Belle of Liberty

Letting Freedom Ring

Monday, July 30, 2012

The Obamacare Saga

A friend asked if I would use my blog to highlight some of the horrors of Obamacare so people know what they’ve gotten themselves into it and consider it when they vote 99 days from now.

Seniors have been passing around an e-mail allegedly written to Sen. Evan Bayh of Indiana by a Dr. Stephen E. Fraser, an Indianapolis anesthesiologist, or as a letter sent to River Cities Tribune, by former Judge David Kithil of Marbles Falls, Texas. calls him “Judge Dread” and attributes the talking points to one Peter Fleckenstein, a blogger and former Marine from Phoenix, Ariz.

As we Freedom Warriors often do, we borrow from each other’s writings and apparently Dr. Fraser and Judge Kithil passed the word on. claims that Fleckenstein’s information is based on H.R. 3200, some 2,400 pages long, was never passed, and that what Congress passed was the Patient Protection and Affordable Care Act – H.R. 3590.

Snopes claims that “some” of the entries in the list are outdated and that they reflect aspects of the legislation that were never passed.  But let’s hang on a minute.  I spent most of Friday researching this matter.  I had to download both bills, and compare them and I found that most of what Fleckenstein writes are true – they’re just located in different parts of the bill.

Let’s just take two items, because I don’t have time to post the entire text of both bills.

First, let’s take Fleckenstein’s item on the government’s access to individual finances.  He was right in both cases.  Here is the wording from the original, 2400-page bill, H.R. 3200:

Section 1173A Standardize Electronic Administrative Transaction

(a)    Standards for Financial and Administrative Transactions. –

(1)     In General. – The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).

(2)    Goals for Financial and Administration Transactions. – The goals for standards under paragraph (1) are that such standards shall –

(A)   Be unique with no conflicting or redundant stanrds;

(B)   Be authoritative, permitting no additions or constraints for electronic transactions, including companion guides

(C)   Be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;

(D)    enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service, and to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

(E)    Enable, where feasible, near real-time adjudication of claims;

(F)    Provide for timely acknowledgement, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;

(G)  Describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and

(H)   Harmonize all common data elements across administrative and clinical transaction standards.

Here is the same issue, now in Section 1004 of H.R. 3590:

Section 1104.  Administrative Simplification

(a)     Purpose of Administrative Simplification. – Section 261 of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d note) is amended –

(1)    By inserting “uniform” before standards”; and

(2)    By inserting “and to reduce the clerical burden on patients, health care providers, and health care plans” before the period at the end.

(b)   Operating Rules for Health Information Transactions. –

(1)    Definition of Operating Rules. – Section 1171 of the Social Security Act (42 U.S.C. 1320d) is amended by adding at the end of the following:

(9) Operating Rules. – The term “operating rules” means the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications as adopted for purposes of this part.”

(2)  Transaction Standard; Operating Rules and Compliance.  Section 1173 of the Social Security Act (42 U.S.C. 1320d-2) is amended

                (A) in subsection (a)(2), by adding at the end of the following new subparagraph:

                                (J) Electronic funds transfers.”;

                                (B) in subsection (a), by adding at the end of the following new paragraph:

(4) Requirements for Financial and Administration Transactions.-

                (A) In General. – The standards and associated operating rules adopted by the Secretary shall –

                (i)  to the extent feasible and appropriate, enable determination of an individual’s eligibility and financial responsibility for specific services prior to or at the point of care;

                (ii) be comprehensive, requiring minimal augmentation by paper or other communications;

                (iii) provide for timely acknowledgment, response, and status reporting that supports a transparent claims and denial management process (including adjudication and appeals); and

                (iv) describe all data elements (including reason and remark codes) in unambiguous terms, require that such data elements be required or conditional conditions (except where necessary to implement State or Federal law, or to protect against fraud and abuse).

                (B)  Reduction of clerical burden. – In adopting standards and operating rules for the transactions referred to under paragraph (1), the Secretary shall seek to reduce the number and complexity of forms (including paper and electronic forms) and data entry required by patients and providers.;

The legislation goes on (and on and on and on), justifying the reasons for going paperless.  Perhaps it’s because Congress is aware of the monumental bureaucracy it’s creating.  Or perhaps they’re displaying their environmental consciousness.  However, going paperless is monumentally dangerous and flouts the old legal rule:  “get it in writing.”

Then, there’s Fleckenstein’s charge that Obamacare will open up the health care system to illegal aliens.  They’re already receiving health care at the expense of the taxpayer.   H.R. 3590 does state:

Section 246.  No Federal Payment for Undocumented Aliens.

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

There is a caveat, however.  The bill makes an exception for the “Non-Traditional Medicaid Eligible Individual.”  Tracking down the Health Care’s definition of this non-traditional Medicaid eligible individual was an exercise in red-herring frustration.  The search led back to this section:

Section. 205 (e)(4)(C)

(C) Non-Traditional Medicaid Eligible Individual – The term “non-traditional Medicaid eligible individual” means a Medicaid eligible individual who is not a traditional Medicaid eligible individual.

For those of you too young to understand what Medicaid is, here’s Wikipedia’s definition (as always when reading a Wikipedia entry, do so with a skeptical eye):

Medicaid is the United States health program program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states.  People served by Medicaid are U.S. citizens or legal permanent residents, including low-income adults, their children, and people with certain disabilities.  Poverty alone does not necessarily qualify someone for Medicaid.   Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States.

The legislation states that there will be no “Federal payment for undocumented aliens.”  Coupled with its very unhelpful definition of a “non-traditional Medicaid eligible individual” the language raises suspicions about just who this mysterious, non-traditional individual is.  Will states be obliged to foot the bill for the care of illegal aliens, leaving the Federal government free from charges of unconstitutionality?

The documents can be found online. 

There’s more to come in the next 99 days on Obamacare and on Obama’s decidedly Socialist bent and his Socialist connections, particularly with Acorn.

Fasten your seatbelts; it’s going to be a bumpy election.


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