I sent a letter to my congresswoman asking for her interpretation of a few of the clauses in H.R. 3200. This is her response. I’ve added my comments inline below.
Dear Mr. Shaw:
Thank you for your very thoughtful questions about H.R. 3200, the America’s Affordable Health Choices Act. I appreciate hearing from you and the fact that you are clearly spending time reading this extremely critical bill.
While I will respond to your questions and hope that you will both continue to get in touch if you need information, I also hope that you will share with me your views about how to best achieve reform. [I did, here] It is important to hear from my constituents on a bill that will be so critical to their health and well-being.
Here are my answers.
(1) Section 152, page 50-51, regarding “personal characteristics.” This is designed to address health care disparities and ensure that high-quality, appropriate care is delivered regardless of a person’s race, ethnicity, gender, age, sex orientation or other characteristics. There may be times when care is differentiated because of health status, for example someone taking a medication for a chronic condition may not be given another medication during an acute care episode. But the intent is to eliminate discrimination on other grounds.
Her answer still left me guessing. A crafty lawyer could conceivably use this as a loophole to have anyone covered, regardless of, say, nationality. Being Swedish is a personal characteristic, no?
Also worth mentioning is the fact that the Congress voted down an amendment, which would require citizenship be verified before receiving benefits.
(2) Section 163, pg 58-59, real-time or near-real determination of financial responsibility. This is designed to give individuals an idea of their costsharing requirements. I have heard from many constituents who would like to be able to know what their out-of-pocket responsibilities would be before they get treatment. While this will require the ability to see whether someone is eligible for assistance based on their income, it is not designed to let providers get access to bank accounts or personal financial data. It would, however, let someone know what their copayment would be, whether their provider is innetwork or not, whether they’ve reached their deductible limit, or if they are close to their annual out-of-pocket limit.
I thought the point was to provide a choice of plans. If I want Plan X and I can afford Plan X, I can buy Plan X. If I choose not to buy any private plan and would rather use the public plan, a plan that I’ll pay for in taxes whether I use it or not, what does my income have to do with my out of pocket expense? When I go to the store to buy a TV, I don’t have to show an income statement to determine the price of the TV. And if a high income predetermines ineligibility, does that also exempt one from the responsibility of paying the taxes that fund the public plan? And if a legal tax payer somehow doesn’t qualify, how can it then be called a public plan?
(3) Section 203, pg. 84, the Commissioner specifying benefits in the Exchange.
Under H.R. 3200, there will be minimum benefit requirements that will be based on the recommendations of a Health Benefits Advisory Commission, headed by the U.S. General Surgeon and determined with public input. However, those benefit packages may change from year to year, as new therapies, drugs and treatments become available. Employers are free to provide additional benefits, states may continue to require their own benefits (as long as they pay the Exchange for any additional costs), and individuals are also free to purchase premium policies that will include extra benefits. Without minimum benefit requirements, insurers could create benefit packages designed to avoid costlier enrollees – for example, not including rehabilitative or mental health services in their benefit package.
It’s clear the government will control what options are available. This will stifle competition and eventually lead to a single payer system.
(4) Section 597B, page 170, section 911. This section creates a penalty for individuals who don’t purchase coverage, based on their adjusted gross income. The section, which is under the sole jurisdiction of the House Ways and Means Committee, amends the Internal Revenue Code. Section 911 refers to the Code, not to H.R. 3200.
This is questionably unconstitutional. The 10th amendment states that any power not delegated to the Federal government nor denied to the States is left to the States or the people. Also of concern, why do wealthier people get punished more for an equal crime?
Again, I hope that I have been able to address your questions. Please don’t hesitate to get in touch if you have additional questions or if! can be of help to you in any way.
Sincerely,
J Schakowsky Member of Congress
P.S. I’ve created an Email Newsletter to provide periodic updates on a variety of issues. You can sign up for it by going to my website at http://www.house.gov/schakowsky.
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