Back to Basics

Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.

The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.

To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!

The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.

The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.

The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.

The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:

• Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
• Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.

• Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.

The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.

Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:

• Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.

• The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.

• The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.

Appropriations for these programs total $1,138,000,000 over 10 years.

Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.

I am truly amazed as I continue to read through the bill how anyone could interpret this bill as one that would not increase medical costs, insurance premiums and taxes.  Each section only adds more responsibility to the government, which falls again upon the taxpayer.  This section alone creates a whole new welfare system intended to not only support people requesting assistance, but the bill actually calls for the government to recruit (by identification methods) people to in order to assist them, even when they have not asked for it!

Employers must offer health insurance to all employees, full and part-time, or face penalties, often for actions out of their control.  The pressure on employers could cause adverse consequences in the workplace.  Does the employer start basing hiring decisions on the likelihood that a candidate may or may not participate in the company offered insurance plan?  Will part-time employees now become less of an asset to employers since they too will require benefits?  How does this impact the job market and availability of jobs when the country already has high unemployment?  What appeared to be fairly straightforward (what was I thinking!) turned into many “what if “scenarios.  I’m sure you will develop your own.  If you have any questions regarding the bill, please contact your representatives.

This portion of the bill covers how individuals who cannot afford health insurance coverage or their portion of cost-sharing (co-pays, deductibles) will receive medical insurance and care.  Ultimately these costs have to be absorbed by someone.  The government is going to expand the medical welfare system and pay for premiums, as well as any out of pockets expenses for medical treatment, in the form of affordability credits.  Since it is a known fact that people who have insurance will use medical services more often, then one might expect an increase in medical treatment for newly insured individuals covered by the taxpayer – financed by increased premiums for those who can purchase insurance and higher taxes.

The bill will give eligible individuals affordability credits consisting of affordability premium credits to be applied toward the cost of insurance premiums purchased through the Health Insurance Exchange, and affordability cost-sharing credits to reduce the cost-sharing responsibility of these individuals.

Individuals can apply to the Commissioner for these credits through the Health Insurance Exchange.  The Commissioner can further deem individuals eligible on the basis on information otherwise obtained.  It doesn’t specify what information or how it will be obtain, but somehow the Commissioner is going to get information on individuals without their application or consent, to determine if they may also qualify for affordability credits.  The Commissioner must also establish effective methods that ensure individuals with limited English proficiency are able to apply for affordability credits.  Interpreted by many as a means of providing health insurance and related costs to illegal immigrants or amnesty immigrants – all at the taxpayers expense.

The Commissioner may also determine that a State Medicaid agency has the ability of determining eligibility for affordability premiums and credits, and if that agency does so they will be reimbursed for the costs in conducting those determinations.  So now the intrusion into our private lives is being expanded, not only to the Federal government,. but the state government; and guess who is paying the bill – the taxpayers.

If it is determined the individual is eligible for Medicaid, they will be enrolled under the State Medicaid plan.  No option.  I thought Medicare and Medicaid were already having financial problems, so now the government will add how many more to a failing system?

For the first two years of the plan the affordability premium credits may only be used for the basic plan.  But, beginning in year three the Commissioner will establish a process allowing affordability credits to be used to purchase enhanced or premium plans, but the individual is responsible for any difference in premiums.  So under this new plan we (the taxpayer) will be giving money in the form of affordability credits so these uninsured individuals can purchase a plan through the exchange.  If these individuals decide the basic plan just isn’t good enough for them, they can then use their own money to upgrade their plan to a better one – while the rest of us subsidizing these plans may only be able to afford the basic plan.  Excuse me, but if you can afford to upgrade your plan, then you can afford to pay for the basic plan out of your own pocket.  Why should taxpayers pay for these people to upgrade to a BMW when they are driving a Ford?

The bill describes an Affordable Credit Eligible Individual as one who is lawfully present in the US (other than as a nonimmigrant), enrolled under an Exchange-participating plan and not enrolled under another plan through an employer, with a family income below 400% of the Federal poverty level for the size of the family involved and who is not a Medicaid eligible individual.  So when Obama grants amnesty to 12 million illegal immigrants they then become eligible for all the benefits of this program covered by the taxpayers.

If you are a full-time employee and your employer offers employee coverage (for the employee and dependents) then you may not qualify as an affordable credit eligible individual.  Exceptions can be made in cases of divorce or separated individuals.  But, beginning in year two, if the cost in obtaining coverage under that employer-based plan exceeds 11 percent of your current family income, then that is considered unaffordable employer coverage.  This has the potential of expanding the current problem and government spending, resulting again in the increase in premiums and taxes.  If a family or individual currently has insurance and is paying for those premiums now, regardless of the cost, under this exception, those premiums could be determined as unaffordable employer coverage and then the government (taxpayer) would also subsidize this coverage!