By Mitch Gurney

September 2009

(Revised version)

I imagine the “You Tube” videos by a John C Crawford speaking out on the Health Care bill have been making the rounds lately. I became familiar with them through another website Keep America at Work (KAW) which had featured them in two separate postings on September 13^th the first posting was titled:

“Shame on you, US Government”

In this video, following his introduction, Mr Crawford at about the 6.05 minute mark states the following:

• “Now I am going to read a few lines that are exact excerpts from the house bill”

Mr Crawford does not specifically name the house bill he is referring to but based on the titles of his videos I assume he is referring to the Health Care Bill accessible here and have utilized this document for my critique:

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

I list below each of these “exact excerpts” as he has read them and follow with the text from the Health Care Bill pdf document and following this with my assessments. As a safety of margin for any potential error or oversight on my part I have included pages that proceed and those that follow the specific pages he references for his excerpts.

Referencing pg 29 he reads the following:

• “All health care will be rationed based on age, present health condition of any patient, and availability of health services and supplies”

Referencing pg 30 he reads the following two exact excerpts:

• “A government committee will decide what treatment or benefits will be made available under health care that will be provided”
• “It will be illegal to provide any medical benefits to anyone that haven’t been pre-approved by the committee”

The following is the text from the bill beginning with the last sentence on pg 26 thru pg 32:

(Because the pages and subjects overlap with the three excerpts above, I have combined them together)

(Beginning with page 26):

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

(continuing with pg 27):

ensure the provision of quality health care and financial security, that-

(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

(4) complies with section 115(a) (relating to network adequacy); and

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.

(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, including emergency department services.

(continuing with pg 28):

(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 in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

(9) Maternity care.

(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

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

(1) NO COST-SHARING FOR PREVENTIVE SERVICES.-There shall be no cost-sharing under the essential benefits package for preventive items and

(continuing with pg 29):

services (as specified under the benefit standards), including well baby and well child care.

(2) ANNUAL LIMITATION.-

(A) ANNUAL LIMITATION.- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

(B) APPLICABLE LEVEL. – The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

(C) USE OF COPAYMENTS. – In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.

(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

(continuing with pg 30):

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).

(B) REFERENCE BENEFITS PACKAGE DESCRIBED.-The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.

(a) ESTABLISHMENT.-

(1) IN GENERAL.-There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(2) CHAIR.-The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.

(3) MEMBERSHIP.-The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:

(continuing with pg 31):

(A) 9 members who are not Federal employees or officers and who are appointed by the President.

B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.

(C) Such even number of members (not to exceed [eight]) who are Federal employees and officers, as the President may appoint. Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.

(4) TERMS. – Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.

(5) PARTICIPATION. – The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, (continuing through first section on pg 32); labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of  such Committee.

Assessments

Pg 29 excerpt:

I did not find an exact excerpt in the bill as read by Mr Crawford.

• Nor do I find any specific verbiage that states anything about the rationing of health care based on age, the health condition of the patient, or the availability of services and supplies.

Pg 30 excerpts:

I did not find exact excerpts in the bill for either of the two as read by Mr Crawford.

• Pgs 30 – 31 of the bill does outline the establishment of a “private-public” committee; in this section it only discusses the formation, member composition, terms, and structure of the committee but makes no references as to what they decide, and for whom, nor even how such decisions are made.
• There are no statements in the bill on pages 26 – 31 that states what is legal versus illegal nor any statement that specifically states “it will be illegal to provide any medical benefits to anyone that haven’t been pre-approved by the committee.”

Referencing to pg 179 he reads the following:

• “Any non-resident alien is exempt from individual health care taxes”

The following is the text from the bill beginning with page 178 thru 180:

(c) RETURN REQUIREMENT.-Subsection (a) of section 6012 of such Code is amended by inserting after paragraph (9) the following new paragraph:

(10) Every individual to whom section 59B(a) applies and who fails to meet the requirements of section 59B(d) with respect to such individual or any qualifying child (as defined in section 152(c)) of  such individual.”.

(d) CLERICAL AMENDMENTS.-

(1) The table of parts for subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

‘‘PART VIII. HEALTH CARE RELATED TAXES.”.

(2) The table of sections for subpart B of part III of subchapter A of chapter 61 is amended by adding at the end the following new item:

‘‘Sec. 6050X. Returns relating to health insurance coverage.”

(e) SECTION 15 NOT TO APPLY. – The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.

(f) EFFECTIVE DATE.-

(1) IN GENERAL. – The amendments made by this section shall apply to taxable years beginning after December 31, 2012.

(continuing with page 179):

(2) RETURNS. – The amendments made by subsection (b) shall apply to calendar years beginning after December 31, 2012.

PART 2-EMPLOYER RESPONSIBILITY

SEC. 411. ELECTION TO SATISFY HEALTH COVERAGE PARTICIPATION REQUIREMENTS.

(a) IN GENERAL. – Chapter 43 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

‘‘SEC.  4980H. ELECTION WITH RESPECT TO HEALTH COVERAGE PARTICIPATION REQUIREMENTS.

(a) ELECTION OF EMPLOYER RESPONSIBILITY TO PROVIDE HEALTH COVERAGE.-

(1) IN GENERAL.-Subsection (b) shall apply to any employer with respect to whom an election under paragraph (2) is in effect.

(2) TIME AND MANNER. – An employer may make an election under this paragraph at such time and in such form and manner as the Secretary may prescribe.

(3) AFFILIATED GROUPS.-In the case of any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414, the election under paragraph (2) shall be made by such person

(continuing with pg 180):

as the Secretary may provide. Any such election, once made, shall apply to all members of such group.

(4) SEPARATE ELECTIONS. – Under regulations prescribed by the Secretary, separate elections may be made under paragraph (2) with respect to-

(A) separate lines of business, and

(B) full-time employees and employees who are not full-time employees.

(5) TERMINATION OF ELECTION IN CASES OF SUBSTANTIAL NONCOMPLIANCE. -

The Secretary may terminate the election of any employer under paragraph (2) if the Secretary (in coordination with the Health Choices Commissioner) determines that such employer is in substantial noncompliance with the health coverage participation requirements.

(b) EXCISE TAX WITH RESPECT TO FAILURE TO MEET HEALTH COVERAGE PARTICIPATION REQUIREMENTS.-

(1) IN GENERAL.-In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee to whom such election applies, there is hereby imposed on each such failure

(continuing with pg 181):

with respect to each such employee a tax of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.

(2) LIMITATIONS ON AMOUNT OF TAX.-

(A) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE DILIGENCE. – No tax shall be imposed by paragraph (1) on any failure during any period for which it is established to the satisfaction of the Secretary that the employer neither knew, nor  exercising reasonable diligence would have known, that such failure existed.

(B) TAX NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS. – No tax shall be imposed by paragraph (1) on any failure if -

(i) such failure was due to reasonable cause and not to willful neglect, and

(ii) such failure is corrected during the 30-day period beginning on the 1^st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed.

Assessment:

Pg 179 Excerpt:

I did not find an exact excerpt as read by Mr. Crawford

• Pg 178 of the bill does discuss taxes and continues through pg 179 as they relate to employer responsibility but I did not find any specific references or any verbiage regarding “non-resident aliens” or any statements exempting such individuals of such taxes.

The second KAW posting featuring Mr Crawford’s second video is titled:

“Our own politicians are undermining everything that America stands for and will be held accountable from this time forward.”

Mr Crawford opens with reading additional exact excerpts:

Referencing to pg 239 he reads the following:

• “The government will reduce physician’s services for Medicaid thereby rationing medical support for the poor”

The following is the text from the bill beginning with pg 238 thru pg 239:

Subtitle B-Provisions Related to Part B

PART 1 – PHYSICIANS’ SERVICES –

SEC. 1121. SUSTAINABLE GROWTH RATE REFORM.

(a) TRANSITIONAL UPDATE FOR 2010. – Section 1848(d) of the Social Security Act (42 U.S.C. 1395w – 4(d)) is amended by adding at the end the following new paragraph:

(10) UPDATE FOR 2010. – The update to the single conversion factor established in paragraph (1)(C) for 2010 shall be the percentage increase in the MEI (as defined in section 1842(i)(3)) for that 16 year.”

(b) REBASING SGR USING 2009; LIMITATION ON CUMULATIVE ADJUSTMENT PERIOD.-Section 1848(d) (4) of such Act (42 U.S.C. 1395w-4(d)(4)) is amended-

(1) in subparagraph (B), by striking ‘‘subparagraph (D)” and inserting ‘‘subparagraphs (D) and (G)”; and

(2) by adding at the end the following new subparagraph:

(continuing with pg 239):

(G) REBASING USING 2009 FOR FUTURE UPDATE ADJUSTMENTS. – In determining the update adjustment factor under subparagraph

(B) for 2011 and subsequent years-

(i) the allowed expenditures for 2009 shall be equal to the amount of the actual expenditures for physicians’ services during 2009; and

‘(ii) the reference in subparagraph (B)(ii)(I) to ‘April 1, 1996′ shall be treated as a reference to ‘January 1, 2009 (or, if later, the first day of the fifth year before the year involved)’.”

(c) LIMITATION ON PHYSICIANS’ SERVICES INCLUDED IN TARGET GROWTH RATE COMPUTATION TO SERVICES COVERED UNDER PHYSICIAN FEE SCHEDULE.-

Effective for services furnished on or after January 1, 2009, section 1848(f)(4)(A) of such Act is amended striking ‘‘(such as clinical” and all that follows through ‘‘in a physician’s office” and inserting ‘‘for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than

(continuing with first line on pg 240):

such services when furnished in the facility of a provider of services)”.

Assessment:

Pg 239 Excerpt:

I did not find an exact excerpt as read by Mr. Crawford

• I did not find any specific statements in the bill that states “the government will reduce physician’s services for Medicaid thereby rationing medical support for the poor.”
• There are no specific statements or verbiage regarding “rationing medical services for the poor”

Referencing to pg 241 he reads the following:

• “All doctors will be paid equally with no regard to specialties of training required”

The following is the text in the bill beginning with pg 240 thru 242:

(d) ESTABLISHMENT OF SEPARATE TARGET GROWTH RATES FOR CATEGORIES OF SERVICES.-

(1) ESTABLISHMENT OF SERVICE CATEGORIES.-Subsection (j) of section 1848 of the Social Security Act (42 U.S.C.1395w-4) is amended by adding at the end the following new paragraph:

(5) SERVICE CATEGORIES. – For services furnished on or after January 1, 2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’:

(A) Evaluation and management services that are procedure codes (for services covered under this title) for

(i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009, and as subsequently modified by the Secretary); and

(continuing with page 241):

(ii) preventive services (as defined in section 1861(iii)) for which payment is made under this section.

(B) All other services not described in subparagraph (A). Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”

(2) ESTABLISHMENT OF SEPARATE CONVERSION FACTORS FOR EACH SERVICE CATEGORY. -

Subsection (d)(1) of section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended-

(A) in subparagraph (A) -

(i) by designating the sentence beginning ‘‘The conversion factor” as clause (i) with the heading ‘‘APPLICATION OF SINGLE CONVERSION FACTOR. -” and with appropriate indentation;

(ii) by striking ‘‘The conversion factor” and inserting ‘‘Subject to clause (ii), the conversion factor”; and (iii) by adding at the end the following new clause:

(continuing with first section on page 242):

(ii) APPLICATION OF MULTIPLE CONVERSION FACTORS BEGINNING WITH 2011. -

(I) IN GENERAL.-In applying clause (i) for years beginning with 2011, separate conversion factors shall be established for each service  category of physicians’ services (as defined in subsection (j)(5)) and any reference in this section to a conversion factor for such years shall be deemed to be a reference to the conversion factor for each of such categories.

Assessment:

Pg 241 Excerpt:

I did not find an exact excerpt as read by Mr. Crawford

On pg 241 the bill does state after outlining the establishment of service categories the following:

• “(B) All other services not described in subparagraph (A). Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”
  • This statement appears to a proviso type of statement covering general areas not specifically categorized in the proceeding sections.

In conclusion:

After carefully reviewing the text on these pages of the Health Care Bill and having not found any of the “exact excerpts” as read by Mr. Crawford I conclude he is either mistaken as to which pages he pulled his “exact excerpts” from or he was actually giving us his interpretations of these pages.

It is my conclusion Mr Crawford is giving us his interpretations and he is most certainly entitled to do so.

Sorry, but a personal interpretation is NOT the same as an “exact excerpt.”

My interpretation of these pages differs greatly from that of Mr Crawford and it is my opinion he has misinterpreted them and of course we each are entitled to our interpretations.

I want to close with a final thought on this. And I have stated this before. There are forces that are working overtime to defeat any form of health care reform. There are industries that profit from how things work today and these entities don’t want the terrain changed for obvious reasons. They in essence decide policy in Washington. They know policymakers rather than be agents of balance in policy will cater to party and corporate favors. They know most Americans lack the basis to judge the relative merits on the arguments of an issue of this magnitude and will stir up emotions in any manner possible to confuse us and are betting we will not do our OWN due diligence to become more informed but instead take the lazy way out and listen to 30 second sound bites delivered in a video or through the corporate owned MSM pertaining to a very important life quality issue covering a document that is 1018 pages in length. Once passed it will determine our fate for years to come and vested special interest will have protected its turf and carved out their piece of the pie in order to better pick our pockets for profit.

I mean no disrespect to Mr Crawford who states he is acting on his own and he may be but my suggestion is not to take my word for this or his or anyone else’s for that matter. Read the DARN document yourself and develop your own interpretation, do not take the lazy way out. I have taken the time to copy the text from the bill to enable you do so or you may go the actual document itself and review the respective pages in question.  I have included the link above.

Mitch Gurney

Addendum:

Since posting this critique on the KAW site it has been suggested there may be multiple bills floating about that may differ from the one I used for my critique and made available above. I recognize text might get inserted into a bill like this as it works its way through Congress. Changes and last minute inserts have happened with other bills in the past right up to the last minute when a vote is due. We can only speculate on the political intrigue and games that are playing out right now with something of this nature where profits and industries are wrestling over control and striving to protect their turfs.

If there are multiple versions of this bill floating around my suggestion for any one posting some commentary on this is to provide the link or document from which they are basing their commentary so their audience can cross reference the data. For now until some one can produce an alternate document or documents all I can go on is what I have found and made available here.

I think it is important to point out that in my assessments of the presentations by Mr. Crawford that I have given my findings based on what we were told are exact excerpts. When someone tells me they are providing exact excerpts from a document it is my expectation that if I go to that document and pages given as the source for those exact excerpts I will find them. Other than to express my opinion that I believe we have been given his interpretations and not exact excerpts and that I think we need to do our own due diligence and not take any ones word on this I have not given my interpretations of these documents or my opinion of health care reform in general.

I have provided the sources for my data and my findings as it relates to the statements given by Mr. Crawford who did not provide the source except by reference only. I leave it to each reader to review the sources of my data and invite the reader to make their own determination.

Mitch Gurney

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