HOUSE BILL – HR 3200 Key Provisions Health Advisory Commission – administration appointees authorized to make ALL the HC rules with primary objective to be cost control and with no outside oversight, no administrative appeal, no judicial review. HC plans standardized as to benefits without individual choice. Broad mandates in minimum plan – tobacco cessation, drug use disorder, mental health, marriage counseling, preventative services. Health Insurance Exchange where insurers all provide the same standard insurance plans and compete on price, with stated intent for all existing plans to migrate to exchange plans over time. Public option insurance plan to compete with private insurance, where public plan is subsidized and not subject to government taxes, and government makes rules favoring the public option. Mandated plans do not apply to unions, federal employees, Congress.

HOUSE BILL – HR 3200 Key Provisions Employers required to provide insurance or else pay a tax. Individuals required to have insurance or pay a tax. Ability to keep existing HC plan & doctor is very limited and contingent. New government HC facilities, HC workers and community services. Reduced payments to doctors and hospitals, especially specialists. Penalties on doctors and hospitals when patients are readmitted. No attempt to streamline current paperwork that doctors must deal with due to government regulations & insurance company requirements. New regulation and paperwork on doctors, hospitals, medical schools, individuals, employers, and insurance companies. Lots of data collection, analyses, reporting and oversight by the government -- no mention of oversight of government players.

HOUSE BILL – HR 3200 Key Provisions IRS to provide personal financial information to the Commission and IRS to have much expanded enforcement powers. No malpractice tort reform to alleviate high cost of malpractice insurance and reduction in unnecessary tests. No attempt to address shortage of specialists and shortage will increase. No stated restriction against abortion services and illegal alien benefits. Broad end of life planning with instructions to doctors and HC providers and included in Medicare handbook – supposedly going to be dropped. Reduction in Medicare funding ($500 to $600 billion) – supposedly from elimination of waste and fraud. Rationing -- inevitable due to increased demand and decreased providers and facilities -- in the form of delays, reduction of benefits, financial cost benefit analyses advocated by Obama’s HC advisors.

HOUSE BILL – HR 3200 Income & Wealth Redistribution Individual premium rates based on individual’s income. Premium credits for people with lower income. “Affordability” credits to cover out of pocket costs for lower income people. Employers to pay a fee to federal government which is a percentage of the employee wages (not related to the number of employees). An explicit fee (tax) to be paid by higher income individuals. Reduction in pay to physicians, especially specialists Lots of money to be paid in the form of grants, or provided in the form of low interest loans, to become physicians and other HC professionals. Stated preference to give grants and loans to minorities and people living in low income areas, to cover tuition and fees, plus a monthly stipend while they are in school and employment for several years (from 2 to 10 years). Physicians “prohibited” from future investing in healthcare facilities - also facilities with physician investment “prohibited” from expanding.

HOUSE BILL – HR 3200 Ways to Reduce Cost with Government Healthcare Increase premiums to the insured Increase patient deductible costs Tax employers more Tax high income people more Decrease payments to physicians and hospitals Reduce coverage and benefits Increase rationing, especially in Medicare Decrease administrative waste, fraud and abuse – (this is unlikely – history shows that it will probably increase) Decrease profits of insurance companies – average now is 3% Decrease unnecessary treatments – Who decides what is necessary? Who is liable for not delivering “unnecessary” care that turns out to have been necessary? HR 3200 says that the government is not liable.

Max Baucus Senate Bill Status: Senate is taking up Baucus Bill today and hundreds of amendments are under consideration. Humana sent letter to Medicare Advantage customers advising them of the potential loss in benefits. Baucus complained and Humana was ordered to withdraw their letter (WSJ 9/22/2009) Improvements: Public option dropped in favor of co-ops – However, co-ops would be under government control and Health Commission and Health Insurance Exchange would remain, so federal government would still be controlling the healthcare system. (Amendment re-inserting public option to be voted on in committee next week (being pushed by Schumer and Rockefeller) Interstate compacts for insurance purchasing beginning in 2015 – Would allow insurers to provide national products, which would be exempt from state mandated benefits.

Max Baucus Senate Bill Criticisms: Employer mandate of $400 tax on employees not insured. Punitive individual mandates to purchase minimum insurance – failure to comply could result in a fine as high as $3,800 for a family of four. (Fine has been reduced to $1,900) Mandate healthy lifestyles, as defined by government. Instruct doctors on best practices. Punish hospitals for readmitted patients. 35% excise tax imposed on health insurance plans that offer benefits in excess of $8,000 for individuals or $24,000 for families. Limits on Health Savings Accounts. Private coverage will gradually be replaced by public insurance. Tort reform is addressed through a “Sense of the Senate” resolution.

Max Baucus Senate Bill Medicare and Medicaid: States to increase Medicaid eligibility to people at 133% of poverty level and to enroll single childless adults, with the states responsible for much of the cost. Estimated $500 billion cuts in Medicare are being billed as savings from waste, fraud, and abuse. Bill would cut payments to the Medicare Advantage program, and many insurers may stop participating in the program while others could increase premiums. So millions of seniors will likely be forced off their current plan and back into traditional Medicare.