Saturday, February 18, 2012

That Health Care Thing

I do believe that the current confrontation between religious groups and the Administration is just the beginning of a long "debate."
The Patient Protection and Affordable Care Act (PPACA) contains over
3,000 references to "the Secretary." Most refer to the Secretary of Health and Human Services, although there are references to the Secretary of Labor, and the Secretary of the Treasury. Over 650 times it uses the phrase, "by the Secretary."
What does that mean? Well, here are some items I found on government web sites.

First, here is an excerpt from an Executive order that concerns the implantation of PPACA.

Executive Order 13535

“Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rulemaking to issue regulations, which will have the force of law, …."

The Act doesn't tell us what affordable health care is, it authorizes the Administration to tell us what it is, and make the law.

The Act itself is hundreds of pages long. What could take so many pages to say if it is the "Secretary" who will determine the law?

Here is the section on insurance for abortion from the act as amended. Remember this was a major issue before the bill passed. This is how it was resolved as compiled by the Office of Legislative Counsel.

Compilation of patient protection and affordable care act

[as amended through May 1, 2010]

Including

Patient Protection And Affordable Care Act

Health-Related Portions Of The Health Care And

Education Reconciliation Act Of 2010

Prepared by the Office Of The Legislative Counsel

For the use of the U.S. House Of Representatives

SEC. 1303 [42 U.S.C. 18023].. SPECIAL RULES.

[Replaced by section 10104(c)]

(a) STATE OPT-OUT OF ABORTION COVERAGE.—

(1) IN GENERAL.—A State may elect to prohibit abortion

coverage in qualified health plans offered through an Exchange

in such State if such State enacts a law to provide for such prohibition.

(2) TERMINATION OF OPT OUT.—A State may repeal a law

described in paragraph (1) and provide for the offering of such

services through the Exchange.

(b) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERVICES.—

(1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES.—

(A) IN GENERAL.—Notwithstanding any other provision

of this title (or any amendment made by this title)—

(i) nothing in this title (or any amendment made

by this title), shall be construed to require a qualified

health plan to provide coverage of services described

in subparagraph (B)(i) or (B)(ii) as part of its essential

health benefits for any plan year; and

(ii) subject to subsection (a), the issuer of a qualified

health plan shall determine whether or not the

plan provides coverage of services described in subparagraph

(B)(i) or (B)(ii) as part of such benefits for

the plan year.

(B) ABORTION SERVICES.—

(i) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROHIBITED.—

The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and

Human Services is not permitted, based on the law as

in effect as of the date that is 6 months before the beginning

of the plan year involved.

(ii) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—

The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and

Human Services is permitted, based on the law as in

effect as of the date that is 6 months before the beginning

of the plan year involved.

(2) PROHIBITION ON THE USE OF FEDERAL FUNDS.—

(A) IN GENERAL.—If a qualified health plan provides

coverage of services described in paragraph (1)(B)(i), the

issuer of the plan shall not use any amount attributable

to any of the following for purposes of paying for such

services:

(i) The credit under section 36B of the Internal

Revenue Code of 1986 (and the amount (if any) of the

advance payment of the credit under section 1412 of

the Patient Protection and Affordable Care Act).

(ii) Any cost-sharing reduction under section 1402

of the Patient Protection and Affordable Care Act (and

the amount (if any) of the advance payment of the reduction

under section 1412 of the Patient Protection

and Affordable Care Act).

(B) ESTABLISHMENT OF ALLOCATION ACCOUNTS.—In the

case of a plan to which subparagraph (A) applies, the

issuer of the plan shall—

(i) collect from each enrollee in the plan (without

regard to the enrollee’s age, sex, or family status) a

separate payment for each of the following:

(I) an amount equal to the portion of the premium

to be paid directly by the enrollee for coverage

under the plan of services other than services

described in paragraph (1)(B)(i) (after reduction

for credits and cost-sharing reductions described

in subparagraph (A)); and

(II) an amount equal to the actuarial value of

the coverage of services described in paragraph

(1)(B)(i), and

(ii) shall deposit all such separate payments into

separate allocation accounts as provided in subparagraph

(C).

In the case of an enrollee whose premium for coverage

under the plan is paid through employee payroll deposit,

the separate payments required under this subparagraph

shall each be paid by a separate deposit.

(C) SEGREGATION OF FUNDS.—

(i) IN GENERAL.—The issuer of a plan to which

subparagraph (A) applies shall establish allocation accounts

described in clause (ii) for enrollees receiving

amounts described in subparagraph (A).

(ii) ALLOCATION ACCOUNTS.—The issuer of a plan

to which subparagraph (A) applies shall deposit—

(I) all payments described in subparagraph

(B)(i)(I) into a separate account that consists solely

of such payments and that is used exclusively

to pay for services other than services described in

paragraph (1)(B)(i); and

(II) all payments described in subparagraph

(B)(i)(II) into a separate account that consists solely

of such payments and that is used exclusively

to pay for services described in paragraph

(1)(B)(i).

(D) ACTUARIAL VALUE.—

(i) IN GENERAL.—The issuer of a qualified health

plan shall estimate the basic per enrollee, per month

cost, determined on an average actuarial basis, for including

coverage under the qualified health plan of the

services described in paragraph (1)(B)(i).

(ii) CONSIDERATIONS.—In making such estimate,

the issuer—

(I) may take into account the impact on overall

costs of the inclusion of such coverage, but may

not take into account any cost reduction estimated

to result from such services, including prenatal

care, delivery, or postnatal care;

(II) shall estimate such costs as if such coverage

were included for the entire population covered;

and

(III) may not estimate such a cost at less than

$1 per enrollee, per month.

(E) ENSURING COMPLIANCE WITH SEGREGATION REQUIREMENTS.—

(i) IN GENERAL.—Subject to clause (ii), State

health insurance commissioners shall ensure that

health plans comply with the segregation requirements

in this subsection through the segregation of

plan funds in accordance with applicable provisions of

generally accepted accounting requirements, circulars

on funds management of the Office of Management

and Budget, and guidance on accounting of the Government

Accountability Office.

(ii) CLARIFICATION.—Nothing in clause (i) shall

prohibit the right of an individual or health plan to

appeal such action in courts of competent jurisdiction.

(3) RULES RELATING TO NOTICE.—

(A) NOTICE.—A qualified health plan that provides for

coverage of the services described in paragraph (1)(B)(i)

shall provide a notice to enrollees, only as part of the summary

of benefits and coverage explanation, at the time of

enrollment, of such coverage.

(B) RULES RELATING TO PAYMENTS.—The notice described

in subparagraph (A), any advertising used by the

issuer with respect to the plan, any information provided

by the Exchange, and any other information specified by

the Secretary shall provide information only with respect

to the total amount of the combined payments for services

described in paragraph (1)(B)(i) and other services covered

by the plan.

(4) NO DISCRIMINATION ON BASIS OF PROVISION OF ABORTION.—

No qualified health plan offered through an Exchange

may discriminate against any individual health care provider

or health care facility because of its unwillingness to provide,

pay for, provide coverage of, or refer for abortions

(c) APPLICATION OF STATE AND FEDERAL LAWS REGARDING

ABORTION.—

(1) NO PREEMPTION OF STATE LAWS REGARDING ABORTION.—

Nothing in this Act shall be construed to preempt or

otherwise have any effect on State laws regarding the prohibition

of (or requirement of) coverage, funding, or procedural requirements

on abortions, including parental notification or consent

for the performance of an abortion on a minor.

(2) NO EFFECT ON FEDERAL LAWS REGARDING ABORTION.—

(A) IN GENERAL.—Nothing in this Act shall be construed

to have any effect on Federal laws regarding—

(i) conscience protection;

(ii) willingness or refusal to provide abortion; and

(iii) discrimination on the basis of the willingness

or refusal to provide, pay for, cover, or refer for abortion

or to provide or participate in training to provide

abortion.

(3) NO EFFECT ON FEDERAL CIVIL RIGHTS LAW.—Nothing in

this subsection shall alter the rights and obligations of employees

and employers under title VII of the Civil Rights Act of

1964.

(d) APPLICATION OF EMERGENCY SERVICES LAWS.—Nothing in

this Act shall be construed to relieve any health care provider from

providing emergency services as required by State or Federal law,

including section 1867 of the Social Security Act (popularly known

as ‘‘EMTALA’’)

Well, I guess that clears it all up. Just in case you missed it, here is that section 1 B (i) again. It is listed 8 times in this section alone.

(B) ABORTION SERVICES.—

(i) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROHIBITED.—

The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and

Human Services is not permitted, based on the law as

in effect as of the date that is 6 months before the beginning

of the plan year involved.

No comments:

Post a Comment