The next section beginning with Page 202, line 18 discusses 'Special Rules' for paying the excise tax, because some people and entities will be treated differently including Non-Resident Aliens that will have to pay the tax, Citizens and Residents living abroad, Charitable Trusts and the FACT that the excise tax will not begin under this law until after the year ending 2010.
From here the bill goes on and one about codes for IRS interpretation and guidelines for language used to identify taxed entities and their degree of taxation and penalities for under payment.
On Page 215, line 21 begins a section entitled "Division B - Medicare and Medicaid Improvements." The table of contents of this section goes through to the end of Page 222. But, much of the 'context' of the bill dealing with areas of that might effect 'payments' to facilities won't cause any changes until January 1, 2010. There are exceptions to payment rule changes to psychiatric hospitals that begin in 2011. This section relies heavily on the Social Security Act regarding Medicare, Medicaid and SCHIP. To properly analyze the entire section it would be necessary to also look up those particular laws. I can understand why these provisions might appear in this bill, because, it will impact certain aspects of existing laws whereby insured individuals might find subscribing under this new law more advantageous. Therefore, all this 'payment' information is about a 'timeline' whereby payments would be honored up to a certain date. It makes sense from the standpoint of psychiatric facilities especially because their clients will have to be provided for by 'guardians' which might have a different time scale for change than others such as SCHIP.
This part of the bill is almost written as 'incidentally' to cover any occurrences that might impact existing laws. It is included to clear up where monies will come from to pay these institutions should clients find better opportunity in health care coverage within the new law. These provisions aren't 'changes' to services of people currently covered by Medicare, Medicaid or SCHIP, it is about payments made to them SHOULD there be a change in the choices of their patients/clients/citizens. It is an 'incidental' set of provisions. It will prevent confusion and prevent litigation as well in regard to payments to institutions.
What comes to mind in regard to Medicare in particular are the 'opportunities' the handicapped or disabled might find in having a health insurance that better serves their need, IF, they are competent enough to actually earn more money at jobs than is allowed under Medicare. I think there might be some movement by those currently on Medicare into a different opportunity for coverage that will actually allow them to earn more than they do now under the provisions of Medicare.
I really believe the provisions that discuss Medicare are in the areas of disability or handicapped. Page 236, lines 22 through 25 and Page 237, lines 1 through 3 SPECIFICALLY indicate the delineation of 'under age 65.'
(B) NATIONAL RATE OF UNINSURANCE DEFINED.—The term ‘‘national rate of uninsurance’’ means, for a year, such rate for the under-65 population for the year as determined and published by the Bureau of the Census in its Current Population Survey in or about September of the succeeding year.
The more I look at these provisions the more it seems obvious to me these new laws will open up opportunity to people that otherwise are dependant on incomes that do not exceed limits set by Medicare. In other words, some handicapped or disabled, including the military, that receive disabilty and Medicare or some form of government health insurance will have the 'income limitations' removed as they will have access to a Public Option that does not discriminate to Pre-existing condition. You want to know something? This is going to expand the tax base of the nation and improve the quality of life to people if they are able to work full time and provide health insurance that will not limit their opportunity to income. Wow. I like this new bill. I really do. It doesn't demand people have to change their lives or lifestyles, but, it certainly opens up that opportunity if they desire it. Wow.
Beginning with Page 238, line 4 there in begins the same discussion of provisions for the payment of Physicians (Medicare Part B) as existed for (Part A) institutions. In other words, when physicians will begin to receive payments from health insurance companies or the Public Option and when the transition will occur to the payments from Medicare. Same type of stuff for Physicians.
The interesting aspect of this is that physicians will actually receive 'the same' payment of services for the folks that fall under Part B or they will receive more under the Public Option depending on the 'Provider Base' and the Commissions determination of payments amounts. This is interesting. If a citizen decides to leave Medicare and move to the Public Option in order to earn more money, their physicians will probably not change, but, they will receive higher payments for their services. That is really interesting. Physicians that normally would only receive payments on Medicare scale rates, will now receive more for treating the same patient IF that patient has moved off Medicare to a Public Option or Private Insurance. Wow.
The provisions regarding Medicare and payments, etc. goes on for some number of pages, but, it would seem as though the Secretary of Health and Human Services coordinates all these provisions. So, the responsibility for a smooth transition will occur under the authority of one branch of the cabinet. It won't be necessary for any other offices of the federal government to be involved, but, only that of Health and Human Services. That is a good thing. It will reduce cost of the transition and will make it more efficient.
I will end it there for today. Page 256, beginning with line 1 starts to discuss changes and 'incentive payments' for 'efficient areas.' What are 'efficient areas?' Those areas where electronic records are utilized for administering health care.
I might take Sunday off, so I'll pick up again Monday.
'til then...
