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Updated House Version of Health Care Reform Bill


The White House has revised its proposed health care bill and released a very favorable summary for all to read. I must admit there are improvements in this version but many lingering questions keep coming to my mind. Please help me to understand if you can.

One of the president’s selling points is that there will be no more ‘discrimination’ against people with preexisting illnesses or conditions. My question concerns the definition of risk adjustment versus discrimination. It is a hard question. Is it fair to people with preexisting illnesses to be excluded from inexpensive insurance? Conversely, is it fair for healthy young Americans to pay premiums for the chronically ill? I wish I knew the answer to this ethical dilemma but I do know that risk adjustment is not synonymous with discrimination.

The option for a national plan has been removed from the current plan. This proposed plan focuses instead on affordability of health insurance. Again, this is a difficult question for me. How many uninsured Americans are simply gambling that they will not become ill? My personal cable services bill is in excess of 150.00/month and I do not have many premium channels. More people have cable TV services than health insurance though. After all, who wants to bet that they will become gravely ill? Go to any casino and you will see the eternal optimism of the American gambler even though we know the odds are in favor of the house. Most of us don’t like to face this fact until we have to and that is when health insurance becomes extremely expensive. And yet, I am not allowed to drive without insurance. I wonder what would happen if health insurance became mandatory?

And just because I am feeling controversial today, I think it is interesting that unearned income will also be subject to Hospital Insurance taxes in the same way that earned income is. This looks really good on paper but when you stop to think about it, it is the elderly and a handful of very wealthy folks who have a significant amount of unearned income. My own parents live off of ‘their retirement’ – interest (unearned income) from investments made while they were actively employed and contributing to Medicare. Help me out here. Is this fair?

Since I am complaining about so much, let me point out that I really like the idea of adding funding to community health centers in underserved areas. I mean, it’s only fair since I am quite vocal about what I don’t like.

There is a lot of talk about reducing fraud and abuse in the current bill. There was also a lot of talk about reducing fraud and abuse in the BBA97. And yet, in case you haven’t noticed, we still have fraud and abuse. Oops.

My point is that all of us – certainly anyone interested enough in home health to be reading this knows fraudulent providers are out there. Most of us can name one or more. And yet, if we know about them, why don’t the feds? Isn’t fraud and abuse a concern that should be currently being met with overwhelming diligence even without any new legislation being offered? I must admit the collusion of the IRS and CMS is an interesting twist. In our office we complete a lot of CMS paperwork. It would astound you to know how many social security numbers we submit to CMS. Pretty much anyone who runs, manages, owns more than five percent of a provider or just happens to be a consultant gets their SSN submitted to CMS. Being able to cross reference databases on the assumption that fraudulent providers are also prone to tax evasion might provide us all with some entertainment in the future.

There is a provision for smiting people who sell Medicare or Medicaid numbers for the purposes of fraudulent billing. I must be mistaken because I thought that was covered under HIPAA and the new Red Flags rule. And just to set your anxieties aside, the limitations on what can be reviewed by MACs prior to payment (ADRs) have been relaxed.

There is so much more that confuses but the one issue that has truly caught me off guard is the closure of the tax loophole for biocellulistic fuels. Folks, we will no longer be able to manufacture black liquor as produced by the Kraft technique and get a tax credit. Please, please, please, somebody tell me what that means, why it is in a health care reform bill and why I should care.

If you have any questions, I suggest that you send them to the whitehouse.gov website. On the other hand if you have any answers, clarifications or comments, please post below or email us.

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