ΑΡΧΑΙΑ ΙΘΩΜΗ

Κωφεύουν τα ΜΜΕ δυστυχώς !!!

ΚΩΦΕΥΟΥΝ ΤΑ Μ.Μ.Ε. ΠΕΡΑΣΕ Ο ΝΌΜΟΣ.

ΑΠΌ 1-1-2013 ΚΑΘΕ ΑΜΕΡΙΚΑΝΟΣ ΘΑ ΠΡΕΠΕΙ ΝΑ .. ΠΑΡΕΙ ΤΟ ΤΣΙΠ ΣΤΟ ΧΕΡΙ ΓΙΑ ΝΑ ΕΧΕΙ ΥΓΕΙΟΝΟΜΙΚΗ ΠΕΡΙΘΑΛΨΗ…

Πέρασε από το ανώτατο δικαστήριο των ΗΠΑ και ισχύει από 1-1-2013 ο νόμοςOBAMA CARE, ο νέος υγειονομικός νόμος του Ομπάμα, που απαιτεί από όποιον θέλει να έχει ιατροφαρμακευτική περίθαλψη θα πρέπει από 1-1-2013 μέχρι 31-12-2014 να έχει ενταχθεί στο νέο σύστημα, που είναι αυτό που απαιτεί εμφύτευση μικροτσίπ.

O νόμος του Ομπάμα, δεν απαιτεί απλά να βάλει κάποιος το μικροτσίπ,όποιος δεν το βάλει θα είναι παράνομος και θα του επιβάλλεται σε πρώτη φάση πρόστιμο και βέβαια θα πεθαίνει στο δρόμο σαν το σκυλί.

. Χωρίς βέβαια τον αριθμό κοινωνικής ασφάλισης δε μπορείς να εργάζεσαι, ουσιαστικά στην Αμερική δεν υπάρχεις.

Επίσης, επιβάλει και την ευθανασία σε ασθενείς που έχουν δύσκολο “χειρισμό” ή που είναι μεγάλοι σε ηλικία και “καταλαμβάνουν ένα κρεββάτι αδίκως”. Εκείνο που επίσης προβλέπει είναι η υιοθέτηση της “υγιεινής διατροφής”. Τι είναι αυτό; Οι κρεατόμαζες και τα εγγεκριμένα άλευρα του CODEX ALIMENTARIUS.

Από ό,τι βλέπετε, επειδή ο Αριθμός Κοινωνικής Ασφάλισης στην Αμερική (Social Security Number), είναι ουσιαστικά και ο αριθμός ταυτότητος του καθενός. Μέσω της υγείας θα έρθει και το τσιπ που θα γίνει και πορτοφόλι και θα λύσει δήθεν και το θέμα της φοροδιαφυγής. Έτσι θα το περάσουν στην Ευρώπη και βέβαια θα το περάσουν για πλάκα στους ανίδεους του λεγόμενου Τρίτου Κόσμου.

Χωρίς το τσιπ θα είσαι παράνομος και δε θα μπορείς να αγοράσεις ή να πουλήσεις τίποτε.

Τα μάτια ανοικτά Ύστερα σου λένε η ΧΑ είναι ρατσιστές!! Μα μόνο αυτή?? εδώ ο Ομπάμα πέρασε ότι πιο χειρότερο μπορούσε να φανταστεί ανθρώπινος νους, Με ένα τσιπ ανταλλάσεις τα πάντα την υγειά σου, την αξιοπρέπειά σου, την ελευθερία σου, το δικαίωμα στη ζωή, στον έρωτα, στην οικογένεια.

Ο δημοκρατικός Ομπάμα !!!! Μπράβο και πάλι μπράβο!!!

Ας τα βλέπει ο φίλος μου ο Παναγιώτης πόσο αισιόδοξα είναι τα μηνύματα από τη μεγάλη προστάτιδα της..δημοκρατίας. Τι άλλο έμεινε να μας βάλουν και ένα τσ ιπ για το πως θα σκεφτόμαστε!!!

Υποχρεωτικό τσιπ στο χέρι για τους Αμερικάνους

=====================================================================

Τελικά πέρασε από το ανώτατο δικαστήριο των ΗΠΑ και ισχύει από 1-1-2013 ο νόμος OBAMA CARE, ο νέος υγειονομικός νόμος του Ομπάμα, που απαιτεί από όποιον θέλει να έχει ιατροφαρμακευτική περίθαλψη θα πρέπει από 1-1-2013 μέχρι 31-12-2014 να έχει ενταχθεί στο νέο σύστημα, που είναι αυτό που απαιτεί εμφύτευση μικροτσίπ.

O νόμος του Ομπάμα, δεν απαιτεί απλά να βάλει κάποιος το μικροτσίπ, όποιος δεν το βάλει θα είναι παράνομος και θα του επιβάλεται σε πρώτη φάση πρόστιμο και βέβαια θα πεθαίνει στο δρόμο σαν το σκυλί. Χωρίς βέβαια τον αριθμό κοινωνικής ασφάλισης δε μπορείς να εργάζεσαι, ουσιαστικά στην Αμερική δεν υπάρχεις. O Αριθμός Κοινωνικής Ασφάλισης στην Αμερική (Social Security Number), είναι ουσιαστικά και ο αριθμός ταυτότητος του καθενός.

Επίσης, επιβάλει και την ευθανασία σε ασθενείς που έχουν δύσκολο «χειρισμό» ή που είναι μεγάλοι σε ηλικία και «καταλαμβάνουν ένα κρεββάτι αδίκως». Εκείνο που επίσης προβλέπει είναι η υιoθέτηση της «υγιεινής διατροφής». Τι είναι αυτό; Οι κρεατόμαζες και τα εγγεκριμένα άλευρα του CODEX ALIMENTARIUS. Μέσω της υγείας θα έρθει και το τσιπ που θα γίνει και πορτοφόλι και θα λύσει δήθεν και το θέμα της φοροδιαφυής. Έτσι θα το περάσουν στην Ευρώπη και βέβαια θα το περάσουν για πλάκα στους ανίδεους του λεγόμενου Τρίτου Κόσμου. Χωρίς το τσιπ θα είσαι παράνομος και δε θα μπορείς να αγοράσεις ή να πουλήσεις τίποτε.

http://en.wikipedia.org/wiki/Microchip_implant_(human)

http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm072141.htm

http://www.infowars.com/they-really-do-want-to-implant-microchips-into-your-brain/

http://www.saveamericafoundation.com/2012/07/30/will-americans-receive-a-microchip-implant-in-2013-per-obamacare-by-paul-mcguire/

http://www.newswithviews.com/McGuire/paul136.htm

http://www.dailymail.co.uk/news/article-2153587/Science-fiction-writer-resurrects-controversial-idea-slapping-BARCODES-infants-birth-make-surveillance-easier.html?ito=feeds-newsxml

http://www.scientificamerican.com/article.cfm?id=microchip-implant-medication

http://www.cbsnews.com/8301-505123_162-42843125/microchip-implant-to-link-your-health-records-credit-history-social-security/

http://money.cnn.com/2012/08/03/technology/startups/ingestible-sensor-proteus/

http://articles.nydailynews.com/2012-06-01/news/31965723_1_verichip-dna-testing-microchip

Dogs suffer cancer after ID chipping

Obama Care
Americans Will Get RFID Microchip
July 26, 2012
Americans Will Get RFID Microchip. Surely but slowly
government wants you to get a RFID chip for your safety and health. The goal is to get everyone chipped. As soon as people ge
chip for healthcare the next step is to use the chip to make you pay in real time for your healthcare procedures, which means your chip
will be tied into your bank account. The goal is to get everyone chipped and make people use a chip that is implanted in your
transactions, travel and, so on. It is about control.
Currently Louisiana is a test bed where people can
<iframe width=”420″ height=”315″ src=”http://www.youtube.com/embed/iMzl
<iframe width=”480″ height=”360″ src=”http://www.youtube.com/embed/zHdrTiPcQ3g?rel=0″ frameborder=”0″
<iframe width=”480″ height=”360″ src=”http://www.youtube.com/embed/hgcZUIc3oks?rel=0″ frameborder=”0″
Debunked: Obama care RFID Chip Implant Law Hoax
July 13, 2012
There’s a hoax going around that the health care reform act HR3200 (HR 3962 The Affordable Care Act, aka “Obama care”) requires
everyone to get a chip implanted in their body. Answer: that’s not a hoax that’s misinformation. Because the Obama healthcare
3962.
HR3200 or any other bill has nothing to do with obama care only HR 3962 is obama care
This has already been quite well debunked over on Snopes:
http://www.snopes.com/politics/medical/microchip.asp
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
& www.witnessesforjesuschrist.co.za
-1-
6 August 2012
Approves RFID Chips
they are implementing RFID chips for Americans. Don’t be so naive to think
e o cannot buy second hand products with cash. They want a cashless society.
iMzl-4jDI3Q?rel=0″ frameborder=”0″
allowfullscreen></iframe>
allowfullscreen></iframe>
allowfullscreen></iframe>
crochip.The Witness
get an RFID
body for all
not bill is
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
info@witnessesforjesuschrist.co.za & www.witnessesforjesuschrist.co.za
-2-
The bottom line is:
The proposed law did not require anyone to get anything implanted Answer: In bill HR 3962 you do get a rfid chip that’s the affordable
health care act or Obama care.
It just created a national registry of a huge of range of medical devices from pacemakers to dental implants Wrong again their is two
classifications for medical implants. RFID chips fall under class 3
The intent of the registry was to collect statistics on how safe and effective the devices are Wrong RFID chips were granted permission in
2004 by the FDA.
HR3200 is not the bill that passed. That’s HR 3590, which does not have the registry. Both those bills are wrong the actual obama care
bill is HR 3962
Obama care hr bill 3962 video proving RFID chips will be used in the future healthcare and for other reasons such as paying debts.
Microchip implant (human)
The hand of microchip implant hobbyist Amal Graafstra, just after an operation to insert an RFID tag. The yellow coloration comes from
iodine used to disinfect the hand for surgery.
A human microchip implant is an integrated circuit device or RFID transponder encased
in silicate glass and implanted in the body of a human being. A subdermal implant typically
contains a unique ID number that can be linked to information contained in an external
database, such as personal identification, medical history, medications, allergies, and
contact information.
Hobbyists
The first reported experiment with an RFID implant was carried out in 1998 by the British
scientist Kevin Warwick.[1] As a test, his implant was used to open doors, switch on lights,
and cause verbal output within a building. The implant has since been held in the Science
Museum (London).[citation needed]
Since that time, several additional hobbyists have placed RFID microchip implants into their hands or had them placed there by others.
Amal Graafstra, author of the book “RFID Toys,” asked doctors to place implants in his hands. A cosmetic surgeon used a scalpel to
place a microchip in his left hand, and his family doctor injected a chip into his right hand using a veterinary Avid injector kit. Graafstra
uses the implants to open his home and car doors and to log on to his computer.
Mikey Sklar had a chip implanted into his left hand and filmed the procedure. He has done a number of media[2] and personal interviews[3]
about his experience of being microchipped.
Commercial implants
In 2002, the VeriChip Corporation (known as the “PositiveID Corporation” since November 2009) received preliminary approval from
the United States Food and Drug Administration (FDA) to market its device in the U.S. within specific guidelines. The device received
FDA approval in 2004, and was marketed under the name VeriChip or VeriMed. In 2007, it was revealed that nearly identical implants
had caused cancer in hundreds of laboratory animals.[4] a revelation that had a devastating impact on the company’s stock price. Some
time between May and July 2010, the Positive ID Corporation discontinued marketing the implantable human microchip.[5]
In January 2012, the VeriTeQ Acquisition Corporation acquired the VeriChip implantable microchip and related technologies, and Health
Link personal health record from PositiveID Corporation. VeriTeQ is majority owned and led by Scott R. Silverman, former Chairman
and CEO of PositiveID and VeriChip Corporation. PositiveID has retained an ownership interest in VeriTeQ.[6]
Medical records use
The PositiveID Corporation (previously known as The VeriChip Corporation; Applied Digital Solutions, Inc.; and The Digital Angel
Corporation) distributed the implantable chip known as the VeriChip or VeriMed until the product was discontinued in the second quarter
of 2010. The company had suggested that the implant could be used to retrieve medical information in the event of an emergency, as
follows: Each VeriChip implant contained a 16-digit ID number. This number was transmitted when a hand-held VeriChip scanner is
passed within a few inches of the implant. Participating hospitals and emergency workers would enter this number into a secure page on
the VeriChip Corporation’s website to access medical information that the patient had previously stored on file with the company.
According to some reports, in 2006 80 hospitals had agreed to own a VeriChip scanner provided by the company and 232 doctors had
agreed to inject the devices into patients who requested them.[7] However, the VeriChip Corporation/Applied Digital Solutions was sued
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
info@witnessesforjesuschrist.co.za & www.witnessesforjesuschrist.co.za
-3-
by its shareholders for making “materially false and misleading statements” regarding hospital acceptance figures. According to Glancy &
Binkow, the law firm that filed the class action suit:
“…on May 9, 2002, defendants [the then Applied Digital Corporation] claimed that nearly every major hospital in the West Palm Beach,
Florida area would be equipped with VeriChip scanners, an indispensable component of the Company’s VeriChip technology. However,
one day later on May 10, 2002, the truth was disclosed that no hospital had accepted a scanner, an essential device for retrieving the
VeriChip’s information. Following the May 10, 2002, disclosure, the price of Applied Digital stock again fell sharply, dropping nearly
30% in a single day.”[8]
Building access and security
The VeriChip Corporation has marketed the implant as a way to restrict access to secure facilities such as power plants. Microchip
scanners would be installed at entrances so locks only work for persons whose chip numbers are entered into the system. Two employees
of CityWatcher, an Ohio video surveillance company, had RFID tags injected into their arms in 2007. The workers needed the implants to
access the company’s secure video tape room, as documented in USA Today.[9] The company closed, but there is no word on what
happened to the employees or their implants.
A major drawback for such systems is the relative ease with which the 16-digit ID number contained in a chip implant can be obtained
and cloned using a hand-held device, a problem that has been demonstrated publicly by security researcher Jonathan Westhues[10] and
documented in the May 2006 issue of Wired magazine,[11] among other places.
The Baja Beach Club, a nightclub in Rotterdam, the Netherlands, once used VeriChip implants for identifying VIP guests.[12]
[edit] Possible future applications
Theoretically, a GPS-enabled chip could one day make it possible for individuals to be physically located by latitude, longitude, altitude,
speed, and direction of movement. Such implantable GPS devices are not technically feasible at this time. However, if widely deployed at
some future point, implantable GPS devices could conceivably allow authorities to locate missing persons and/or fugitives and those who
fled from a crime scene. Critics contend, however, that the technology could lead to political repression as governments could use
implants to track and persecute human rights activists, labor activists, civil dissidents, and political opponents; criminals and domestic
abusers could use them to stalk and harass their victims; slaveholders could use them to prevent captives from escaping; and child abusers
could use them to locate and abduct children.[citation needed]
Another suggested application for a tracking implant, discussed in 2008 by the legislature of Indonesia’s Irian Jaya would be to monitor
the activities of persons infected with HIV, aimed at reducing their chances of infecting other people.[13][14] The microchipping section
was not, however, included into the final version of the provincial HIV/AIDS Handling bylaw passed by the legislature in December
2008.[15] With current technology this would not be workable anyway, since there is no implantable device on the market with GPS
tracking capability.
Potential problems
Cancer
Veterinary and toxicology studies carried out from 1996 to 2006 found that lab mice and rats injected with microchips sometimes
developed cancerous tumors around the microchips (subcutaneous sarcomas). Data suggest that between 1% and 10% of the implanted
lab animals developed malignant cancers originating in the tissue surrounding the microchips. Dr. Cheryl London, a veterinarian
oncologist at Ohio State University, noted: “It’s much easier to cause cancer in mice than it is in people. So it may be that what you’re
seeing in mice represents an exaggerated phenomenon of what may occur in people.” London suggested a 20-year study of chipped
canines was needed “to see if you have a biological effect.” Specialists from several pre-eminent cancer institutions have supported such
testing before microchips are implanted on a large scale in humans.[16]
Other medical complications
According to the FDA, implantation of the VeriChip poses potential medical downsides.[17] Electrical hazards, MRI incompatibility,
adverse tissue reaction, and migration of the implanted transponder are just a few of the potential risks associated with the Verichip ID
implant device, according to an October 12, 2004 letter issued by the Food and Drug Administration (FDA).[18]
A patient could be burned if the chip reacts to outside source of EMF radiation, such as a strong electrical field or a magnetic resonance
imager (MRI) machine. The strong magnets used in an MRI scanner could destroy the implant and cause serious burns, internally and
externally.[citation needed] According to the FDA’s Primer on Medical Device Interactions with Magnetic Resonance Imaging Systems,
“electrical currents may be induced in conductive metal implants” that can cause “potentially severe patient burns.”
However, when the Mythbusters TV show, in Season 5 Episode 18, Myth Evolution, tested a microchip implant in an MRI machine,
neither test subject showed any signs of pain or trauma. Since MRI machines come in various strengths, it is possible that higher energyemitting
MRI machines may be more problematic. The model and make of the chip could affect possible outcomes as well.
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
info@witnessesforjesuschrist.co.za & www.witnessesforjesuschrist.co.za
-4-
Security risks
Since nearly all implantable microchips are unencrypted, they are extremely vulnerable to being read by third-party scanners. By
scanning secretly, someone could steal the information on a chip and clone the signal, enabling a hacker to impersonate a chipped
individual. This could create security problems for building or computer access or potentially enable criminal misuse of a medical
account held by an unrelated person. Also, the chip could easily be removed from the person, or the appendage containing the device
could be removed.[7]
Societal and religious criticism
Microchip implant in humans have raised new ethical discussions by scientific professional forums[clarification needed],[19] academic groups,[20]
human rights organizations, government departments and religious groups. The Council on Ethical and Judicial Affairs (CEJA) of the
American Medical Association published a report in 2007 alleging that RFID implanted chips may compromise privacy because there is
no assurance that the information contained in the chip can be properly protected, notwithstanding health risks (chips may travel under the
skin).[21]
RFID tagging has been criticised by believers of Abrahamic religions. In Christianity, some believe the implantation of chips may be the
fulfillment of The Mark of the Beast, prophesied to be a requirement for buying and selling,[22] and a key element of the Book of
Revelation.[23][24] In Judaism, Conservative, Orthodox, and Reform Jewish beliefs hold that that cutting, piercing or marking the flesh, a
requirement for implantation, is contrary to the notion that people were made “in the image of God”,[25] and the orders in Leviticus
19:28.[26] Islam also considers body modifications “haram”, an Arabic term meaning “forbidden”, because they involve changing the
body, a creation of God.[27] The health risks associated with implantable microchips described above may also invoke Islamic
prohibitions.[28]
Legislation
Following Wisconsin and North Dakota,[29] California issued Senate Bill 362 in 2007, which prohibits employers and others from forcing
anyone to have a RFID device implanted under their skin.[29]
On April 5, 2010, Georgia, Atlanta, Senate passed Senate Bill 235 that prohibits forced microchip implants in humans and that would
make it a misdemeanor for anyone to require them, including employers. The bill would allow voluntary microchip implants, as long as
they’re performed by a physician and regulated by the Georgia Composite Medical Board. If the General Assembly passes the new Senate
version, Georgia would join California, North Dakota and Wisconsin in banning mandatory microchip implant.[30]
On February 10, 2010 Virginia’s House of Delegates also passed a bill that forbids companies from forcing their employees to be
implanted with tracking devices.[31]
See also
• VeriChip
• Cyborg
• RFID
• Ambient intelligence
Senate bans forced microchip implants
By Ernie Suggs
GEORGIA AND NATIONAL ELECTIONS 2012 5:14 p.m. Thursday, February 4, 2010
The Atlanta Journal-Constitution
The Senate voted Thursday to protect Georgians from evildoers, covert corporations and rogue doctors, seen and unseen, with the passage
of a bill that would make it illegal to implant a microchip into someone without their permission.
The bill, ironically sponsored by Sen. Chip Pearson (R-Dawsonville) and Senate Majority Leader Chip Rogers, would make it a
misdemeanor to implant someone against their will with a microchip, sensor, transmitter or other tracking device. The Senate passed the
bill 47-2.
“We are sending the message that Georgia is committed to upholding its citizens’ constitutional rights and protection of their person,”
Pearson said. “Advances in technology are moving fast, and while most of these are for the good, we must be careful that it doesn’t come
at the harm of citizens.”
But is this really a problem in Georgia?
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
info@witnessesforjesuschrist.co.za & www.witnessesforjesuschrist.co.za
-5-
Pearson said that he knows of no case in Georgia where someone has been involuntarily microchipped. He added that during his
preliminary meetings on the bill, no one came to complain about it, and he has heard of no conspiracy plots or theories to put implants in
massive amounts of Georgians. The notion that legions of people have been forcibly implanted by the government, aliens or nefarious
corporations runs rampant throughout the Internet and in science fiction movies. Think Neo and his forced implantation by Agent Smith
in “The Matrix.”
“I have no firsthand knowledge of anything,” Pearson said. “I am simply trying to get ahead of this and protect the people. We don’t
know what is going to happen.”
Pearson added that any information put inside a chip and then implanted into someone’s body can just as easily be stored somewhere
above the skin.
“The benefits of a microchip that can be internally implanted are also available in many external forms,” Pearson said.
There have been a handful of corporations worldwide that have begun developing technology to inject people with implantable devices.
In 2004, the VeriChip was approved by the FDA. Proponents say that implantable chips could help in identifying victims of major
tragedies like Sept. 11 or the Haitian earthquake, or even wandering Alzheimer’s patients.
Pearson’s bill would clear the way for people who want implants. The bill does not prevent anyone from being able to voluntarily have a
microchip implanted — as long as the implantation is performed by a doctor and is regulated by the Georgia Composite Medical Board.
But opponents say that the devices can lead to unwanted surveillance and even cancer. There are some who say that it has religious
implications and that the implantable devices are the “Mark of the beast.”
If the bill, SB 235, gets past the state House, Georgia would join Wisconsin, North Dakota and California as states that have passed laws
prohibiting the forced implantation of microchips in people.
Pearson said the bill has actually been floating around the Capitol for several years. In 2007, Rep. Ed Setzler (R-Acworth) introduced a
bill in the House that didn’t go anywhere.
Pearson is hoping that his bill will be received favourably in the House.
But some critics of the bill wonder what the point is.
“This is a solution in search of a problem,” said Sen. Vincent Fort (D-Atlanta), one of only two senators to vote against it, along with Sen.
Ronald Ramsey (D-Decatur). “We are spending our precious time — with a billion-and-a-half-dollar deficit — with something that is not a
problem.”
Cost of ObamaCare: Obama Care Cost – June 30, 2012
CBO ObamaCare Costs for Premiums
Click Here Obama Care Looks Like It IS More Expensive Then They Say
Bronze plan is suppose to cost the lease. Bronze Premium plan for 2016 $4,500 to $5,000 dollars for a single person, but over all it says
$5,800 dollars when all averages are counted. Bronze family plan is $12,000 dollars to $12,500 dollars. Premium prices will depend on
age, average spending cost on healthcare in your area, and which plan they chose.
Bronze plan has a deductible of over $2,000 dollars which means you will have to pay that before the subsidy kicks in. The bronze plan is
the cheapest plan. After you pay the deductible you will pay 40% of your healthcare costs. The highest deductible under the bronze plan
is around $5,300 dollars, which it is not allowed to go over.
ACTUALLY Obama care cost is unknown. But expect to pay more than what they say. Where it starts getting expensive is when your
single and make a decent wage. The states have to make exchanges then we will know the cost. It sure isn’t $70.00 as some people are
saying, maybe if your just above the poverty level. Currently to have healthcare for 1 person the average is $2,800 dollars to $3,500
dollars a year.
According to the CBO the above premiums will cost much more. If Obama care costs only $70.00 a month, that’s only $840.00 a year for
a lower income person. Which means somebody else will have to pay through higher taxes to pay the difference. When Obama said he
The Witnesses of the Lord Jesus Christ
South Africa, Pretoria
info@witnessesforjesuschrist.co.za & www.witnessesforjesuschrist.co.za
-6-
was going to transform the nation, he meant it. Middle class Americans will be picking up the healthcare tab for poorer people and
illegals who still use the emergency room for free service.
Americans will be paying Another cost by 2020, the federal government will decrease the amount of
money it will give to the states to pay for the healthcare for low income people, who will have the
medicaid option only. Currently healthcare is free to poor people in the United states through welfare.
Obama care will still leave millions uninsured. Obama care is not free and you will still have to pay for
procedures.
The state healthcare exchanges will be run by the very same healthcare insurance companies for profit.
Only difference now is they are guaranteed money and patients because the government is forcing you
to sign up with them. These healthcare insurance companies are guaranteed a monthly premium
because the government made more people become customers which means these insurance companies
will increase their premiums because their is no law to stop them. As long as people are forced to pay
by threat of a penalty the insurance companies are guaranteed payment. Businesses will stop offering
insurance and drop the millions who do have insurance through their job. It will be cheaper for a
business to drop insurance to millions and pay the penalty. People will just go through their state
healthcare exchange instead, which is run by insurance companies for profit. The Obama care penalty
cost will be $695.00 or 2.5% of your yearly pay whichever one is greater.
Seattle Municipal Archives / Foter
Commonsense tells you there will not be enough money for Obama care when a premium costs $3000 dollars a year and your only paying
$840.00 a year into the premium if you were only paying $70.00 a month. Remember this the current CBO report says it will increase the
deficit. That’s from the most current CBO report.
In 1965 politicians said Medicare would cost only 9 billion dollars by 1990, the actual cost was 66 billion dollars. Be prepared to have
bad healthcare limited care and, rationed care.
More information on Obama Care
How much will Obama care cost each individual?
Obama Care Approves RFID Chips
Obama Care Penalty Is Higher Than $695.00
Obama Care Repeating The Fraud Of 1913
Who Wrote Obama Care
June 30, 2012
Obama care was written by a few departments in Government and healthcare insurance companies. It was backed by the banks,
Pharmaceutical company’s and Insurance companies, AARP.
Insurance Companies write Obama care bill Evil Liz Fowler
theqspeaks / Foter
HR Bill 3962 came about from previous bills revised which related to healthcare. House Education
and Labor, Energy and Commerce and, Ways and means committee. What these departments are
doing writing healthcare bills is strange. The people behind Obama care were Nancy Pelosi Democrat
California who has become very rich since her political career to the tune of a few hundred million
dollars. Robert Andrews Democrat New Jersey, George Miller Democrat California, Frank Pallone
Democrat New Jersey, Charles Rangel Democrat New York, Fortney Stark Democrat California,
Henry Waxman Democrat California. The big daddy was John Dingell Democrat Michigan and czar
of Obama care Liz Fowler has more than 20 years of experience in health services research and health
policy. She served as vice president of public policy and external affairs for WellPoint, Inc. a
healthcare company.
Obama care was written to take control of the economy and control people as John Dingell said. The
goal is to make it universal and in the near future and to make it easily integrate world wide for when
global government takes over as in new world order.
If this don’t make your blood boil, Democrat John Dingell Michigan say’s Obama care is to control
the people
ERROR: undefined
OFFENDING COMMAND: f‘
STACK:

Guidance for Industry and FDA Staff
Class II Special Controls Guidance
Document: Implantable
Radiofrequency Transponder
System for Patient Identification
and Health Information
Document issued on: December 10, 2004
For questions regarding the use or interpretation of this guidance contact: Gail Gantt at 240-276-3700
or by email gail.gantt@fda.hhs.gov
U.S. Department of Health and Human Services
Food and Drug Administration
Center for Devices and Radiological Health
General Hospital Devices Branch
Division of Anesthesiology, General Hospital,
Infection Control and Dental Devices
Office of Device Evaluation
Preface
Public Comment
Written comments and suggestions may be submitted at any time for Agency consideration to
the Division of Dockets Management, Food and Drug Administration, 5630 Fishers Lane, Room
1061, (HFA-305), Rockville, MD, 20852. Alternatively, electronic comments may be submitted
to http://www.fda.gov/dockets/ecomments. Please identify your comments with the docket
number listed in the notice of availability that publishes in the Federal Register announcing the
availability of this guidance document. Comments may not be acted upon by the Agency until
the document is next revised or updated.
Additional Copies
Additional copies are available from the Internet at:
http://www.fda.gov/cdrh/ode/guidance/1541.pdf, or CDRH Facts-On-Demand. In order to
receive this document via your fax machine, call the CDRH Facts-On-Demand system at 800-
899-0381 or 301-827-0111 from a touch-tone telephone. Press 1 to enter the system. At the
second voice prompt, press 1 to order a document. Enter the document number (1541) followed
by the pound sign (#). Follow the remaining voice prompts to complete your request.
Table of Contents
1. BACKGROUND………………………………………………………………………………………………………………………………..1
2. SCOPE………………………………………………………………………………………………………………………………………………2
3. RISKS TO HEALTH …………………………………………………………………………………………………………………………3
4. RECOMMENDED MITIGATION MEASURES ………………………………………………………………………………..4
A. BIOCOMPATIBILITY ……………………………………………………………………………………………………………………….4
B. INFORMATION SECURITY PROCEDURES (DESIGN AND VALIDATION)……………………………………………………..4
C. SOFTWARE VALIDATION ………………………………………………………………………………………………………………..5
D. MIGRATION TESTING OF IMPLANTED TRANSPONDER ………………………………………………………………………….5
E. PERFORMANCE TESTING OF IMPLANTED TRANSPONDER ……………………………………………………………………..5
F. PERFORMANCE TESTING OF INSERTER………………………………………………………………………………………………5
G. PERFORMANCE TESTING AND HAZARD ANALYSIS OF ELECTRONIC SCANNER ………………………………………..5
H. ELECTROMAGNETIC COMPATIBILITY………………………………………………………………………………………………..5
I. ELECTRICAL SAFETY PERFORMANCE TESTING…………………………………………………………………………………..5
J. STERILITY ……………………………………………………………………………………………………………………………………6
K. MAGNETIC RESONANCE IMAGING COMPATIBILITY …………………………………………………………………………….6
L. LABELING…………………………………………………………………………………………………………………………………….6
5. LIMITATIONS OF EXEMPTION FROM PREMARKET NOTIFICATION ……………………………………..7
Contains Nonbinding Recommendations
1
Guidance for Industry and FDA Staff
Class II Special Controls Guidance Document:
Implantable Radiofrequency Transponder
System for Patient Identification and Health
Information
This guidance represents the Food and Drug Administration’s (FDA’s) current thinking on
this topic. It does not create or confer any rights for or on any person and does not operate to
bind FDA or the public. You can use an alternative approach if the approach satisfies the
requirements of the applicable statutes and regulations. If you want to discuss an alternative
approach, contact the FDA staff responsible for implementing this guidance. If you cannot
identify the appropriate FDA staff, call the appropriate number listed on the title page of this
guidance.
1. Background
This guidance document was developed as a special control guidance to support the
classification of the implantable radiofrequency transponder system for patient identification and
health information into class II (special controls). The device is intended to enable access to
secure patient identification and corresponding health information in humans. This guidance is
issued in conjunction with a Federal Register notice announcing the classification of implantable
radiofrequency transponder system for patient identification and health information.
This guidance document describes a means by which implantable radiofrequency transponder
systems for patient identification and health information may comply with the requirement of
class II special controls. Designation of this guidance document as a special control means that
manufacturers of implantable radiofrequency transponder systems for patient identification and
health information who follow the recommendations listed in this document, before introducing
their device into commercial distribution in the United States, will also be able to market their
device without being subject to the premarket notification requirements of section 510(k) of the
Act.
Section 510(m) of the Act provides that FDA may exempt a class II device from the premarket
notification requirements under section 510(k) of the act if FDA determines that premarket
notification is not necessary to provide reasonable assurance of the safety and effectiveness of
Contains Nonbinding Recommendations
2
the device. FDA has determined premarket notification is not necessary to provide reasonable
assurance of the safety and effectiveness of this generic type of device if the manufacturer
follows the recommendations in this special controls guidance or equivalent measures to address
the risks identified in this guidance. Thus, persons who intend to market a device of this type do
not need to submit a premarket notification to FDA and receive agency clearance prior to
marketing the device, but as a class II device, the device must comply with the other applicable
general and special controls (Section 513(a)(1)(B)).
Following the effective date of a final rule exempting the device, manufacturers of implantable
radiofrequency transponder systems for patient identification and health information will need to
address the issues covered in this special control guidance. However, the manufacturer need
only show that its device meets the recommendations of the guidance or in some other way
provides equivalent assurances of safety and effectiveness.1 If manufacturers cannot comply
with these recommendations or equivalent measures, they will not be exempt from the
requirements of premarket notification and will need to submit a premarket notification and
receive clearance for their device prior to marketing.
FDA’s guidance documents, including this guidance, do not establish legally enforceable
responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should
be viewed only as recommendations, unless specific regulatory or statutory requirements are
cited. The use of the word should in Agency guidances means that something is suggested or
recommended, but not required.
The Least Burdensome Approach
The issues identified in this guidance document represent those that we believe need to be
addressed before your device can be marketed. In developing the guidance, we carefully
considered the relevant statutory criteria for Agency decision-making. We also considered the
burden that may be incurred in your attempt to follow the statutory and regulatory criteria in the
manner suggested by the guidance and in your attempt to address the issues we have identified.
We believe that we have considered the least burdensome approach to resolving the issues
presented in the guidance document. If, however, you believe that there is a less burdensome
way to address the issues, you should follow the procedures outlined in the “A Suggested
Approach to Resolving Least Burdensome Issues” document. It is available on our Center
web page at: http://www.fda.gov/cdrh/modact/leastburdensome.html.
2. Scope
The scope of this document is limited to the following device as described in 21 CFR 880.6300
Implantable Radiofrequency Transponder System for Patient Identification and Health
Information (product code: NRV):
1 We recommend that you document how you have addressed the recommendations in your
design history file. Manufacturers must maintain design controls, including a design history file,
in accordance with 21 CFR 820.30.
Contains Nonbinding Recommendations
3
An implantable radiofrequency transponder system for patient identification and health
information is a device intended to enable access to secure patient identification and
corresponding health information. This system may include a passive implanted
transponder, inserter, and scanner. The implanted transponder is used only to store a
unique electronic identification code which is read by the scanner. The identification
code is used to access patient identity and corresponding health information stored in a
database.
3. Risks to Health
In the table below, FDA has identified the risks to health generally associated with the use of the
Implantable Radiofrequency Transponder System for Patient Identification and Health
Information addressed in this document. FDA recommends the following measures to mitigate
the identified risks in this guidance, as shown in the table below.
Identified risk Recommended mitigation measures
(See the corresponding subheading in section 4)
Adverse Tissue Reaction
A. Biocompatibility
J. Sterility
L. Labeling
Migration of implanted transponder D. Migration Testing of Implanted Transponder
Compromised Information Security B. Information Security Procedures (Design and
Validation)
Failure of implanted transponder E. Performance Testing of Implanted Transponder
L. Labeling
Failure of Inserter F. Performance Testing of Inserter
Failure of electronic scanner
G. Performance Testing and Hazard Analysis of
Electronic Scanner
C. Software Validation
L. Labeling
Electromagnetic Interference H. Electromagnetic compatibility
L. Labeling
Electrical Hazards I. Electrical Safety performance testing
L. Labeling
Magnetic Resonance Imaging
Incompatibility
K. Magnetic Resonance Imaging Compatibility
L. Labeling
Needle stick L. Labeling
Contains Nonbinding Recommendations
4
4. Recommended Mitigation Measures
FDA believes that conformance with this guidance document, when combined with the general
controls of the Act, will provided reasonable assurance of the safety and effectiveness of the
implantable radiofrequency transponder system for patient identification and health information.
We recommend that you (the manufacturer) evaluate your device as described below and, where
appropriate, document the results in your design history file as a part of the Quality Systems
Requirements (21 CFR 820.30).
A. Biocompatibility
We recommend that you ensure the biocompatibility of the patient-contacting parts of your
device by following the tests in the:
• International Standard Organization (ISO) standard ISO-10993, Biological
Evaluation of Medical Devices Part 1: Evaluation and Testing.
B. Information Security Procedures (Design and Validation)
When discussing the issue of medical devices that store, access, and/or transfer information
externally, you should address the concept of information security. Information security is
the process of preventing the modification, misuse or denial of use, or the unauthorized use
of that information. We recommend that your specifications for a compatible database
address the following four components of information security: Confidentiality, Integrity,
Availability, and Accountability (CIAA).
• Confidentiality means the characteristic of data and information being
disclosed only to authorized persons, entities and processes at authorized
times and in the authorized manner. (The assurance that no unauthorized
users have access to the information.)
• Integrity means the characteristic of data and information being accurate and
complete and the preservation of accuracy and completeness. (The
assurance that the information is correct (accurate and complete) – that is, it
has not been improperly modified.)
• Availability means the characteristic of data, information and information
systems being accessible and usable on a timely basis in the required manner.
(The assurance that the information will be available when needed.)
• Accountability is the application of identification and authentication to assure
that the prescribed access process is being done by an authorized user.
Contains Nonbinding Recommendations
5
C. Software Validation
We recommend that you validate the software in your device by referring to the following
guidance:
• Guidance for FDA Reviewers and Industry Guidance for the Content of
Premarket Submissions for Software Contained in Medical Devices
http://www.fda.gov/cdrh/ode/57.html
• General Principles of Software Validation; Final Guidance for Industry and
FDA Staff
http://www.fda.gov/cdrh/comp/guidance/938.html
D. Migration Testing of Implanted Transponder
We recommend that you conduct testing of the implanted transponder to demonstrate that the
transponder will not migrate after implantation.
E. Performance Testing of Implanted Transponder
We recommend that you conduct testing of the transponder that will demonstrate that under
conditions of use the transponder sends an identification (ID) code and that the ID code is
correct. The testing should address loss or corruption of the data, latency and through-put,
and be coordinated with the electromagnetic compatibility (EMC) performance of the
implant, scanner and wireless data link.
F. Performance Testing of Inserter
We recommend that you demonstrate the functionality of the insertion device by conducting
testing that demonstrates that inserter can properly implant the transponder.
G. Performance Testing and Hazard Analysis of Electronic Scanner
We recommend that you address the functionality of the electronic scanner by conducting
performance testing and hazard analysis that demonstrate the scanner utility in reading the
transponder identification code.
H. Electromagnetic Compatibility
We recommend that you demonstrate the basic EMC of the device (i.e., transponder and
scanner together) by performing EMC testing in accordance with the following FDArecognized
standard:
• IEC 60601-1-2 (Second Edition, 2001) Medical electrical equipment – Part1:
General requirements for safety; Electromagnetic compatibility –
Requirements and Tests, or its equivalent.
I. Electrical Safety Performance Testing
We recommend that you demonstrate the electrical safety of your device by following the
testing in:
Contains Nonbinding Recommendations
6
• IEC 60601-1, Medical Electrical Equipment – Part 1: General Requirements
for Safety
J. Sterility
We recommend that the transponder and inserter be sterile with a sterility assurance level of
10-6. We also recommend that you address the sterility of your device by reviewing the
following:
• Updated 510(k) Sterility Review Guidance K90-1; Final Guidance for
Industry and FDA. http://www.fda.gov/cdrh/ode/guidance/361.html.
K. Magnetic Resonance Imaging Compatibility
We recommend that you demonstrate the magnetic resonance imaging compatibility of your
device by following:
• ASTM F2052-02 Standard Test Method for Measurement of Magnetically
Induced Displacement Force on Medical Devices in the Magnetic Resonance
Environment
• ASTM F2182-02a Standard Test Method for Measurement of Radio
Frequency Induced Heating Near Passive Implants During Magnetic
Resonance Imaging
• ASTM F2213-04 Standard Test Method for Measurement of Magnetically
Induced Torque on Medical Devices in the Magnetic Resonance Environment
• ASTM F2119-01 Standard Test Method for Evaluation of MR Image
Artifacts from Passive Implants.
In addition, you should also address the EMC concerns for implant exposure to the
significant magnetic and radiofrequency emissions from MRI, including concerns for
implant malfunction or damage from MRI exposure and the use of the scanner during MRI
procedures.
L. Labeling
As a prescription device, under 21 CFR 801.109, the device is exempt from having adequate
directions for lay use.2
2 Final labeling must comply with the requirements of 21 CFR 801 before a medical device is
introduced into interstate commerce.
Contains Nonbinding Recommendations
7
We recommend that instructions delineate the technological features of the specific device
and how the device is to be used on patients. We recommend that the instructions encourage
local/institutional training programs designed to familiarize users with the features of the
device and how to use it in a safe and effective manner. If there are any precautions or
warnings, which relate to packaging or sterility, these should be repeated on the package
labels.
We also recommend that you provide after surgery care instructions to the patient. See also
Guidance on Medical Device Patient Labeling,
http://www.fda.gov/cdrh/ohip/guidance/1128.html.
5. Limitations of Exemption from Premarket Notification
FDA’s decision to exempt a Class II device from the requirement of premarket notification is
based on the existing and reasonably foreseeable characteristics of devices within that generic
type that currently are, or have been, in commercial distribution. Section 21 CFR 880.9 specifies
the limitations to exemption. If any of these limitations apply, your device is not exempt and
you must submit a premarket notification.

A Hidden Secret In ObamaCare
“RFID Chip Implants” Mandatory for All by March 23, 2013
About a year ago or longer I published an article about the mandatory RFID chip
that has been inserted into the Obamacare Plan. I’m sending a reminder, for
those who remember this, and a current update. And for those who are unaware
of this, here is the time to learn about it before it’s too late, so you can pass this
on to your loved ones who should be all mankind. Time is short, less than a year
away before it becomes mandatory. Will it be shot down in the Supreme Court? I
very well doubt it.
Which one of these chips below will the U S government use for the hand and
forehead?
From the size of a grain of rice To the mu-chip tiny RFID tag
To the new “powder type” RFID tag
And that no man might buy or sell, save he that had the mark, or the name of the
beast, or the number of his name.
Revelation 13:17
And the smoke of their torment ascendeth up for ever and ever: and they have
no rest day nor night, who worship the beast and his image, and whosoever
receiveth the mark of his name.
Revelation 14:11
Republican Congressman Ron Paul from Texas, states on his website:
“Buried deep within the over 1,000 pages of the massive US Health Care Bill (PDF) in a
“non-discussed” section titled: Subtitle C-11 Sec. 2521— National Medical Device
Registry, and which states its purpose as……..
He quotes that part of the law and then goes on to say:
“In real-world-speak, according to this report, this new law, when fully implemented,
provides the framework for making the United States the first Nation in the World to
require each and every one of its citizens to have implanted in them a radiofrequency
identification microchip for the purpose of controlling who is, or isn’t,
allowed medical care in their country”.
Read the entire story at: Another hidden secret in Obamacare “RFID … – Patriot Action
Network
On Sunday March 21, 2010 the Senate Healthcare bill HR3200 was passed and
signed into law the following Tuesday. This is a horrible and just plain evil bill and
I’m sure you’ve heard a lot of this by now. This new law now opens a prophetic
door on a magnitude not seen since the reformation of Israel.
This law requires an RFID chip implanted in all of us. This chip will not only
contain your personal information with tracking capability but it will also be linked
to your bank account. And get this, Page 1004 of the new law (dictating the
timing of this chip), reads, and I quote: “Not later than 36 months after the date of
the enactment”. It is now the law of the land that by March 23rd, 2013 we will all
be required to have an RFID chip underneath our skin and this chip will be linked
to our bank accounts as well as have our personal records and tracking capability
built into it.
I’m going to show you the black and white of the law itself and you can see it with
your own eyes and wonder why an event of this magnitude, which is nothing less
than seismic in nature, is met with little more than silence in the Christian
community. Is it now starting to dawn on you just where exactly we are in
prophecy? I’ll ask that question again in a minute and follow up on it, but now I
want to show you the law itself. I’ve downloaded a PDF copy of HR3200 from the
government’s website so what I’m about to show you is from the bill itself. It’s
nothing that I’ve written. You can access it all and see it all for yourself straight
from the source.
H.R. 3200 section 2521, Pg. 1001, paragraph 1: The Secretary shall establish a
national medical device registry (in this subsection referred to as the ‘registry’) to
facilitate analysis of post market safety and outcomes data on each device that —
‘‘is or has been used in or on a patient; ‘‘and is — ‘‘a class III device; or ‘‘a class II
device that is implantable, life-supporting, or life-sustaining.”
What exactly is a class II device that is implantable? As you saw earlier, it is the
device approved by the FDA in 2004. Federal Food, Drug, and Cosmetic Act:
www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuid…
A class II implantable device is an “implantable radio frequency transponder
system for patient identification and health information.” The purpose of a class II
device is to collect data in medical patients such as “claims data, patient survey
data, standardized analytic files that allow for the pooling and analysis of data
from disparate data environments, electronic health records, and any other data
deemed appropriate by the Secretary.”
Going back to what we just looked at, the creation of the national medical device
registry in section 2521, page 1002 line 5: “In developing the registry, the
secretary shall…”
And the law continues on with a laundry list of items that the secretary must do in
the process of creating this registry. In this laundry list of items to do, Line 17,
subparagraph B:
“Validating methods for analyzing patient safety and outcomes data from multiple
sources and for linking such data with the information included in the registry as
described in subparagraph (A)”. Going back to sub-paragraph A [right above subparagraph
B], it says: “including in the registry, in a manner consistent with
subsection (f), appropriate information to identify each device described in
paragraph (1) by type, model, and serial number or other unique identifier;”
Don’t be confused by the intentional obfuscation and skillful wording. This law
first creates the national device registry and then immediately lists the entire task
the secretary of health and human services will have do in the process of creating
this registry. The very first two items in the list mandate that the secretary first
gives a unique identification to each of the items listed in paragraph 1 which is:
‘‘a class III device; or ‘‘a class II device that is implantable.”
Then, the very next thing the secretary is to do is to create the process by which
“patient safety and outcomes data from multiple sources,” which is electronic
medical records, that are linked to these newly and uniquely identified items from
paragraph 1 which are the class III and class II implantable devices. Class III
devises are items such as breast implants, pacemakers, heart valves, etc. A Class
II device that is implantable is, as you see from the FDA, an implantable radio
frequency transponder, RFID chip. From breast implants, to pacemakers, to RFID
chips which is the only possible one that can be used for the stated purpose in
section B which is, “for linking such data with the information included in the
registry”? As we know from subsection A, the information in the registry is the
name of a device. In plain speak, we are being told that our electronic medical
records are going to be linked to a class II implantable device!
Continuing a few lines down in this same section, section B subsection ii on page
1002, the “patient safety and outcomes data from multiple sources”, that is to be
linked is clearly spelled out as electronic medical records. It reads: “link data
obtained under clause (i) with information in the registry”. Information in the
registry is, as we know from sub-paragraph A, the name of the device. So what is
the data obtained under clause i? Back up a few lines to clause i. It reads: “obtain
access to disparate sources of patient safety and outcomes data, including Federal
health-related electronic data”. Again, from breast implants, to pacemakers, to
RFID chips which one is the only possible one that can be used for the stated
purpose in section B? That stated purpose is “for linking such data” and the data
is electronic medical records.
What we already have seen in just the creation of this registry, is the device that
will serve as the link, which is an RFID microchip that is categorized as a Class II
implantable device, as well it will be the link for which is your electronic medical
records.
In case the law wasn’t clear enough on that point, on the next page, page 1005:
“The Secretary to protect the public health; shall establish procedures to permit
linkage of information submitted pursuant to subparagraph (A, remember
subparagraph A is the class 2 implantable device reference) with patient safety
and outcomes data obtained under paragraph (3, which is electronic medical
records); and to permit analyses of linked data;”
Continuing on to page 1007, in the STANDARDS, IMPLEMENTATION CRITERIA,
AND CERTIFICATION CRITERIA section, the Secretary of Health and Human
Services is given full power to intact all mandates from the laundry list of to-do
items in the creation process of the registry as well as dictate how the devices
listed in the National Medical Device Registry are to be used and implemented.
“The Secretary of the Health Human Services, acting through the head of the
Office of the National Coordinator for Health Information Technology, shall adopt
standards, implementation specifications, and certification criteria for the
electronic exchange and use in certified electronic health records of a unique
device identifier for each device described in paragraph 1 (National Medical
Device Registry), if such an identifier is required by section 519(f) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. 360i(f)) for the device.”
On Page 503, section E Lines 13-17 it states:
“encourage, as appropriate, the development and use of clinical registries and the
development of clinical effectiveness research data networks from electronic
health records, post marketing drug and medical device surveillance efforts”.
WHAT? Again, MEDICAL DEVICE SURVEILLANCE EFFORTS!
Take a look at section 163 of HR3200, which gives the government a direct
electronic access to your bank account which will work in conjunction with an
implanted chip.
Page 58 Lines 5 through 15 reads: (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 identity
detection card; (E) enable, where feasible, near real-time adjudication of claims
What does this mean? It means that the government will give everybody a health
ID card that contains a machine readable device (magnetic strip or RFID chip)
similar to a credit card. Embedded in this chip or strip is your Health
Identification Number. When you visit a medical provider, the medical claims will
be processed while you are still in the office. The medical providers will be paid in
real time. The portion that you owe will be deducted from your bank account, in
real time, according to HR 3200.
This is the law that you did not vote for, but will be required to observe. This is
the reality of the MARK coming, not a headband or wristband that a Islamist jihad
wares. The signs of the last days are here, time is running down. MANDATORY
implementation of this RFID chip starting… MARCH 23 2013. Get out of Babylon
before it’s too late.
On The Wings Of The Almighty
Moshe ben-Yosef
www.yonahmusic.com

The Patient Protection and Affordable Care Act
Detailed Summary
The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. The Congressional Budget Office (CBO) has determined that the Patient Protection and Affordable Care Act is fully paid for, will provide coverage to more than 94% of Americans while staying under the $900 billion limit that President Obama established, bending the health care cost curve, and reducing the deficit over the next ten years and beyond.
The Patient Protection and Affordable Care Act contains nine titles, each addressing an essential component of reform:
 Quality, affordable health care for all Americans
 The role of public programs
 Improving the quality and efficiency of health care
 Prevention of chronic disease and improving public health
 Health care workforce
 Transparency and program integrity
 Improving access to innovative medical therapies
 Community living assistance services and supports
 Revenue provisions
Title I. Quality, Affordable Health Care for All Americans
The Patient Protection and Affordable Care Act will accomplish a fundamental transformation of health insurance in the United States through shared responsibility. Systemic insurance market reform will eliminate discriminatory practices such as pre-existing condition exclusions. Achieving these reforms without increasing health insurance premiums will mean that all Americans must be part of the system and must have coverage. Tax credits for individuals and families will ensure that insurance is affordable for everyone. These three elements are the essential links to achieve reform.
Immediate Improvements: Achieving health insurance reform will take some time to implement. In the immediate reforms will be implemented in 2010. The Patient Protection and Affordable Care Act will:
 Eliminate lifetime and unreasonable annual limits on benefits
 Prohibit rescissions of health insurance policies
 Provide assistance for those who are uninsured because of a pre-existing condition
 Require coverage of preventive services and immunizations
 Extend dependant coverage up to age 26
 Develop uniform coverage documents so consumers can make apples-to-apples comparisons when shopping for health insurance
 Cap insurance company non-medical, administrative expenditures
2
 Ensure consumers have access to an effective appeals process and provide consumer a place to turn for assistance navigating the appeals process and accessing their coverage
 Create a temporary re-insurance program to support coverage for early retirees
 Establish an internet portal to assist Americans in identifying coverage options
 Facilitate administrative simplification to lower health system costs
Health Insurance Market Reform: Beginning in 2014, more significant insurance reforms will be implemented. Across individual and small group health insurance markets in all states, new rules will end medical underwriting and pre-existing condition exclusions. Insurers will be prohibited from denying coverage or setting rates based on health status, medical condition, claims experience, genetic information, evidence of domestic violence, or other health-related factors. Premiums will vary only by family structure, geography, actuarial value, tobacco use, participation in a health promotion program, and age (by not more than three to one).
Available Coverage: A qualified health plan, to be offered through the new American Health Benefit Exchange, must provide essential health benefits which include cost sharing limits. No out-of-pocket requirements can exceed those in Health Savings Accounts, and deductibles in the small group market cannot exceed $2,000 for an individual and $4,000 for a family. Coverage will be offered at four levels with actuarial values defining how much the insurer pays: Platinum – 90 percent; Gold – 80 percent; Silver – 70 percent; and Bronze – 60 percent. A lower-benefit catastrophic plan will be offered to individuals under age 30 and to others who are exempt from the individual responsibility requirement.
American Health Benefit Exchanges: By 2014, each state will establish an Exchange to help individuals and small employers obtain coverage. Plans participating in the Exchanges will be accredited for quality, will present their benefit options in a standardized manner for easy comparison, and will use one, simple enrollment form. Individuals qualified to receive tax credits for Exchange coverage must be ineligible for affordable, employer-sponsored insurance any form of public insurance coverage. Undocumented immigrants are ineligible for premium tax credits. The Secretary of Health and Human Services (HHS) will establish a national public option – the Community Health Insurance Option – and permit states to opt-out. Federal support will also be available for new non-profit, member run insurance cooperatives. States will have flexibility to establish basic health plans for non-Medicaid, lower-income individuals; states may also seek waivers to explore other reform options; and states may form compacts with other states to permit cross-state sale of health insurance. No federal dollars may be used to pay for abortion services.
Making Coverage Affordable: New, refundable tax credits will be available for Americans with incomes between 100 and 400 percent of the federal poverty line (FPL) (about $88,000 for a family of four). The credit is calculated on a sliding scale beginning at two percent of income for those at 100 percent FPL and phasing out at 9.8 percent of income at 300-400 percent FPL. If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits. Out of pocket maximums ($5,950 for individuals and $11,900 for families) are reduced to one third for those with income between 100-200 percent FPL, one half for those with incomes between 200-300 percent FPL, and two thirds for those with income between 300-400 percent FPL. Credits are available for eligible citizens
3
and legally-residing aliens. A new credit will assist small businesses with fewer than 25 workers for up to 50 percent of the total premium cost.
Shared Responsibility: Beginning in 2014, most individuals will be required to maintain minimum essential coverage or pay a penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter; for those under 18, the penalty will be one-half the amount for adults. Exceptions to this requirement are made for religious objectors, those who cannot afford coverage, taxpayers with incomes less than 100 percent FPL, Indian tribe members, those who receive a hardship waiver, individuals not lawfully present, incarcerated individuals, and those not covered for less than three months.
Any individual or family who currently has coverage and would like to retain that coverage can do so under a „grandfather‟ provision. This coverage is deemed to meet the requirement to have health coverage. Similarly, employers that currently offer coverage are permitted to continue offering such coverage under the „grandfather‟ policy.
Employers with more than 200 employees must automatically enroll new full-time employees in coverage. Any employer with more than 50 full-time employees that does not offer coverage and has at least one full-time employee receiving the premium assistance tax credit will make a payment of $750 per full-time employee. An employer with more than 50 employees that offers coverage that is deemed unaffordable or does not meet the standard for minimum essential coverage and but has at least one full-time employee receiving the premium assistance tax credit because the coverage is either unaffordable or does not cover 60 percent of total costs, will pay the lesser of $3,000 for each of those employees receiving a credit or $750 for each of their full-time employees total.
Title II. The Role of Public Programs
The Patient Protection and Affordable Care Act expands eligibility for Medicaid to lower income persons and assumes federal responsibility for much of the cost of this expansion. It provides enhanced federal support for the Children‟s Health Insurance Program, simplifies Medicaid and CHIP enrollment, improves Medicaid services, provides new options for long-term services and supports, improves coordination for dual-eligibles, and improves Medicaid quality for patients and providers.
Medicaid Expansion: States may expand Medicaid eligibility as early as January 1, 2011. Beginning on January 1, 2014, all children, parents and childless adults who are not entitled to Medicare and who have family incomes up to 133 percent FPL will become eligible for Medicaid. Between 2014 and 2016, the federal government will pay 100 percent of the cost of covering newly-eligible individuals. In 2017 and 2018, states that initially covered less of the newly-eligible population (“Other States”) will receive more assistance than states that covered at least some non-elderly, non-pregnant adults (“Expansion States”). States will be required to maintain the same income eligibility levels through December 31, 2013 for all adults, and this requirement would be extended through September 30, 2019 for children currently in Medicaid.
Children’s Health Insurance Program: States will be required to maintain income eligibility levels for CHIP through September 30, 2019. Between fiscal years 2014 and 2019, states would receive a 23 percentage point increase in the CHIP federal match rate, subject to a 100 percent cap.
4
Simplifying Enrollment: Individuals will be able to apply for and enroll in Medicaid, CHIP and the Exchange through state-run websites. Medicaid and CHIP programs and the Exchange will coordinate enrollment procedures to provide seamless enrollment for all programs. Hospitals will be permitted to provide Medicaid services during a period of presumptive eligibility to members of all Medicaid eligibility categories.
Community First Choice Option: A new optional Medicaid benefit is created through which states may offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, or intermediate care facility for the mentally retarded.
Disproportionate Share Hospital Allotments: States‟ disproportionate share hospital (DSH) allotments are reduced by 50 percent once a state‟s uninsurance rate decreases by 45 percent (low DSH states would receive a 25 percent reduction). As the rate continues to decline, states‟ DSH allotments would be reduced by a corresponding amount. At no time could a state‟s allotment be reduced by more than 65 percent compared to its FY2012 allotment.
Dual Eligible Coverage and Payment Coordination: The Secretary of Health and Human Services (HHS) will establish a Federal Coordinated Health Care Office by March 1, 2010 to integrate care under Medicare and Medicaid, and improve coordination among the federal and state governments for individuals enrolled in both programs (dual eligibles).
Title III. Improving the Quality and Efficiency of Health Care
The Patient Protection and Affordable Care Act will improve the quality and efficiency of U.S. medical care services for everyone, and especially for those enrolled in Medicare and Medicaid. Payment for services will be linked to better quality outcomes. The Patient Protection and Affordable Care Act will make substantial investments to improve the quality and delivery of care and support research to inform consumers about patient outcomes resulting from different approaches to treatment and care delivery. New patient care models will be created and disseminated. Rural patients and providers will see meaningful improvements. Payment accuracy will improve. The Medicare Part D prescription drug benefit will be enhanced and the coverage gap, or donut hole, will be reduced. An Independent Medicare Advisory Board will develop recommendations to ensure long-term fiscal stability.
Linking Payment to Quality Outcomes in Medicare: A value-based purchasing program for hospitals will launch in FY2013 will link Medicare payments to quality performance on common, high-cost conditions such as cardiac, surgical and pneumonia care. The Physician Quality Reporting Initiative (PQRI) is extended through 2014, with incentives for physicians to report Medicare quality data – physicians will receive feedback reports beginning in 2012. Long-term care hospitals, inpatient rehabilitation facilities and hospice providers will participate in value-based purchasing with quality measure reporting starting in FY2014, with penalties for non-participating providers.
Strengthening the Quality Infrastructure: The HHS Secretary will establish a national strategy to improve health care service delivery, patient outcomes, and population health. The President will
5
convene an Interagency Working Group on Health Care Quality to collaborate on the development and dissemination of quality initiatives consistent with the national strategy.
Encouraging Development of New Patient Care Models: A new Center for Medicare & Medicaid Innovation will be established within the Centers for Medicare and Medicaid Services to research, develop, test, and expand innovative payment and delivery arrangements. Accountable Care Organizations (ACOs) that take responsibility for cost and quality received by patients will receive a share of savings they achieve for Medicare. The HHS Secretary will develop a national, voluntary pilot program encouraging hospitals, doctors, and post-acute providers to improve patient care and achieve savings through bundled payments. A new demonstration program for chronically ill Medicare beneficiaries will test payment incentives and service delivery using physician and nurse practitioner-directed home-based primary care teams. Beginning in 2012, hospital payments will be adjusted based on the dollar value of each hospital‟s percentage of potentially preventable Medicare readmissions.
Ensuring Beneficiary Access to Physician Care and Other Services: The Act extends a floor on geographic adjustments to the Medicare fee schedule to increase provider fees in rural areas and gives immediate relief to areas harmed by geographic adjustment for practice expenses. The Act extends bonus payments by Medicare for ground and air ambulance services in rural and other areas. The Act creates a 12 month enrollment period for military retirees, spouses (and widows/widowers) and dependent children, who are eligible for TRICARE and entitled to Medicare Part A based on disability or ESRD, who have declined Part B.
Rural Protections: The Act extends the outpatient hold harmless provision, allowing small rural hospitals and Sole Community Hospitals to receive this adjustment through FY2010 and reinstates cost reimbursement for lab services provided by small rural hospitals from July 1, 2010 to July 1, 2011. The Patient Protection and Affordable Care Act extends the Rural Community Hospital Demonstration Program for two years and expands eligible sites to additional states and hospitals.
Improving Payment Accuracy: The HHS Secretary will rebase home health payments starting in 2013 based on the current mix of services and intensity of care provided to patients. The Secretary will update Medicare hospice claims forms and cost reports to improve payment accuracy. The Secretary will update Disproportionate Share (DSH) payments to better account for hospital uncompensated care costs; Medicare DSH payments will reflect lower uncompensated care costs tied to decreases in the number of uninsured. The bill also makes changes to improve payment accuracy for imaging services and power-driven wheelchairs. The Secretary will study and report to Congress on reforming the Medicare hospital wage index system and will establish a demonstration program to allow hospice eligible patients to receive all other Medicare covered services during the same period.
Medicare Advantage (Part C): Medicare Advantage payments will be based on the average of the bids submitted by insurance plans in each market. Bonus payments will be available to improve the quality of care and will be based on an insurer‟s level of care coordination and care management, as well as achievement on quality rankings. New payments will be implemented over a four-year transition period. MA plans will be prohibited from charging beneficiaries cost sharing for covered services greater than what is charged under fee-for-service. Plans providing extra benefits must give
6
priority to cost sharing reductions, wellness and preventive care prior to covering benefits not currently covered by Medicare.
Medicare Prescription Drug Plan Improvements (Part D): In order to have their drugs covered under the Medicare Part D program, drug manufacturers will provide a 50 percent discount to Part D beneficiaries for brand-name drugs and biologics purchased during the coverage gap beginning July 1, 2010. The initial coverage limit in the standard Part D benefit will be expanded by $500 for 2010.
Ensuring Medicare Sustainability: A productivity adjustment will be added to the market basket update for inpatient hospitals, home health providers, nursing homes, hospice providers, inpatient psychiatric facilities, long-term care hospitals and inpatient rehabilitation facilities. The Act creates an independent, 15-member Medicare Advisory Board to present Congress with proposals to reduce costs and improve quality for beneficiaries. When Medicare costs are projected to exceed certain targets, the Board‟s proposals will take effect unless Congress passes an alternative measure to achieve the same level of savings. The Board will not make proposals that ration care, raise taxes or beneficiary premiums, or change Medicare benefit, eligibility, or cost-sharing standards.
Health Care Quality Improvements: The Patient Protection and Affordable Care Act will create a new program to develop community health teams supporting medical homes to increase access to community-based, coordinated care. It supports a health delivery system research center to conduct research on health delivery system improvement and best practices that improve the quality, safety, and efficiency of health care delivery. And, it support medication management services by local health providers to help patients better manage chronic disease.
Title IV: Prevention of Chronic Disease and Improving Public Health
To better orient the nation‟s health care system toward health promotion and disease prevention, a set of initiatives will provide the impetus and the infrastructure. A new interagency prevention council will be supported by a new Prevention and Public Health Investment Fund. Barriers to accessing clinical preventive services will be removed. Developing healthy communities will be a priority, and a 21st century public health infrastructure will support this goal.
Modernizing Disease Prevention and Public Health Systems: A new interagency council is created to promote healthy policies and to establish a national prevention and health promotion strategy. A Prevention and Public Health Investment Fund is established to provide an expanded and sustained national investment in prevention and public health. The HHS Secretary will convene a national public/private partnership to conduct a national prevention and health promotion outreach and education campaign to raise awareness of activities to promote health and prevent disease across the lifespan.
Increasing Access to Clinical Preventive Services: The Act authorizes important new programs and benefits related to preventive care and services:
 For the operation and development of School-Based Health Clinics.
 For an oral healthcare prevention education campaign.
 To provide Medicare coverage – with no co-payments or deductibles – for an annual wellness visit and development of a personalized prevention plan.
7
 To waive coinsurance requirements and deductibles for most preventive services, so that Medicare will cover 100 percent of the costs.
 To authorize the HHS Secretary to modify coverage of any Medicare-covered preventive service to be consistent with U.S. Preventive Services Task Force recommendations.
 To provide States with an enhanced match if the State Medicaid program covers: (1) any clinical preventive service recommended with a grade of A or B by the U.S. Preventive Services Task Force and (2) adult immunizations recommended by the Advisory Committee on Immunization Practices without cost sharing.
 To require Medicaid coverage for counseling and pharmacotherapy to pregnant women for cessation of tobacco use.
 To award grants to states to provide incentives for Medicaid beneficiaries to participate in programs providing incentives for healthy lifestyles.
Creating Healthier Communities: The Secretary will award grants to eligible entities to promote individual and community health and to prevent chronic disease. The CDC will provide grants to states and large local health departments to conduct pilot programs in the 55-to-64 year old population to evaluate chronic disease risk factors, conduct evidence-based public health interventions, and ensure that individuals identified with chronic disease or at-risk for chronic disease receive clinical treatment to reduce risk. The Act authorizes all states to purchase adult vaccines under CDC contracts. Restaurants which are part of a chain with 20 or more locations doing business under the same name must disclose calories on the menu board and in written form.
Support for Prevention and Public Health Innovation: The HHS Secretary will provide funding for research in public health services and systems to examine best prevention practices. Federal health programs will collect and report data by race, ethnicity, primary language and any other indicator of disparity. The CDC will evaluate best employer wellness practices and provide an educational campaign and technical assistance to promote the benefits of worksite health promotion. A new CDC program will help state, local, and tribal public health agencies to improve surveillance for and responses to infectious diseases and other important conditions. An Institute of Medicine Conference on Pain Care will evaluate the adequacy of pain assessment, treatment, and management; identify and address barriers to appropriate pain care; increase awareness; and report to Congress on findings and recommendations.
Title V — Health Care Workforce
To ensure a vibrant, diverse and competent workforce, the Patient Protection and Affordable Care Act will encourage innovations in health workforce training, recruitment, and retention, and will establish a new workforce commission. Provisions will help to increase the supply of health care workers. These workers will be supported by a new workforce training and education infrastructure.
Innovations in the Health Care Workforce: The Patient Protection and Affordable Care Act establishes a national commission to review health care workforce and projected workforce needs and to provide comprehensive information to Congress and the Administration to align workforce resources with national needs. It will also establish competitive grants to enable state partnerships to complete comprehensive workforce planning and to create health care workforce development strategies.
8
Increasing the Supply of the Health Care Workers: The federal student loan program will be modified to ease criteria for schools and students, shorten payback periods, and to make the primary care student loan program more attractive. The Nursing Student Loan Program will be increased and the years for nursing schools to establish and maintain student loan funds are updated. A loan repayment program is established for pediatric subspecialists and providers of mental and behavioral health services to children and adolescents who work in a Health Professional Shortage Area, a Medically Underserved Area, or with a Medically Underserved Population. Loan repayment will be offered to public health students and workers in exchange for working at least three years at a federal, state, local, or tribal public health agency. Loan repayment will be offered to allied health professionals employed at public health agencies or in settings providing health care to patients, including acute care facilities, ambulatory care facilities, residences, and other settings located in Health Professional Shortage Areas, Medically Underserved Areas, or with Medically Underserved Populations. Authorization of appropriations for the National Health Service Corps scholarship and loan repayment program will be extended 2010-2015. A $50 million grant program will support nurse-managed health clinics. A Ready Reserve Corps within the Commissioned Corps is established for service in times of national emergency. Ready Reserve Corps members may be called to active duty to respond to national emergencies and public health crises and to fill critical public health positions left vacant by members of the Regular Corps who have been called to duty elsewhere.
Enhancing Health Care Workforce Education and Training: New support for workforce training programs is established in these areas:
 Family medicine, general internal medicine, general pediatrics, and physician assistantship.
 Direct care workers providing long-term care services and supports.
 General, pediatric, and public health dentistry.
 Alternative dental health care provider.
 Geriatric education and training for faculty in health professions schools and family caregivers.
 Mental and behavioral health education and training grants to schools for the development, expansion, or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health, and pre-service or in-service training to paraprofessionals in child and adolescent mental health.
 Cultural competency, prevention and public health and individuals with disabilities training.
 Advanced nursing education grants for accredited Nurse Midwifery programs.
 Nurse education, practice, and retention grants to nursing schools to strengthen nurse education and training programs and to improve nurse retention.
 Nurse faculty loan program for nurses who pursue careers in nurse education.
 Grants to promote the community health workforce to promote positive health behaviors and outcomes in medically underserved areas through use of community health workers.
 Fellowship training in public health to address workforce shortages in state and local health departments in applied public health epidemiology and public health laboratory science and informatics.
 A U.S. Public Health Sciences Track to train physicians, dentists, nurses, physician assistants, mental and behavior health specialists, and public health professionals emphasizing team-based service, public health, epidemiology, and emergency preparedness and response in affiliated institutions.
9
Supporting the Existing Health Care Workforce: The Patient Protection and Affordable Care Act reauthorizes the Centers of Excellence program for minority applicants for health professions, expands scholarships for disadvantaged students who commit to work in medically underserved areas, and authorizes funding for Area Health Education Centers (AHECs) and Programs. A Primary Care Extension Program is established to educate and provide technical assistance to primary care providers about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health.
Strengthening Primary Care and Other Workforce Improvements: Beginning in 2011, the HHS Secretary may redistribute unfilled residency positions, redirecting those slots for training of primary care physicians. A demonstration grant program is established to serve low-income persons including recipients of assistance under Temporary Assistance for Needy Families (TANF) programs to develop core training competencies and certification programs for personal and home care aides.
Improving Access to Health Care Services: The Patient Protection and Affordable Care Act authorizes new and expanded funding for federally qualified health centers and reauthorizes a program to award grants to states and medical schools to support the improvement and expansion of emergency medical services for children needing trauma or critical care treatment. Also supported are grants for coordinated and integrated services through the co-location of primary and specialty care in community-based mental and behavioral health settings. A Commission on Key National Indicators is established.
Title VI—Transparency and Program Integrity
To ensure the integrity of federally financed and sponsored health programs, this Title creates new requirements to provide information to the public on the health system and promotes a newly invigorated set of requirements to combat fraud and abuse in public and private programs.
Physician Ownership and Other Transparency: Physician-owned hospitals that do not have a provider agreement prior to February 2010 will not be able to participate in Medicare. Drug, device, biological and medical supply manufacturers must report gifts and other transfers of value made to a physician, physician medical practice, a physician group practice, and/or a teaching hospital. Referring physicians for imaging services must inform patients in writing that the individual may obtain such service from a person other than the referring physician, a physician who is a member of the same group practice, or an individual who is supervised by the physician or by another physician in the group. Prescription drug makers and distributors must report to the HHS Secretary information pertaining to drug samples currently being collected internally. Pharmacy benefit managers (PBM) or health benefits plans that provide pharmacy benefit management services that contract with health plans under Medicare or the Exchange must report information regarding the generic dispensing rate; rebates, discounts, or price concessions negotiated by the PBM.
Nursing Home Transparency and Improvement: The Act requires that skilled nursing facilities (SNFs) under Medicare and nursing facilities (NFs) under Medicaid make available information on ownership. SNFs and NFs will be required to implement a compliance and ethics program. The Secretary of Health and Human Services will publish new information on the Nursing Home Compare
10
Medicare website: standardized staffing data, links to state internet websites regarding state survey and certification programs, a model standardized complaint form, a summary of complaints, and the number of instances of criminal violations by a facility or its employee. The Secretary also will develop a standardized complaint form for use by residents in filing complaints with a state survey and certification agency or a state long-term care ombudsman.
Targeting Enforcement: The Secretary may reduce civil monetary penalties for facilities that self-report and correct deficiencies. The Secretary will establish a demonstration project to test and implement a national independent monitoring program to oversee interstate and large intrastate chains. The administrator of a facility preparing to close must provide written notice to residents, legal representatives of residents, the state, the Secretary and the long-term care ombudsman program in advance of the closure.
Improving Staff Training: Facilities must include dementia management and abuse prevention training as part of pre-employment training for staff.
Nationwide Program for Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers: The Secretary will establish a nationwide program for national and state background checks of direct patient access employees of certain long-term supports and services facilities or providers.
Patient-Centered Outcomes Research: The Patient Protection and Affordable Care Act establishes a private, nonprofit entity (the Patient-Centered Outcomes Research Institute) governed by a public-private board appointed by the Comptroller General to provide for the conduct of comparative clinical outcomes research. No findings may be construed as mandates on practice guidelines or coverage decisions and important patient safeguards will protect against discriminatory coverage decisions by HHS based on age, disability, terminal illness, or an individual‟s quality of life preference.
Medicare, Medicaid, and CHIP Program Integrity Provisions: The Secretary will establish procedures to screen providers and suppliers participating in Medicare, Medicaid, and CHIP. Providers and suppliers enrolling or re-enrolling will be subject to new requirements including a fee, disclosure of current or previous affiliations with any provider or supplier that has uncollected debt, has had their payments suspended, has been excluded from participating in a Federal health care program, or has had their billing privileges revoked. The Secretary is authorized to deny enrollment in these programs if these affiliations pose an undue risk.
Enhanced Medicare and Medicaid Program Integrity Provisions: CMS will include in the integrated data repository (IDR) claims and payment data from Medicare (Parts A, B, C, and D), Medicaid, CHIP, health-related programs administered by the Departments of Veterans Affairs (VA) and Defense (DOD), the Social Security Administration, and the Indian Health Service (IHS). New penalties will exclude individuals who order or prescribe an item or service, make false statements on applications or contracts to participate in a Federal health care program, or who know of an overpayment and do not return the overpayment. Each violation would be subject to a fine of up to $50,000. The Secretary will take into account the volume of billing for a DME supplier or home health agency when determining the size of a surety bond. The Secretary may suspend payments to a
11
provider or supplier pending a fraud investigation. Health Care Fraud and Abuse Control (HCFAC) funding will be increased by $10 million each year for fiscal years 2011 through 2020. The Secretary will establish a national health care fraud and abuse data collection program for reporting adverse actions taken against health care providers, suppliers, and practitioners, and submit information on the actions to the National Practitioner Data Bank (NPDB). The Secretary will have the authority to disenroll a Medicare enrolled physician or supplier who fails to maintain and provide access to written orders or requests for payment for durable medical equipment (DME), certification for home health services, or referrals for other items and services. The HHS Secretary will expand the number of areas to be included in round two of the DME competitive bidding program from 79 of the largest metropolitan statistical areas (MSAs) to 100 of the largest MSAs, and to use competitively bid prices in all areas by 2016.
Additional Medicaid Program Integrity Provisions: States must terminate individuals or entities from their Medicaid programs if the individuals or entities were terminated from Medicare or another state‟s Medicaid program. Medicaid agencies must exclude individuals or entities from participating in Medicaid for a specified period of time if the entity or individual owns, controls, or manages an entity that: (1) has failed to repay overpayments; (2) is suspended, excluded, or terminated from participation in any Medicaid program; or (3) is affiliated with an individual or entity that has been suspended, excluded, or terminated from Medicaid participation. Agents, clearinghouses, or other payees that submit claims on behalf of health care providers must register with the state and the Secretary. States and Medicaid managed care entities must submit data elements for program integrity, oversight, and administration. States must not make any payments for items or services to any financial institution or entity located outside of the United States.
Additional Program Integrity Provisions: Employees and agents of multiple employer welfare arrangements (MEWAs) will be subject to criminal penalties if they provide false statements in marketing materials regarding a plan‟s financial solvency, benefits, or regulatory status. A model uniform reporting form will be developed by the National Association of Insurance Commissioners, under the direction of the HHS Secretary. The Department of Labor will adopt regulatory standards and/or issue orders to prevent fraudulent MEWAs from escaping liability for their actions under state law by claiming that state law enforcement is preempted by federal law. The Department of Labor is authorized to issue “cease and desist” orders to temporarily shut down operations of plans conducting fraudulent activities or posing a serious threat to the public, until hearings can be completed. MEWAs will be required to file their federal registration forms, and thereby be subject to government verification of their legitimacy, before enrolling anyone.
Elder Justice Act: The Elder Justice Act will help prevent and eliminate elder abuse, neglect, and exploitation. The HHS Secretary will award grants and carry out activities to protect individuals seeking care in facilities that provide long-term services and supports and provide greater incentives for individuals to train and seek employment at such facilities. Owners, operators, and employees would be required to report suspected crimes committed at a facility. Owners or operators of such facilities would be required to submit to the Secretary and to the state written notification of an impending closure of a facility within 60 days prior to the closure.
12
Sense of the Senate Regarding Medical Malpractice: The Act expresses the sense of the Senate that health reform presents an opportunity to address issues related to medical malpractice and medical liability insurance, states should be encouraged to develop and test alternative models to the existing civil litigation system, and Congress should consider state demonstration projects to evaluate such alternatives.
Title VII – Improving Access to Innovative Medical Therapies
Biologics Price Competition and Innovation: The Patient Protection and Affordable Care Act establishes a process under which FDA will license a biological product that is shown to be biosimilar or interchangeable with a licensed biological product, commonly referred to as a reference product. No approval of an application as either biosimilar or interchangeable is allowed until 12 years from the date on which the reference product is first approved. If FDA approves a biological product on the grounds that it is interchangeable to a reference product, HHS cannot make a determination that a second or subsequent biological product is interchangeable to that same reference product until one year after the first commercial marketing of the first interchangeable product.
More Affordable Medicines for Children and Underserved Communities: Drug discounts through the 340B program are extended to inpatient drugs and also to certain children‟s hospitals, cancer hospitals, critical access and sole community hospitals, and rural referral centers.
Title VIII – Community Living Assistance Services and Supports
Establishment of national voluntary insurance program for purchasing community living assistance services and support (CLASS program). The Patient Protection and Affordable Care Act establishes a new, voluntary, self-funded long-term care insurance program, the CLASS Independence Benefit Plan, for the purchase of community living assistance services and supports by individuals with functional limitations. The HHS Secretary will develop an actuarially sound benefit plan that ensures solvency for 75 years; allows for a five-year vesting period for eligibility of benefits; creates benefit triggers that allow for the determination of functional limitation; and provides a cash benefit that is not less than an average of $50 per day. No taxpayer funds will be used to pay benefits under this provision.
TITLE IX – REVENUE PROVISIONS
Excise Tax on High Cost Employer-Sponsored Health Coverage: The Patient Protection and Affordable Care Act levies a new excise tax of 40 percent on insurance companies and plan administrators for any health coverage plan with an annual premium that is above the threshold of $8,500 for single coverage and $23,000 for family coverage. The tax applies to self-insured plans and plans sold in the group market, and not to plans sold in the individual market (except for coverage eligible for the deduction for self-employed individuals). The tax applies to the amount of the premium in excess of the threshold. A transition rule increases the threshold for the 17 highest cost states for the first three years. An additional threshold amount of $1,350 for singles and $3,000 for families is available for retired individuals age 55 and older and for plans that cover employees engaged in high risk professions.
13
Increasing Transparency in Employer W-2 Reporting of Value of Health Benefits: This provision requires employers to disclose the value of the benefit provided by the employer for each employee‟s health insurance coverage on the employee‟s annual Form W-2.
Distributions for Medicine Qualified Only if for Prescribed Drug or Insulin: Conforms the definition of qualified medical expenses for HSAs, FSAs, and HRAs to the definition used for the medical expense itemized deduction. Over-the-counter medicine obtained with a prescription continues to qualify as qualified medical expenses.
Increase in Additional Tax on Distributions from HSAs and Archer MSAs Not Used for Qualified Medical Expenses: Increases the additional tax for HSA withdrawals prior to age 65 that are used for purposes other than qualified medical expenses from 10 percent to 20 percent and increases the additional tax for Archer MSA withdrawals from 15 percent to 20 percent.
Limiting Health FSA Contributions: This provision limits the amount of contributions to health FSAs to $2,500 per year.
Corporate Information Reporting: This provision requires businesses that pay any amount greater than $600 during the year to corporate providers of property and services to file an information report with each provider and with the IRS.
Pharmaceutical Manufacturers Fee: This provision imposes an annual flat fee of $2.3 billion on the pharmaceutical manufacturing sector beginning in 2010 allocated across the industry according to market share. The fee does not apply to companies with sales of branded pharmaceuticals of $5 million or less.
Medical Device Manufacturers Fee: This provision imposes an annual flat fee of $2 billion on the medical device manufacturing sector beginning in 2010 allocated across the industry according to market share. The fee does not apply to companies with sales of medical devices in the U.S. of $5 million or less. The fee also does not apply to any sale of a Class I product or any sale of a Class II product that is primarily sold to consumers at retail for not more than $100 per unit (under the FDA product classification system).
Health Insurance Provider Fee: This provision imposes an annual flat fee of $6.7 billion on the health insurance sector beginning in 2010 allocated across the industry according to market share. The fee does not apply to companies whose net premiums written are $25 million or less and whose fees from administration of employer self-insured plans are $5 million or less.
Eliminating the Deduction for Employer Part D Subsidy: This provision eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.
Modification of the Threshold for Claiming the Itemized Deduction for Medical Expenses: This provision increases the adjusted gross income threshold for claiming the itemized deduction for
14
medical expenses from 7.5 percent to 10 percent. Individuals age 65 and older would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.
Tax on Elective Cosmetic Surgery. This provision imposes a five percent excise tax on voluntary cosmetic surgical and medical procedures performed by a licensed medical professional. The tax would be collected by the medical professional at the point of service. The definition of voluntary cosmetic procedures generally would be the same as the definition of cosmetic surgery or similar procedures that are not treated as included in medical care under the current Section 213(d)(9) definition. The excise tax would be effective for procedures performed on or after January 1, 2010.
Executive Compensation Limitations. This provision limits the deductibility of executive compensation for insurance providers if at least 25 percent of the insurance provider‟s gross premium income is derived from health insurance plans that meet the minimum essential coverage requirements in the bill (“covered health insurance provider”). The deduction is limited to $500,000 per taxable year and applies to all officers, employees, directors, and other workers or service providers performing services for or on behalf of a covered health insurance provider.
Additional Hospital Insurance Tax for High Wage Workers. The provision increases the hospital insurance tax rate by 0.5 percentage points on an individual taxpayer earning over $200,000 ($250,000 for married couples filing jointly).
Special Deduction for Blue Cross Blue Shield (BCBS): Requires that non-profit BCBS organizations have a medical loss ratio of 85 percent or higher in order to take advantage of the special tax benefits provided to them, including the deduction for 25 percent of claims and expenses and the 100 percent deduction for unearned premium reserves.
Simple Cafeteria Plans for Small Businesses. This provision would establish a new employee benefit cafeteria plan to be known as a Simple Cafeteria Plan. This eases the participation restrictions so that small businesses can provide tax-free benefits to their employees and it includes self-employed individuals as qualified employees.

THE PRESIDENT’S PROPOSAL February 22, 2010 The President’s Proposal puts American families and small business owners in control of their own health care.
• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
The President’s Proposal bridges the gap between the House and Senate bills and includes new provisions to crack down on waste, fraud and abuse. It includes a targeted set of changes to the Patient Protection and Affordable Care Act, the Senate-passed health insurance reform bill. The President’s Proposal reflects policies from the House-passed bill and the President’s priorities. Key changes include:
• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.
2
A detailed summary of the provisions included in the President’s Plan is set forth below: Policies to Improve the Affordability and Accountability Increase Tax Credits for Health Insurance Premiums. Health insurance today often costs too much and covers too little. Lack of affordability leads people to delay care, skip care, rack up large medical bills, or become uninsured. The House and Senate health insurance bills lower premiums through increased competition, oversight, and new accountability standards set by insurance exchanges. The bills also provide tax credits and reduced cost sharing for families with modest income. The President’s Proposal improves the affordability of health care by increasing the tax credits for families. Relative to the Senate bill, the President’s Proposal lowers premiums for families with income below $44,000 and above $66,000. Relative to the House bill, the proposal makes premiums less expensive for families with income between roughly $55,000 and $88,000. HouseSenatePresident’s ProposalFrom:To:$22,000$29,0001.5%2.0%2.0 – 3.0%$29,000$33,0001.5 – 3.0%4.0 – 4.6%3.0 – 4.0%$33,000$44,0003.0 – 5.5%4.6 – 6.3%4.0 – 6.3%$44,000$55,0005.5 – 8.0%6.3 – 8.1%6.3 – 8.1%$55,000$66,0008.0 – 10.0%8.1 – 9.8%8.1 – 9.5%$66,000$77,00010.0 – 11.0%9.8%9.5%$77,000$88,00011.0 – 12.0%9.8%9.5%Ranges from 133-150% of poverty, then 150-400% of poverty in 50% increments, rounded to the nearest $1,000Tax Credits: Maximum Percent of Income Paid for PremiumsIncome for a Family of Four The President’s Proposal also improves the cost sharing assistance for individuals and families relative to the Senate bill. Families with income below $55,000 will get extra assistance; the additional funding to insurers will cover between 73 and 94% of their health care costs. It provides the same cost-sharing assistance as the Senate bill for higher-income families and the same assistance as the House bill for families with income from $77,000 to $88,000. HouseSenatePresident’s ProposalFrom:To:$29,000$33,00097%90%94%$33,000$44,00093%80%85%$44,000$55,00085%70%73%$55,000$66,00078%70%70%$66,000$77,00072%70%70%$77,000$88,00070%70%70%Ranges from 133-150% of poverty, then 150-400% of poverty in 50% increments, rounded to the nearest $1,000Reduced Cost Sharing: Percent of Costs Paid for by Health Insurance PlanIncome for a Family of Four
Close the Medicare Prescription Drug “Donut Hole”. The Medicare drug benefit provides vital help to seniors who take prescription drugs, but under current law, it leaves many beneficiaries without assistance when they need it most. Medicare stops paying for prescriptions after the plan and beneficiary have spent $2,830 on prescription drugs, and only starts paying again after out-of-pocket spending hits $4,550. This “donut hole” leaves seniors paying the full
3
cost of expensive medicines, causing many to skip doses or not fill prescriptions at all – harming their health and raising other types of health costs. The Senate bill provides a 50% discount for certain drugs in the donut hole. The House bill fully phases out the donut hole over 10 years. Both bills raise the dollar amount before the donut hole begins by $500 in 2010. Relative to the Senate bill, the President’s Proposal fills the “donut hole” entirely. It begins by replacing the $500 increase in the initial coverage limit with a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. It also closes the donut hole completely by phasing down the coinsurance so it is the standard 25% by 2020 throughout the coverage gap. Invest in Community Health Centers. Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers. Strengthen Oversight of Insurance Premium Increases. Both the House and Senate bills include significant reforms to make insurance fair, accessible, and affordable to all people, regardless of pre-existing conditions. One essential policy is “rate review” meaning that health insurers must submit their proposed premium increases to the State authority or Secretary for review. The President’s Proposal strengthens this policy by ensuring that, if a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable. A new Health Insurance Rate Authority will be created to provide needed oversight at the Federal level and help States determine how rate review will be enforced and monitor insurance market behavior. Extend Consumer Protections against Health Insurer Practices. The Senate bill includes a “grandfather” policy that allows people who like their current coverage, to keep it. The President’s Proposal adds certain important consumer protections to these “grandfathered” plans. Within months of legislation being enacted, it requires plans to cover adult dependents up to age 26, prohibits rescissions, mandates that plans have a stronger appeals process, and requires State insurance authorities to conduct annual rate review, backed up by the oversight of the HHS Secretary. When the exchanges begin in 2014, the President’s Proposal adds new protections that prohibit all annual and lifetime limits, ban pre-existing condition exclusions, and prohibit discrimination in favor of highly compensated individuals. Beginning in 2018, the President’s Proposal requires “grandfathered” plans to cover proven preventive services with no cost sharing.
Improve Individual Responsibility. All Americans should have affordable health insurance coverage. This helps everyone, both insured and uninsured, by reducing cost shifting, where people with insurance end up covering the inevitable health care costs of the uninsured, and making possible robust health insurance reforms that will curb insurance company abuses and increase the security and stability of health insurance for all Americans. The House and Senate bills require individuals who have affordable options but who choose to remain uninsured to make a payment to offset the cost of care they will inevitably need. The House bill’s payment is
4
a percentage of income. The Senate sets the payment as a flat dollar amount or percentage of income, whichever is higher (although not higher than the lowest premium in the area). Both the House and Senate bill provide a low-income exemption, for those individuals with incomes below the tax filing threshold (House) or below the poverty threshold (Senate).The Senate also includes a “hardship” exemption for people who cannot afford insurance, included in the President’s Proposal. It protects those who would face premiums of more than 8 percent of their income from having to pay any assessment and they can purchase a low-cost catastrophic plan in the exchange if they choose. The President’s Proposal adopts the Senate approach but lowers the flat dollar assessments, and raises the percent of income assessment that individuals pay if they choose not to become insured. Specifically, it lowers the flat dollar amounts from $495 to $325 in 2015 and $750 to $695 in 2016. Subsequent years are indexed to $695 rather than $750, so the flat dollar amounts in later years are lower than the Senate bill as well. The President’s Proposal raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years – the same percent of income as in the House bill, which makes the assessment more progressive. For ease of administration, the President’s Proposal changes the payment exemption from the Senate policy (individuals with income below the poverty threshold) to individuals with income below the tax filing threshold (the House policy). In other words, a married couple with income below $18,700 will not have to pay the assessment. The President’s Proposal also adopts the Senate’s “hardship” exemption. Strengthen Employer Responsibility. Businesses are strained by the current health insurance system. Health costs eat into their ability to hire workers, invest in and expand their businesses, and compete locally and globally. Like individuals, larger employers should share in the responsibility for finding the solution. Under the Senate bill, there is no mandate for employers to provide health insurance. But as a matter of fairness, the Senate bill requires large employers (i.e., those with more than 50 workers) to make payments only if taxpayers are supporting the health insurance for their workers. The assessment on the employer is $3,000 per full-time worker obtaining tax credits in the exchange if that employer’s coverage is unaffordable, or $750 per full-time worker if the employer has a worker obtaining tax credits in the exchange but doesn’t offer coverage in the first place. The House bill requires a payroll tax for insurers that do not offer health insurance that meets minimum standards. The tax is 8% generally and phases in for employers with annual payrolls from $500,000 to $750,000; according to the Congressional Budget Office (CBO), the assessment for a firm with average wages of $40,000 would be $3,200 per worker. Under the President’s Proposal, small businesses will receive $40 billion in tax credits to support coverage for their workers beginning this year. Consistent with the Senate bill, small businesses with fewer than 50 workers would be exempt from any employer responsibility policies.
The President’s Proposal is consistent with the Senate bill in that it does not impose a mandate on employers to offer or provide health insurance, but does require them to help defray the cost if taxpayers are footing the bill for their workers. The President’s Proposal improves the transition to the employer responsibility policy for employers with 50 or more workers by subtracting out the first 30 workers from the payment calculation (e.g., a firm with 51 workers that does not
5
offer coverage will pay an amount equal to 51 minus 30, or 21 times the applicable per employee payment amount). It changes the applicable payment amount for firms with more than 50 employees that do not offer coverage to $2,000 – an amount that is one-third less than the average House assessment for a typical firm and less than half of the average employer contribution to health insurance in 2009. It applies the same firm-size threshold across the board to all industries. It fully eliminates the assessment for workers in a waiting period, while maintaining the 90-day limit on the length of any waiting period beginning in 2014. Policies to Crack Down on Waste, Fraud and Abuse The House and Senate health reform bills contain an unprecedented array of aggressive new authorities to fight waste, fraud and abuse. The President’s Proposal builds on those provisions by incorporating a number of additional proposals that are either part of the Administration’s FY 2011 Budget Proposal or were included in Republican plans.
Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities. (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs. It ensures that entities that bill for Medicare on behalf of providers are in good standing. It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims. (Source: H.R. 3970, “Medical Rights & Reform Act” ( Kirk bill))
Expanded Access to the Healthcare Integrity and Protection Data Bank. Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens
6
standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse. (Source: Roskam Amendment offered in House Ways & Means Committee markup)
Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges. Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Study of Universal Product Numbers Claims Forms for Selected Items and Services under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), Roskam Amendment offered in House Ways & Means Committee markup)
Medicaid Prescription Drug Profiling. The President’s Proposal requires States to monitor and remediate high-risk billing activity, not limited to prescription drug classes involving a high volume of claims, to improve Medicaid integrity and beneficiary quality of care. States may choose one or more drug classes and must develop or review and update their care plan to reduce utilization and remediate any preventable episodes of care where possible. Requiring States to monitor high-risk billing activity to identify prescribing and utilization patterns that may indicate abuse or excessive prescription drug utilization will assist in improving Medicaid program integrity and save taxpayer dollars. (Source: President’s FY 2011 Budget)
Medicare Advantage Risk Adjustment Errors. The President’s Proposal requires in statute that the HHS Secretary extrapolate the error rate found in the risk adjustment data validation (RADV) audits to the entire Medicare Advantage contract payment for a given year when
7
recouping overpayments. Extrapolating risk score errors in MA plans is consistent with the methodology used in the Medicare fee-for-service program and enables Medicare to recover risk adjustment overpayments. MA plans have an incentive to report more severe beneficiary diagnoses than are justified because they receive higher payments for higher risk scores. (Source: President’s FY 2011 Budget) Modify Certain Medicare Medical Review Limitations. The Medicare Modernization Act of 2003 placed certain limitations on the type of review that could be conducted by Medicare Administrative Contractors prior to the payment of Medicare Part A and B claims. The President’s Proposal modifies these statutory provisions that currently limit random medical review and place statutory limitations on the application of Medicare prepayment review. Modifying certain medical review limitations will give Medicare contractors better and more efficient access to medical records and claims, which helps to reduce waste, fraud and abuse. (Source: President’s FY 2011 Budget) Establish a CMS-IRS Data Match to Identify Fraudulent Providers. The President’s Proposal authorizes the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with the Internal Revenue Service (IRS) to determine which providers have seriously delinquent tax debt to help identify potentially fraudulent providers sooner. The data match will primarily target certain high-risk provider types in high-vulnerability areas. This proposal also enables both IRS and Medicare to recoup any monies owed to the Federal government through this program. By requiring the Internal Revenue Service (IRS) to disclose to CMS those entities that have evaded filing taxes and matching the data against provider billing data, this proposal will enable CMS to better detect fraudulent providers billing the Medicare program. (Source: President’s FY 2011 Budget) Preventing Delays in Access to Generic Drugs. Currently, brand-name pharmaceutical companies can delay generic competition through agreements whereby they pay the generic company to keep its drug off the market for a period of time, called “pay-for-delay.” This hurts consumers by delaying their access to generic drugs, which are usually less expensive than their branded counterparts. The Federal Trade Commission (FTC) recently estimated that this could cost consumers $35 billion over 10 years. The President’s proposal adopts a provision from the bipartisan legislation that gives the FTC enforcement authority to address this problem. Specifically, it makes anti-competitive and unlawful any agreement in which a generic drug manufacturer receives anything of value from a brand-name drug manufacturer that contains a provision in which the generic drug manufacturer agrees to limit or forego research, development, marketing, manufacturing or sales of the generic drug. This presumption can only be overcome if the parties to such an agreement demonstrate by clear and convincing evidence that the pro-competitive benefits of the agreement outweigh the anti-competitive effects of the agreement. The proposal also requires the Chief Executive Officer of the branded pharmaceutical company to certify to the accuracy and completeness of any agreements required to be filed with the FTC. Policies to Contain Costs and Ensure Fiscal Sustainability
8
Improve Medicare Advantage Payments. Medicare currently overpays private plans by 14 percent on average to provide the same benefits as the traditional program – and much more in some areas of the country. The Medicare Advantage program has also done little to reward quality. Moreover, plans have gamed the payment system in ways drive up the public cost of the program. All of this is why Medicare Advantage has become a very profitable line of business for some of the nation’s largest health insurers. The Senate bill creates a bidding model for payment rates and phases in changes to limit potential disruptions for beneficiaries. The House proposal phases payments down based on local fee-for-service costs. The President’s Proposal represents a compromise between the House and Senate bills, blending elements of both bills, while providing greater certainty of cost savings by linking to current fee-for-service costs. Specifically, the President’s Proposal creates a set of benchmark payments at different percentages of the current average fee-for-service costs in an area. It phases these benchmarks in gradually in order to avoid disruption to beneficiaries, taking into account the relative payments to fee-for-service costs in an area. It provides bonuses for quality and enrollee satisfaction. It adjusts rebates of savings between the benchmark payment and actual plan bid to take into account the transition as well as a plan’s quality rating: plans with low quality scores receive lower rebates (i.e., can keep less of any savings they generate). Finally, the President’s Proposal requires a payment adjustment for unjustified coding patterns in Medicare Advantage plans that have raised payments more rapidly than the evidence of their enrollees’ health status and costs suggests is warranted, based on actuarial analysis. This is the primary source of additional savings compared to the Senate proposal. Delay and Reform the High-Cost Plan Excise Tax. Part of the reason for high and rising insurance costs is that insurers have little incentive to lower their premiums. The Senate bill includes a tax on high-cost health insurance plans. CBO has estimated that this policy will reduce premiums as well as contribute to long-run deficit reduction. The President’s Proposal changes the effective date of the Senate policy from 2013 to 2018 to provide additional transition time for high-cost plans to become more efficient. It also raises the amount of premiums that are exempt from the assessment from $8,500 for singles to $10,200 and from $23,000 for families to $27,500 and indexes these amounts for subsequent years at general inflation plus 1 percent. To the degree that health costs rise unexpectedly quickly between now and 2018, the initial threshold would be adjusted upwards automatically. To ensure that the tax affects firms equitably, the President’s Proposal reforms it by including an adjustment for firms whose health costs are higher due to the age or gender of their workers, and by no longer counting dental and vision benefits as potentially taxable benefits. The President’s Proposal maintains the Senate bill’s permanent adjustment in favor of high-risk occupations such as “first responders.”
Broaden the Medicare Hospital Insurance (HI) Tax Base for High-Income Taxpayers. Under current law, people who earn a salary pay the Medicare HI tax on their earned income, but those who have substantial unearned income do not, raising issues of fairness. The House bill includes a 5.4% surcharge on high-income households to improve the fairness of the tax system and to support health reform. The Senate bill includes an increase in the HI tax for high-income households for similar reasons, an increase of 0.9% on earnings above a specific threshold for a total employee assessment of 2.35% on these amounts. The President’s Proposal adopts the Senate bill approach and adds a 2.9 percent assessment (equal to the combined employer and
9
employee share of the existing HI tax) on income from interest, dividends, annuities, royalties and rents, other than such income which is derived in the ordinary course of a trade or business which is not a passive activity (e.g., income from active participation in S corporations) on taxpayers with respect to income above $200,000 for singles and $250,000 for married couples filing jointly. The additional revenues from the tax on earned income would be credited to the HI trust fund and the revenues from the tax on unearned income would be credited to the Supplemental Medical Insurance (SMI) trust fund. Increase in Fees on Brand Name Pharmaceuticals. As more Americans gain health insurance, more will be able to pay for prescription drugs. Moreover, the President’s plan closes the Medicare “donut hole,” ensuring that seniors do not skip or cut back on needed prescriptions. Both policies will result in new revenue for the pharmaceutical industry. The President’s Proposal increases the revenue from the assessment on this industry which is $23 billion in the Senate bill by $10 billion over 10 years. It also delays the implementation of these fees by one year, until 2011, and makes changes to facilitate administration by the IRS. Close Tax Loopholes. Adopts two House proposals to close tax loopholes: (1) Current law provides a tax credit for the production of cellulosic biofuels. The credit was designed to promote the production and use of renewable fuels. Certain liquid byproducts derived from processing paper or pulp (known as “black liquor” when derived from the kraft process) were not intended to be covered by this credit. The President’s Proposal adopts the House bill’s policy to clarify that they are not eligible for the tax credit. (2) The President’s Proposal helps prevent unjustified tax shelters by clarifying the circumstances under which transactions have “economic substance” (as opposed to being undertaken solely to obtain tax benefits) and raises the penalties for transactions that lack economic substance. In so doing, it adopts the House’s policy, with minor technical changes. OTHER POLICY IMPROVEMENTS Improve the Fairness of Federal Funding for States. States have been partners with the Federal government in creating a health care safety net for low-income and vulnerable populations. They administer and share in the cost of Medicaid and the Children’s Health Insurance Program (CHIP). The Senate bill creates a nationwide Medicaid eligibility floor as a foundation for exchanges at $29,000 for a family of 4 (133% of poverty) – and provides financial support that varies by State to do so. Relative to the Senate bill, the President’s Proposal replaces the variable State support in the Senate bill with uniform 100% Federal support for all States for newly eligible individuals from 2014 through 2017, 95% support for 2018 and 2019, and 90% for 2020 and subsequent years. This approach resembles that in the House bill, which provided full support for all States for the first two years, and then 91% support thereafter. The President’s Proposal also recognizes the early investment that some States have made in helping the uninsured by expanding Medicaid to adults with income below 100% of poverty by increasing those States’ matching rate on certain health care services by 8 percentage points beginning in 2014. The President’s Proposal also provides additional assistance to the Territories, raising the Medicaid funding cap by 35% rather than the Senate bill’s 30%.
10
Simplify Income Definitions. The President’s Proposal seeks to simplify eligibility rules for various existing programs as well as for the new tax credits. Consistent with some of the policies in the House bill, the President’s Proposal will conform income definitions to make the system simpler for beneficiaries to navigate and States and the Federal government to administer by: changing the definition of income used for assistance from modified gross income to modified adjusted gross income, which is easier to implement; creating a 5% income disregard for certain Medicaid eligibility determinations to ease the transition from States’ current use of income disregards; streamlining the income reconciliation process for determining tax credits and reduced cost sharing; and clarifying the tax treatment of employer contributions for adult dependent coverage. Delay and Reform of Fees on Health Insurance Providers. Like the drug industry, the health insurance industry stands to gain as more Americans get coverage. The Senate bill includes a $67 billion assessment on health insurers over 10 years to offset some of the cost of enrolling millions of Americans in their plans. The President’s Proposal delays the assessment until 2014 to coincide with broader coverage provisions which will substantially expand the market for health insurance providers. It provides limited exemptions for plans that serve critical purposes for the community, including non-profits that receive more than 80 percent of their income from government programs targeting low-income or elderly populations, or those with disabilities, as well as for voluntary employees’ beneficiary associations (VEBAs) that are not established by employers. Delay and Convert Fee on Medical Device Manufacturers to Excise Tax. The medical device industry also stands to gain from expanding health insurance coverage. Both the House and Senate bills raise $20 billion in revenue from this industry over 10 years. The President’s Proposal replaces the medical device fee with an excise tax (yielding the same revenue) that starts in 2013 to facilitate administration by the IRS. Strengthen the CLASS Act. The House and Senate health insurance reform proposals include the Community Living Assistance Services and Supports (CLASS) Program, a voluntary, privately-funded long-term services insurance program. The CLASS Program offers workers an optional payroll deduction for an insurance program that provides a cash benefit if they become disabled. The President’s Proposal makes a series of changes to the Senate bill to improve the CLASS program’s financial stability and ensure its long-run solvency. Protect the Social Security Trust Funds. The President’s Proposal provides that, if necessary, funds will be transferred to the Social Security Trust Funds to ensure that they are held harmless by the Proposal.
Ensure Effective Implementation. The policy changes in health insurance reform will require careful, effective, deliberate, and transparent implementation. The President’s Proposal appropriates $1 billion for the Administration to implement health insurance reform policies. It also delays several of the policies to ensure effective implementation and improve transitions: the therapeutic discovery credit, elimination of the deduction for expenses allocable to the
11
Medicare Part D subsidy, the pharmaceutical and medical device industry fees, and the health insurance industry fee.
Learn more about the President’s Proposal at http://www.whitehouse.gov/health-care-meeting

Dimitrios Adamopoulos makrinitsa@hotmail.com