Health Care Bill - Part Six

Thank you so much for joining me in reading the health care bill. I just wanted to clarify for those of you that are reading this - I want to do this for the purposes of all of us having a basic, general understanding of what is in this bill and, what we can expect will happen because this bill was passed. I find that there are a lot of folks out there saying things and, I want to be armed with the truth.

Today, I began on page 324...

CHAPTER 48—MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE

So, this is the section that talks about penalties if you don't carry essential, minimum coverage.  Beginning 2013, you and all your dependents MUST carry minimum, ESSENTIAL coverage. If you fail to do this for more than a month in a calendar year, than you are required to pay a fine. This fine is worked into your taxes. The fine will be...


The penalty determined under this subsection for any month with respect to any individual is an amount equal to 1⁄12 of the applicable dollar amount for the calendar year.

The limitation shall not exceed an amount equal to 300 percent the applicable dollar amount, which is 750 dollars. They actually phase this in. The year of 2014 shall be 95 dollars and, for 2015, it will be 350 dollars. Then, beginning 2016, it will go to the 750 dollars, however, they put some sort of a clause in here that basically states that this could be increased based on cost of living and will be rounded up to the nearest multiple of 50 dollars.

Through page 329, they discuss some other effects of this fine, like family size and household income. Again, this is more tax stuff so, I will let you read it directly but, I think the main thing to know here is that they are going to enforce this penalty through the IRS.

Beginning on page 330, there is an exemption for religious conscience. Here is the exact wording:

RELIGIOUS CONSCIENCE EXEMPTION.—Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.

So, this will take some cross referencing. Another exemption listed here are individuals that belong to a health care sharing ministry. This would be an organization that falls under the tax exempt 501c3, and they share medical expenses. (Bottom of pg. 330 and 331).

If you are an illegal alien, you don't pay this fine. I guess that's because, they are here illegally and won't be filling taxes.

Incarcerated individuals are not responsible for the months they are incarcerated.

Individuals who cannot afford coverage are also exempt from the penalty. The description of this is on pg. 332 and, it says that if the required contribution is more than 8 percent of the total household income, then you are deemed not to be able to afford coverage.

Through page 340, there is some more information concerning taxes and some other exemptions. I just covered the more important ones at the beginning. Since, those will be the ones that apply to MOST people.

Page 340 - SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE

I am reading this section as, whoever is providing the insurance, will then have to report to the Secretary who they have insured and, include that the individual and, their dependents are covered with essential coverage.

No later than June 30th of each year, a notification will be sent to individuals not covered. In the notification, it will include information about where a person can receive essential coverage and, what is available to them through the Exchange.

SEC. 1511. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS. Pg. 346.

Large employers are those that have more than 200 full time employees and they offer one or more health care plans. All new employees will be automatically enrolled but, they are required to give the employee a notice that will allow them to opt-out, if they so chose.

Page 347 SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOYEES OF COVERAGE OPTIONS

Pretty self explanatory.

SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH COVERAGE. Pg. 348

If a large employer does not offer essential insurance for it's full time employees (an employee that works on average 30 hours per week), they will have to pay an amount equal to the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month.

If they offer coverage but, there is a waiting period of more than 30 days, then a fine is paid for that as well. For further details of this, see pg. 350.

The next several pages deal with tax information for large employers.

SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE COVERAGE Pg. 357

Large employers are required to report employees that are covered. What follows is an outline of reporting procedures for the employer.


Pg. 364 - SEC. 1552. TRANSPARENCY IN GOVERNMENT.

Within 30 days of this act being passed, the Secretary of health and human services is required to post on their website a list of all the authorities that are provided to them through this act.

SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE

This is oddly placed and oddly worded. It basically says if the federal, state, or local government is receiving financial assistance under this act, it cannot discriminate a health care entity (defined as a physician, a hospital, health care professional, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan), that does NOT provide assisted suicide services.

Pg. 366 SEC. 1554. ACCESS TO THERAPIES

This is just a list of things that basically states that the Secretary shall not do anything unreasonable that would stand in the way of a patient having access to medical care.

SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS

This part says that you are not required to participate in any health insurance program that is created under this act. If you do not participate, you will not be fined.

Okay but, you still need to get essential care from somewhere...so, it won't be long till the government plan is all you have for an option.

The next several pages are what I consider common knowledge stuff. You can't be discriminated against for age, education, ect. Civil rights stuff. 

SEC. 1560. RULES OF CONSTRUCTION- no effect on anti-trust laws. Details for all this are on pg. 371.

Subtitle C—Other Provisions SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS. Pg. 373

This section is basically for the Secretary. They will have to initiate a program that will allow for electronic enrollment. This section discusses the standards and outlines them.

The next several pages are very confusing and I have to admit, I am completely lost. Here is an example of what I mean:

(i) in paragraph (1)—
2 (I) in the matter preceding sub
paragraph (A), by striking ‘‘small employer’’ and inserting ‘‘employer, or
5 individual, as applicable,’’;
6 (II) in subparagraph (A), by adding ‘‘and’’ at the end;
8 (III) by striking subparagraphs
9 (B) and (C); and
10 (IV) in subparagraph (D)—
11 (aa) by inserting ‘‘, or individual, as applicable,’’ after ‘‘employer’’; and
14 (bb) by redesignating such
15 subparagraph as subparagraph
16 (B);
17 (ii) in paragraph (2)—
18 (I) by striking ‘‘small employers’’
19 each place that such term appears
20 and inserting ‘‘employers, or individuals, as applicable,’’; and
22 (II) by striking ‘‘small employer’’
23 and inserting ‘‘employer, or individual, as applicable,’’; and

It's pages of "striking" and "inserting."

TITLE II—ROLE OF PUBLIC PROGRAMS Subtitle A—Improved Access to Medicaid

SEC. 2001. MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS Pg. 396

This gives information as to who qualifies for medicaid. This mostly applies to those that are 100 percent of the poverty line (I take this to me above or below), and childless, not considered a dependent, ect.

The bill then goes on to deal with even past the year 2019. Then, the will make increases. Of course!

Beginning Jan 1, 2011, parents that receive health care plan assistance are required to have their children enrolled under the program.

The next few pages deal with how the states will work with the Federal government concerning funding for assistance.

Page 411, discusses that the Medicade must be considered essential coverage - just like what the private insurance companies must offer, what the exchanges, and co-ops must offer as well. This is effective Jan 1, 2014.

SEC. 2002. INCOME ELIGIBILITY FOR NONELDERLY DETERMINED USING MODIFIED GROSS INCOME Pg. 418

This is a section that discusses how they are going to arrive at someone's eligibility for received medical assistance. A modified gross income is what will be used to determine this. It further goes on to explain what will not be used to determine eligibility, like assets. This determination is left up to the Secretary and the state. They will figure out what test shall be applied. Modified gross income is defined in Internal Revenue Code of 1986. I do not have that bill handy.

The next few pages deal more with tax stuff and, dealings between the Secretary and the state; you are more than welcome to read that yourself.

Tomorrow, I will start with p. 427. That's all for today.