross income for the taxable year, over
         (2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .”

EVALUATION OF THE PASSAGE:

1. This section amends the Internal Revenue Code.
2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.
3. The IRS will be a major enforcement mechanism for the plan.

3. What constitutes “acceptable” coverage?

Here is what the bill says, pages 26–30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:

(a) IN GENERAL. – In this division, the term “essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .

(b) MINIMUM SERVICES TO BE COVERED. – The items and services described in this subsection are the following:

1. Hospitalization.
2. Outpatient hospital and outpatient clinic services . . .
3. Professional services of physicians and other health professionals.
4. Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .
5. Prescription drugs.
6. Rehabilitative and habilitative services.
7. Mental health and substance use disorder services.
8. Preventive services . . .
9. Maternity care.
10. Well baby and well child care . . .

(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

(3) MINIMUM ACTUARIAL VALUE. –

(A) IN GENERAL. – The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

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August 21, 2009

Copyright © 2009 John David Lewis