To be more specific, the Republican scare tactics surround the issue of COST and deficit and debt. The Democrats HAVE TO address those issues with FACTUAL analysis of the cost, the deficit and the debt and drive those facts home every chance they get.
To be completely accurate, this could be the chance the Democrats have been waiting for to nail down the SSI, Medicare entitlements and how they are better financed today than before the law passed. It is also their chance to address the deficit and debt the way they see it and even call into legislation how the entitlements will be 'secured' by law and how the deficit and debt will be handled through 'law' so it can't be taken away from citizens ever again. I see all this as an opportunity to 'out shine' the previous and potential Republican leadership that never addressed these entitlements and their security ever before. I don't know any other President or administration that could before now. There is significant expertise throughout this administration and to the extent law can apply, it should be part of the reality of where the country is going and how it is solving its problems, today and tomorrow.
As I read through this law and the Reconciliation Bill to follow it is completely obvious whom the experts are in the legislature as well. These provisions are clearly discernible and expertly written. I am grateful the Democrats wrote the bills that lead to their passage into law without the 'sleazy methodology of the Republicans' tainting it. There, to date, aren't any hazy issues to resolve.
It is obvious from the Graham rhetoric the Republicans are completely dismissive of the needs of Americans. One cannot write a bill with this scope and not hit on valuable change to the American landscape. Even statistically that is grossly inaccurate.
It is all good.
The CORRECT name of the new law is:
"Patient Protection and Affordable Care Act."
For uninsured citizens to receive health care insurance.
(d) Eligible Individual- An individual shall be deemed to be an eligible individual for purposes of this section if such individual--
(1) is a citizen or national of the United States or is lawfully present in the United States (as determined in accordance with section 1411);
Section 1411 is under Part 1, subpart B, eligibility determinations. It is a very long section.
SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND REDUCED COST-SHARING, AND INDIVIDUAL RESPONSIBILITY EXEMPTIONS.
The title is plain language.(a) Establishment of Program- The Secretary shall establish a program meeting the requirements of this section for determining--
(1) whether an individual who is to be covered in the individual market by a qualified health plan offered through an Exchange, or who is claiming a premium tax credit or reduced cost-sharing, meets the requirements of sections 1312(f)(3)...
1312(f) reads:
(3) ACCESS LIMITED TO LAWFUL RESIDENTS- If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
That is clear to me. It is about an individual and not a relative circumstance, so the person seeking to qualify is judged appropriate on the merits of their own person and not that of anyone else, at least at this point.
...1402(e),
(e) Rules for Individuals Not Lawfully Present-
Not lawfully present means the individual is in the members household illegally.
(1) IN GENERAL- If an individual who is an eligible insured is not lawfully present--
If an individual is an illegal alien there is no cost-sharing reduction for that individual. In other words that individual is not allowed to participate in the exchange. Nothing saying they cannot get health insurance without the exchange, but, they won't be allowed to participate in an exchange.
(A) no cost-sharing reduction under this section shall apply with respect to the individual; and
(B) for purposes of applying this section, the determination as to what percentage a taxpayer’s household income bears to the poverty level for a family of the size involved shall be made under one of the following methods:
This section under B defines poverty line. It doesn't provide any other exemptions to Illegals participating. If a person is illegal then they are not included in any of the exchanges. This section under B is irrelevant to that reality. There are provisions in the USA welfare laws that would provide for government payment. I believe section B is to clarify that standard.
The reason this is placed here is due to children that have been born in the USA, but, their parents are illegal aliens. We know that those children are considered citizens and their eligibility will rely on the family's income as to whether they are allowed into the exchanges. I think that is why it is entered here. Because (2) goes on to talk about lawfully present.
(i) A method under which--
(I) the taxpayer’s family size is determined by not taking such individuals into account, and
(II) the taxpayer’s household income is equal to the product of the taxpayer’s household income (determined without regard to this subsection) and a fraction--
(aa) the numerator of which is the poverty line for the taxpayer’s family size determined after application of subclause (I), and
(bb) the denominator of which is the poverty line for the taxpayer’s family size determined without regard to subclause (I).
(ii) A comparable method reaching the same result as the method under clause (i).
(2) LAWFULLY PRESENT- For purposes of this section, an individual shall be treated as lawfully present only if the individual is, and is reasonably expected to be for the entire period of enrollment for which the cost-sharing reduction under this section is being claimed, a citizen or national of the United States or an alien lawfully present in the United States.
There are no illegal aliens allowed to participate in any exchanges even if they are high risk exchanges.
(3) SECRETARIAL AUTHORITY- The Secretary, in consultation with the Secretary of the Treasury, shall prescribe rules setting forth the methods by which calculations of family size and household income are made for purposes of this subsection. Such rules shall be designed to ensure that the least burden is placed on individuals enrolling in qualified health plans through an Exchange and taxpayers eligible for the credit allowable under this section.
This is not entirely within it's 'home' section. It is just referred to here and that is why I brought it forward. Within its 'home' section the words have more meaning than they do here. To some extent. What is different here, is that the Secretary of Health and Human Services acts in CONSULTATION with the USA Treasury Secretary. It will be those two cabinet level departments that will agree upon the rules mapped out here.
and 1412(d)
(d) No Federal Payments for Individuals Not Lawfully Present- Nothing in this subtitle or the amendments made by this subtitle allows Federal payments, credits, or cost-sharing reductions for individuals who are not lawfully present in the United States.
There it is. There will be no inclusion anywhere within this law to allow illegal aliens a place within it. President Obama and the House and Senate Democrats don't lie, the Republicans and Right Wing Media DOES.
...of this title and section 36B(e) of the Internal Revenue Code of 1986 (click here) that the individual be a citizen or national of the United States or an alien lawfully present in the United States;
(2) in the case of an individual claiming a premium tax credit or reduced cost-sharing under section 36B of such Code or section 1402--
(A) whether the individual meets the income and coverage requirements of such sections; and
B) the amount of the tax credit or reduced cost-sharing;
(3) whether an individual’s coverage under an employer-sponsored health benefits plan is treated as unaffordable under sections 36B(c)(2)(C) and 5000A(e)(2); and
There are more sections to look up. The 36(B)(2)(C) is from the IRS codes and those sections are really tedious to find. I tried one more time on line and it is futile. I'll find the 5000 section. I am going off line for awhile.
Okay, who hid section 5000?
Sec. 4402. Effectiveness of Federal health and wellness initiatives.
TITLE V--HEALTH CARE WORKFORCE
Subtitle A--Purpose and Definitions
Sec. 5001. Purpose.Here it is:
This is established law. Don't get carried away thinking this was recently
dreamed up by the Democrats. Let me see if I can find out when it
was written.
Originally part of the law in Oct. 21, 1986, then
amended Dec. 19, 1989 and last amended before the
Health Care Reform Law (which really isn't called
the Health Care Reform Law) on Aug. 10, 1993.
There is a lot explained in Section 5000 of the
IRS Code,but, basically it states anyone receiving
benefits from a non-conforming insurance product no
longer has to pay the taxes if they don't want to, but,
they are ELIGIBLE for inclusion to an exchange so
long as they meet all the other requirements as well.
Sec. 5000. Certain group health plans
(a) Imposition of tax
There is hereby imposed on any employer (including a
self-employed person) or employee organization that contributes to
a nonconforming group health plan a tax equal to 25 percent of the
employer's or employee organization's expenses incurred during the
calendar year for each group health plan to which the employer or
employee organization contributes.
(b) Group health plan and large group health plan
For purposes of this section -
(1) Group health plan
The term ''group health plan'' means a plan (including
self-insured plan) of, or contributed to by, an employer
(including a self-employed person) or employee organization to
provide health care (directly or otherwise) to the employees,
former employees, the employer, others associated or formerly
associated with the employer in a business relationship,or their
families.
(2) Large group health plan
The term ''large group health plan'' means a plan of, or
contributed to by, an employer or employee organization
(including a self-insured plan) to provide health care (directly
or otherwise) to the employees, former employees, the employer,
others associated or formerly associated with the employer in a
business relationship, or their families, that covers employees
of at least one employer that normally employed at least 100
employees on a typical business day during the previous calendar
year. For purposes of the preceding sentence -
(A) all employers treated as a single employer under
subsection (a) or (b) of section 52 shall be treated as a
single employer,
(B) all employees of the members of an affiliated service
group (as defined in section 414(m)) shall be treated as
employed by a single employer, and
(C) leased employees (as defined in section 414(n)(2)) shall
be treated as employees of the person for whom they perform
services to the extent they are so treated under section
414(n).
(c) Nonconforming group health plan
For purposes of this section, the term ''nonconforming group
health plan'' means a group health plan or large group health plan
that at any time during a calendar year does not comply with the
requirements of subparagraphs (A) and (C) or subparagraph (B),
respectively, of paragraph (1), or with the requirements of
paragraph (2), of section 1862(b) of the Social Security Act.
d) Government entities
For purposes of this section, the term ''employer'' does not
include a Federal or other governmental entity.
(4) whether to grant a certification under section 1311(d)(4)(H) (This is about veterans. Evidently they are as eligible as anyone else to join any exchange they want, including their families, it would seem.) attesting that, for purposes of the individual responsibility requirement under section 5000A...
(This is the same section as above only particularly the A under that section)
(A) all employers treated as a single employer underIt seems to me the more I read these 'inclusions' the law goes through a lot of trouble to include EVERYONE with the opportunity for health care insurance through the exchanges INCLUDING disabled veterans.
subsection (a) or (b) of section 52 shall be treated as a
single employer,
This 'qualifications' come from later in the bill. One has to remember that. Why? Because
these provisions don't expire. They don't end on January 1, 2014. This is it. These are the
citizens included in the reform.
...of the Internal Revenue Code of 1986, an individual is entitled to an exemption from either the individual responsibility requirement or the penalty imposed by such section.
I'll read more tomorrow.
I happen to think this is a great law that will only become greater over time.
(b) Information Required To Be Provided by Applicants-
This is the information that is allowed to be obtained by insurers.
(1) IN GENERAL- An applicant for enrollment in a qualified health plan offered through an Exchange in the individual market shall provide--
(A) the name, address, and date of birth of each individual who is to be covered by the plan (in this subsection referred to as an ‘enrollee’); and
(B) the information required by any of the following paragraphs that is applicable to an enrollee.
(2) CITIZENSHIP OR IMMIGRATION STATUS- The following information shall be provided with respect to every enrollee:
(A) In the case of an enrollee whose eligibility is based on an attestation of citizenship of the enrollee, the enrollee’s social security number.
(B) In the case of an individual whose eligibility is based on an attestation of the enrollee’s immigration status, the enrollee’s social security number (if applicable) and such identifying information with respect to the enrollee’s immigration status as the Secretary, after consultation with the Secretary of Homeland Security, determines appropriate.
The new law also brings in National Security as a directive as the Secretary of Health and Human Services has to consult with the Secretary of Homeland Security to determine citizen and/or immigration status.
There is also a provision with an amendment that was proposed by Sessions. At this point I don't know if it was incorporated into this bill, but, it may be an option for the consulting period to include the provisions within that bill:
(c) Verification of Eligibility Through Documentation.— (click here)
(1) IN GENERAL.—Each Exchange shall conduct eligibility verification, using the information provided by an applicant under subsection (b), in accordance with this subsection.
(2) VERIFICATION OF CITIZENSHIP OR IMMIGRATION STATUS.—
(A) VERIFICATION OF ATTESTATION OF CITIZENSHIP.—Each Exchange shall verify the eligibility of each enrollee who attests that they are a citizen or national of the United States, as required by subsection (b)(1)(A) of this section, in accordance with the provisions of section 1903(x) of the Social Security Act.
(B) VERIFICATION OF ATTESTATION OF ELIGIBLE IMMIGRATION STATUS.—Each Exchange shall verify the eligibility of each enrollee who attests that they are eligible to participate in the exchange by virtue of having been a lawful permanent resident for not less than 5 years, as required by subsection (b)(l)(B) of this section, in accordance with the provisions of section 1137 of the Social Security Act.
Five years seems excessive, but, a more reasonable standard might come from the length of time they have held a drivers' license and/or maintained a residence whereby they have receipts from rent and/or mortgage. The idea that an infant might be in danger is a factor that really should not be debated. Children are victim to their parents decisions. Considering the age of the individual might be a factor as well.
(3) ELIGIBILITY AND AMOUNT OF TAX CREDIT OR REDUCED COST-SHARING- In the case of an enrollee with respect to whom a premium tax credit or reduced cost-sharing under section 36B of such Code (the 36B Code is where credits to the Income Tax Code are placed when written into law) or section 1402 (This is the part of the IRS Code for the self-employed.) is being claimed, the following information:
(A) INFORMATION REGARDING INCOME AND FAMILY SIZE- The information described in section 6103(l)(21)...
Section 6103 deals with disclosure laws. I am trying to find (l)(21). I've checked two sources and the (l) sections go up to (20), but, no (21). That doesn't really mean anything as the online sources might not be the most up to date references, especially, if this is a fairly new provision. I'll try one more, but, it doesn't appear online anywhere. As a matter of fact the second source I checked is stated to be accurate up to January 7, 2003. So, I many not be able to find it online.
Nope. The online sources don't include it, but, they are somewhat dated to their status. Well. It is about disclosure. What this law does all through the context is draw on existing statutes to build on the upgrades that is this law. That is good practice, it also saves time and work. So, the (21) section somehow describes disclosure that will assist the Secretary of Health and Human Services and the Secretary of Homeland Security define 'citizen' and 'legally present immigrants.'
Something occurred to me.
It would be darn decent of the administration if they would ask the folks that oppose abortion if they believe it would be beneficial to have expectant mothers included in any of the statue that does not address the unborn, if indeed this law ever includes illegal immigrant children born outside the USA as important enough to allow them to PURCHASE on the exchanges.
They can purchase insurance if they have the funds anyway, but, it would be a kind gesture to include those priorities if there are House Members of that constituency that would like to one more time add one more amendment (If not already there.) to include those children and expectant mothers. It might be cheaper to have an expectant mother, even though illegally in the country, have an abortion than not even if she feels strongly about wanting the child. She might be too burdened by her 'status' to keep the pregnancy.
If nothing else it would get them on record to their position and it would help clarify issues in the future for candidates seeking to uphold the dignity of these folks. Wanting women to take their pregnancies to term is not a bad thing, but, it is a bad thing to drop them off on the doorstep of life afterward and simply state, 'Cope with it.'
Abortion is a cultural issue and a socio-economic issue. That is something the Religious Right never owns as a reality. So do they accept illegal immigrants that are pregnant women with or without children in tow as important enough to accommodate? This could also be carried through in new Immigration Law rather than as an additional amendment to this law.
I would not EXPECT any USA law to purposely sabotage a parent that wants to keep their child by stating they HAVE TO provide the child for adoption after the pregnancy was attended to by an insurance exchange. No, no. Offering a child for adoption is a decision parent(s) have to make willingly and without doubt or regret, not as part of a law.
The previous five paragraphs are 'human rights' provisions if anything like that were adopted. It would prove to the greater community exactly our concern for those within our borders as human beings vs 'capital tools of labor.'
Justice Ginsberg, whom has a long record of upholding such interests with the USA and outside considerations, would probably consider that constitutional. I can't say that the conservative justices that are owned by corporations would though.
...for the taxable year ending with or within the second calendar year preceding the calendar year in which the plan year begins.
This plan began at the signature of the President. So the plan begins for the taxable year following this year or sometime within the next year.
The fiscal year for the USA government is:
- 1st Quarter: October 1, 2009 - December 31, 2009
- 2nd Quarter: January 1, 2010 - March 31, 2010
- 3rd Quarter: April 1, 2010 - June 30, 2010
- 4th Quarter: July 1, 2010 - September 30, 2010
The income tax records for most if not all citizens for 2008 will have already been filed, so it will be that year of proof that will count in regard to the 'status' of citizenship or legally present immigrants for the purpose of the law.
(B) CHANGES IN CIRCUMSTANCES- The information described in section 1412(b)(2),
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS.
(b) Advance Determinations-(2) (The lack of specification of subsection (A) or (B) indicates all of (2) and not just one section or the other.) CHANGES IN CIRCUMSTANCES- The Secretary shall provide procedures for making advance determinations on the basis of information other than that described in paragraph (1)(B)
This is from Section 1412.
(1) IN GENERAL- The Secretary shall provide under the program established under subsection (a)
(Sub-section) (a) In General- The Secretary, in consultation with the Secretary of the Treasury, shall establish a program under which--
(1) upon request of an Exchange, advance determinations are made under section 1411 (1411 is what this consists. Rather than saying, '...under this section...' the legislation clearly states the section of which this is. This mention of section 1411 is to redirect attention to the fact this is continuing content of this statute.) with respect to the income eligibility of individuals enrolling in a qualified health plan in the individual market through the Exchange for the premium tax credit allowable under section 36B of the Internal Revenue Code of 1986 (I've already discussed this.) and the cost-sharing reductions under section 1402;
(2) the Secretary notifies--
A) the Exchange and the Secretary of the Treasury of the advance determinations; and
(B) the Secretary of the Treasury of the name and employer identification number of each employer with respect to whom 1 or more employee of the employer were determined to be eligible for the premium tax credit under section 36B of the Internal Revenue Code of 1986 and the cost-sharing reductions under section 1402...
SEC. 1402. REDUCED COST-SHARING FOR INDIVIDUALS ENROLLING IN QUALIFIED HEALTH PLANS.
Section 1402 is a bit lengthy, but, it discusses the 'cost-sharing' and I'll discuss it within its location of the bill. It applies to Section 1412 that is inserted here....because--
(i) the employer did not provide minimum essential coverage; or
(ii) the employer provided such minimum essential coverage but it was determined under section 36B(c)(2)(C) (That is the provision within this law below and I'll read it as it occurs in the law.)...
‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
‘(c) Definition and Rules Relating to Applicable Taxpayers, Coverage Months, and Qualified Health Plan- For purposes of this section--‘(2) COVERAGE MONTH- For purposes of this subsection--
‘(C) SPECIAL RULE FOR EMPLOYER-SPONSORED MINIMUM ESSENTIAL COVERAGE- For purposes of subparagraph (B)--
...of such Code to either be unaffordable to the employee or not provide the required minimum actuarial value; and...
In other words, to qualify for an exchange one can move outside that of an employer provided health care insurance IF the insurance is inadequate to provide "...minimal actuarial value...". Minimal Actuarial Value is basically the deductible to the policy. 70 : 30 Policy. 60 : 30 Policy. The actuarial value is the percentage that is provided by the insurer/company. The deductibles might also be unreasonable exceeding $5100.00 annually. If those 'values' are a burden then even if an individual is covered by employer provided insurance, that individual can move into an exchange to improve their costs for health care insurance.
So long as citizens take advantage of this provision, it should eliminate corrupt health care plans that don't deliver value to their enrollees.
While the subject presented itself, I would like to look at what makes a 'good' vs 'bad' health care insurance company.
When one is shopping for any kind of insurance, and I do mean any kind, one has to take into consideration the 'viability' of the company that is issuing the policy. One aspect of the Exchanges is the companies supplying benefits have to have enough 'assets' to cover the expenses of those that they insure. There won't be any fly by night companies in the Exchanges.
In other words, if a health insurance company has to be liquidated to pay its costs including that of the insured claims, there is a good change the consumer will be stuck with their health costs that should have been paid by the company in liquidation.
So, while costs are important, if the cost to insurance is low, it doesn't matter a 'hill of beans' if they can't stay solvent long enough for enrolles to be covered if the occurrence happens when the enrollee needs to file claims.
The most secure health care insurance in the USA is Medicare and Medicaid. Just think about what would have happened to the nation's health care infrastructure after October of 2008 and then realize why regulation of those companies is paramount to the well being of the citizens of this country.
If nothing else was saved after the global economic collapse of 2008, the health care infrastructure of the country was. It is why Homeland Security has to have in place a 'Single Payer System' should such happen again.
...that advance determination of eligibility with respect to any individual shall be made--
(B) on the basis of the individual’s household income for the most recent taxable year for which the Secretary, after consultation with the Secretary of the Treasury, determines information is available.
cases where information included with an application form demonstrates substantial changes in income, changes in family size or other household circumstances, change in filing status, the filing of an application for unemployment benefits, or other significant changes affecting eligibility, including--
(A) allowing an individual claiming a decrease of 20 percent or more in income, or filing an application for unemployment benefits, to have eligibility for the credit determined on the basis of household income for a later period or on the basis of the individual’s estimate of such income for the taxable year; and
(B) the determination of household income in cases where the taxpayer was not required to file a return of tax imposed by this chapter for the second preceding taxable year.
including information with respect to individuals who were not required to file an income tax return for the taxable year described in subparagraph (A) (this is the paragraph A immediately above) or individuals who experienced changes in marital status or family size or significant reductions in income.
This section of the law continues, but, here it will continue in the next entry.
Thank you.
