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.

For those who claim there are no additional “taxes” imposed by this bill, they should refer to Title IV, Amendments to Internal Revenue Code of 1986 in which you will find “Sec. 401 Tax on Individuals Without Acceptable Health Care Coverage” as the first item to be added.  This bill not only increases government spending but it WILL INCREASE TAXES in more than one way.  Unfortunately, this section constantly refers to the Internal Revenue Code, so without actually looking at that code it is impossible to tell exactly what is being change.  Many of the references include “strike this and add…” and many times this is an increase in percentages or wording changes, so you would have to refer to the IRS code to determine what affect this has.

There are a number of business related changes to the IRS Code, many of which I could not interpret.  So if you are a business owner, especially a small business owner, I would recommend you read this section to see how it would apply to you.  This whole section reads like Greek, and if you have ever tried to read and interpret the IRS manuals this section of the bill is written in the same manner.  Consult your representative or tax accountant for clarification.  Because of this, I have included only portions of the tax code changes that apply to individuals and some general requirements as they apply to businesses.

The first tax is one imposed on individuals who do not have acceptable health care coverage.  This tax is 2.5 percent of the excess of the taxpayer’s modified adjusted gross income (adjusted gross income increased by the amount of interest received or accrued which is exempt from tax) for the year over the amount of gross income specified in section 6012(a)(1).  (I could not locate the reference in the bill to section 6012, so this may be an IRS code reference.)  This tax cannot exceed the national average premium for the taxable year as determined by the Secretary of Health & Human Services, under a basic plan offered in the Health Insurance Exchange.  If an individual resides outside the US they must get coverage, as well as anyone residing in possessions of the US.

This tax shall not apply to any individual who is a non-resident alien.

Acceptable coverage is (a) Qualified health benefits plan, (b) Grandfathered health insurance coverage, coverage under grandfathered employment-based health plan, (c) Medicare Part A, (d) Medicaid, (e) Members of the armed forces and dependents, including Tricare, (f) VA, and (g) Other coverage recognized by the Secretary in coordination with the Commissioner.

There are requirements for anyone who provides acceptable coverage, including a return that contains the name, address and TIN of the primary insured and the name of each individual obtaining coverage under the policy, the period each individual was provided coverage, and other information the Secretary may require.  If the insurance is provided by a governmental unit or agency, then the officer or employee who enters into the agreement to provide the coverage shall make the returns.  There is a penalty for failure to file, which amends sections of the IRS code and without referring to that code you cannot tell what is being amended.

If an employer fails (during any period) to satisfy the health coverage participation requirements a tax of $100 is imposed for each day in the period until the failure is corrected.  If a civil penalty is imposed, then this tax will be reduced by the amount of the civil penalty.

If an employer elects not to provide health benefits, in addition to other taxes imposed, an excise tax equal to 8 percent of the wages paid by him with respect to employment (defined in another section) will be imposed.  Small employers will be charged varied percentages from 0-6 as long as the annual payroll does not exceed $400,000.

There are some clauses with regard to the Small Business Employee Health Coverage Credit, which will not allow credit to highly compensated employees – any employee paid over $80,000 a year.

A surcharge on high income individuals is also being imposed, in addition to any other taxes imposed.  This surcharge is a tax equal to 1 percent of the modified adjusted gross income that exceed $350,000 but under $500,000; 1.5 percent of income over $500,000 but under $1,000,000 and 5.4 percent of income that exceeds $1,000,000.

As I initially read and took notes throughout this section I really didn’t grasp the absurdity of the program.  When I started writing this column I was overwhelmed by the stupidity of the thought that someone would actually think this was health care reform and not just a government take over of the health industry.  The public option is based on the same business model (if you could actually call it that) of the Medicare system – the system that is currently failing and going bankrupt today!  So why would one think that applying the same standards of a failing business to another model is going to create success.  Did any of the members participating in the creation of this bill have any business background?  Failure x 2 does not equal success.  With that said, I will continue on my quest at reporting on bill H.R. 3200.

The Public Health option is the portion of the bill allowing the government to sell insurance.  The Public Option is basically a Medicare type program offered to those who do not quality for Medicare, operating concurrently and competing against the private plans offered in the Health Insurance Exchange.  The government controls the Health Insurance Exchange, controls the policies offered within the exchange, and would now be able to sell government policies.  Try side stepping this all you want, but this is a government take over of health care.

Some of the bill’s BS (sorry) just could not be reworded or interpreted, so I had to quote the bill so you could fully understand the vague references and enthusiastic goals of the Public Option.

The Magic Wand of Health Care

The bill establishes the administration of a Public Health Insurance Option, an exchange qualified plan, which is supposed to “ensure choice, competition and stability of affordable, high quality coverage.”  The Secretary of Health & Human Services is responsible to create a “low-cost plan without compromising quality or access to care.”  WOW!  Apparently the magic formula has been discovered to have low-cost insurance premiums that will give accessible and quality care, and if you listen to Obama’s promises, this will not raise taxes.  Since this is similar to Medicare, one would have to wonder why this magic wand hasn’t already been applied to Medicare to ensure the same quality of care without bankrupting the system.

The Public Option will only be made available through the Health Insurance Exchange, so if you cannot obtain insurance through the exchange for whatever reason, you will also not be able to obtain the Public Option insurance either.  (For further information, please visit article H.R. 3200 – The Health Insurance Exchange.)

The Public Option must comply with the requirements that apply to an exchange plan, including benefits, benefit levels, provider networks, notices, consumer protections and cost-sharing.  Different levels of plans will also be offered.  The Secretary enters into the contracts for the public option.  This is similar to that of the Commissioner on the Health Insurance Exchange.

The Secretary sets the premiums for the public option and may allow for geographic adjustments.  The rates must be set at a level sufficient to fully finance the cost of the health benefits provided by the public options and all administrative costs related to operating the public option.

The Secretary will determine the payment rates for services and providers based on similar services and providers under Parts A and B of Medicare.  Since this public option includes services typically not provided under Medicare (such as well-child visits) the Secretary has the ability to modify payment rates to accommodate these services.  The same goes for prescription drugs not typically covered under Medicare Part A or B.

An incentive is offered to get providers to participate, allowing rates 5% greater for the first three years.  Anyone on Medicare knows how difficult it is to find a doctor that will accept patients under Medicare – they just don’t want to get involved with the government program.  So to try to get doctors to even participate in this new Public Option plan, they will allow them to charge more for services just to get them to sign up.  The catch – but only if they participate in both Medicare and the Public Option.  Pediatricians and other practitioners who typically do not participate in Medicare would also be eligible for increased payment rates.

JFK’S Secretary of State, Dean Rusk, was in France in the early 60’s when DeGaule decided to pull out of NATO. DeGaule said he wanted all US military out of France as soon as possible.

Rusk responded “does that include those who are buried here?

DeGuale did not respond.

You could have heard a pin drop

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When in England , at a fairly large conference, Colin Powell was asked by the Archbishop of Canterbury if our plans for Iraq were just an example of empire building by George Bush.

He answered by saying, ‘Over the years, the United States has sent many of its fine young men and women into great peril to fight for freedom beyond our borders. The only amount of land we have ever asked for in return is enough to bury those that did not return.’

You could have heard a pin drop.

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There was a conference in France where a number of international engineers were taking part, including French and American. During a break, one of the French engineers came back into the room saying ‘Have you heard the latest dumb stunt Bush has done? He has sent an aircraft carrier to Indonesia to help the tsunami victims. What does he intended to do, bomb them?’