December 7, 2009 Merry Xmas/Happy Hanukkah This is the holiday season and Congress has a gift for us. Here are some of the contents of Nancy Pelosi’s gift to us, H.R. 3962 the first stage of Obamacare. I thought you might want to know, since the media, Congress and the White House did not tell you… and because one of our related businesses is insurance- Sec. 202 (p. 91-92) Each individual is required to enroll in a “qualified plan” (a plan designed by the Secretary of Health and Human Services). If you have your own insurance, as soon as any term in your current plan changes, such as the co-pay, deductible or benefit, you must change to a “qualified plan”. No Plan Yet Sec 224 (p.118) 18 months after the bill becomes law the Secretary of Health and Human Services will decide what a “qualified plan” covers and how much you will be legally required to pay for it. (That’s like a banker telling you to sign the loan agreement now then filling in the interest rate and repayment terms 18 months later) Cost To You The Congressional Budget Office estimates individuals earning $44,000 who purchases his own insurance will have to pay a premium of $5,300 and an estimated $2,000 in out of pocket expenses for a total of $7,300 which is 17% of his pretax income. A family earning $102,100 will have to pay a $15,000 premium plus an estimated $5,300 out of pocket for an annual total of $20,200 or 20% of pretax income. Individuals and families earning less than these amounts will be eligible for to be determined subsidies paid directly to their insurer. No Choice-One Size Fits All Sec 303 (p.167-168) Although the “qualified plan” is not yet designed, it will be of the one size fits all variety. The benefits will be the same, only the co- pays and deductibles will vary. You will have to enroll in the same plan whether the government is paying for it or you and your employer are footing the bill. (This is like when Ford made the Model T, you could order any color car, as long as it was black. Consumers were so distressed, GM became the leading car company because it offered a choice of colors.) You Will Be Fined Sec 596 (p.297-299) When you file your income taxes, you must include proof you are in a “qualified plan”, otherwise you will be fined thousands of dollars. Illegal immigrants are exempt. Sec 412 (p. 272) Employers with payrolls over $750,000 must provide a “qualified plan” for their employees and pay 72.5% of the cost for individuals and a smaller percentage for family coverage or incur an 8% payroll tax. Employers with payrolls from $500,000 to $750,000 will be fined 6%. Seeing a Doctor is a Privilege Not a Right Sec 1302 (pp.672-692) Medicare is changed from a fee for service payment system in which patients choose which doctors to see and doctors are paid for each service they provide; instead, those on Medicare will go to a medical home, essentially a version of an HMO with restrictions on care. A primary care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients will have to settle for a nurse practitioner rather than a physician as the primary care provider. (The reduction of referrals to specialists will mean less costly and aggressive treatment given to the elderly with cancer and other serious diseases) The life expectancy of seniors will decline. It’s Cheaper to Let the Elderly Die Sec 1114 (pp.391-393) Physicians are replaced with physician assistants in overseeing care for hospice patients. They Will Pay Drs in NY and FL What it Costs in AK Sec 1158-1160 (pp.499-520) Creates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country for hospital patients in higher cost areas such as New York and Florida. How long do you think doctors will stay in practice under these conditions? Medicare Advantage Cut Sec 1161 (pp.520-545) Payments to Medicare Advantage plans (which are used by 20% of seniors) will be cut. Increase Inner City Social Work Sec 399V (p. 1422) Grants billions of dollars to community “entities” (like ACORN) with no required qualifications except having “documented community activity and experiences with community healthcare workers to “educate, guide and provide experiential learning opportunities” aimed at drug abuse, poor nutrition, smoking and obesity.” Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program.” (But no plans to increase funding to create more family physicians. If the personal tuition costs of creating a doctor remains the same and the financial rewards are reduced, so do you think there will be more or less doctors?) Language Will Be A Good College Major Sec 222 (p. 617) Reimbursement is provided for culturally and linguistically appropriate services. This program will train healthcare workers to inform Medicare beneficiaries of their “right” to have an interpreter at all times with no co-pays for language services. Minority Preferences Sec 2521 (p. 1379)Sec 2533 (p. 1437) Establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary school health science programs. Newborns Sec 305 (p. 189) Automatic Medicaid enrollment of newborns who do not otherwise have insurance. For the rest of the bill, with page numbers, you may go to www.defendyourhealthcare.us President Reagan was right, the most terrifying statement you can hear is, “I’m from the government and I’m here to help you!” A Future Growth Industry There is always a silver lining in any dark cloud. I see opportunity in the future of the medical tourism industry (to India). Remembering Soupy Sales It was the talk of the playground: Soupy Sales’ show was suspended. In a fit of pique at station management for making him work on New Year’s Day in 1965, the kid show host asked his viewers to look in Mom’s purse and Dad’s wallet, find the pieces of paper with Presidents on them and mail them to him. This incident cemented his legend among teenagers. I was one of them. The one thing you have to understand, it was not cool to be watching kids shows in middle school, except for the Soupy Sales’ show. Sales, born Milton Supman, in Franklinton, North Carolina, with fans that included Frank Sinatra and the Rat Pack, died in a New York City hospice at the age of 83 and took a little piece of the swinging 60’s with him. We hope you have a healthy and safe holiday season. If you have any questions about the foregoing or any other financial matters, please do not hesitate to call us. Remember, We’re Here For You!!