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A Layman's View of the Proposed Health Care Bill (HR 3200) - Part Two (Title II, Subtitle A)

In case you missed the first part of my full reading of the proposed health care bill HR 3200, here it is:

A Layman's View of the Proposed Health Care Bill (HR 3200) - I am reading through the whole thing....slowly

After my first post on this topic, I was a little surprised at how many emails and phone calls I received, the overwhelming majority of which were in support of what I am trying to accomplish.  However, there were also a handful of not-so-nice messages mixed in.  One person called me "naive" (I feel like I am probably closer to "hardened" sometimes), and I was told that I shouldn't express a layman's opinion on this topic, but listen to others instead.  One person told me that I was ignoring the facts, and another one implied that I was being selfish.  I guess my skin got a bit thicker over the past few days, because here is the latest installment.  :)  I don't expect everyone to agree with me, but at least you will see where I am getting my information.

Here's what I am actually trying to do:

I want to form an opinion for myself based exclusively on the facts, rather than listening to so-called experts on either side.  I also hope to spur debate and discussion on this massive piece of proposed legislation.  

In my opinion, everyone's ideas are filtered through their experiences and priorities.  I have already shared what is important to me in my first post.  I have an online network of almost 17,000 people who regularly pay attention to what I say (this comes from my involvement on multiple platforms).  I am hoping to have at least a small impact on this critical debate.  After all, this is one of the few things that will affect everyone in this country.

The post I wrote a couple of days ago (link above) was forwarded to a U.S. Congressmen, a national TV personality, and a link will be included in a newspaper article set to be published next week in a city up north.  Additionally, it was re-posted on many blogs, and it was included in a massive email blast by one reader.  If you don't yet understand how powerful blogging can be, let that sink in for a moment.

This is an even longer post than before, and I am only a little over 10% of the way through the bill.  Without further ado, my observations are below.



(b) Outline of Duties of Commissioner- In accordance with this subtitle and in coordination with appropriate Federal and State officials as provided under section 143(b), the Commissioner shall--

(1) under section 204 establish standards for, accept bids from, and negotiate and enter into contracts with, QHBP offering entities for the offering of health benefits plans through the Health Insurance Exchange, with different levels of benefits required under section 203, and including with respect to oversight and enforcement.

MY NOTE: Again, this seems to come back to the point I made in my original post.  Isn't the insurance industry already regulated at the state level?  I know that we have the Texas Department of Insurance for this stuff.  I wonder if this will add another layer of regulation, or if it will shift to the federal level instead.  As I mentioned previously, the newly-appointed Commissioner appears to have an amazing amount of responsibility and power.


(a) Access to Coverage- In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

MY NOTE: Does this mean that only people with no insurance coverage at all are eligible, or does it mean that you have to cancel your current coverage if you are accepted into one of the health exchange plans?  I think it probably means the latter, but the meaning is certainly not clear at this point.  I hope this section is edited later.


(3) FAR NOT APPLICABLE- The provisions of the Federal Acquisition Regulation shall not apply to contracts between the Commissioner and QHBP offering entities for the offering of Exchange-participating health benefits plans under this title.

MY NOTE: I had to look this up to understand what the Federal Acquisition Regulation (FAR) actually does.  Basically, this is in place to regulate the purchase of good and services by the federal government.  Why is the Commissioner allowed to enter contracts without the normal safeguards in place for other agencies? 


SEC 204 (b)(4)  ENROLLMENT- The entity shall accept all enrollments under this subtitle, subject to such exceptions (such as capacity limitations) in accordance with the requirements under title I for a qualified health benefits plan. The entity shall notify the Commissioner if the entity projects or anticipates reaching such a capacity limitation that would result in a limitation in enrollment.

MY NOTE: Could someone explain to me why an insurance company would be limited to a specific number of enrollees?  This seems like a bad business plan to me.  I am just a real estate broker, but I think I would call this "a good problem to have", meaning that I would hire the necessary help to handle all of the clients that we have. 

I don't think a provision should be included to allow companies to invoke this "capacity limitation" to avoid covering specific people.  It seems like the type of thing that could easily lead to abuse.



(b)(2)(B) SPECIAL ENROLLMENT- The Commissioner shall also provide for special enrollment periods to take into account special circumstances of individuals and employers, such as an individual who--

(i) loses acceptable coverage;

(ii) experiences a change in marital or other dependent status;

(iii) moves outside the service area of the Exchange-participating health benefits plan in which the individual is enrolled; or

(iv) experiences a significant change in income

MY NOTE: It's hard to argue with that section, but I'm sure someone will find a way to do so.  :)  Clearly, they are trying to make allowances for the current economic climate., which I can appreciate.


SEC. 205 (c)(2)(D) ensure that the Internet website described in subparagraph (A) and the information described in subparagraph (B) is developed using plain language (as defined in section 133(a)(2)).

MY NOTE: This section is one of several that allude to using "plain language" to describe benefits, etc. to the public.  Why is it not possible to do this with the bill itself?  I realize that this stuff is written by teams of attorneys, but this is something that will all of us, at least to some degree.  I guess it just seems ironic to me.



(A) IN GENERAL- In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed

(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and

(ii) to have elected to enroll in Medicaid through the application of paragraph (3).

2(B) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL- In the case of a child described in subparagraph (A) who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains such coverage or the State otherwise makes a determination of the child's eligibility for medical assistance under its Medicaid plan pursuant to section 1943(c)(1) of the Social Security Act) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B) of such Act

MY NOTE: As I read this last night, I saw a lot of potential for major political disagreement over these paragraphs.  Since no distinction is made about the parents of the child born here in the U.S., this section would clearly cover newborns with parents who are here illegally, for at least the first 2 months.  As it stands right now, no one can be denied care if they are admitted into an emergency room in the U.S.  This is under the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay.  This section of the bill seems to grant even more benefits, providing for automatic coverage for anyone born on U.S. soil to be eligible for Medicare immediately.  Please note that it doesn't provide this for anyone who already has insurance in place.

As a father of four, I am obviously in favor of taking care of babies, who are utterly helpless.  However, I think this section has the potential to cause a huge influx of immigrants who want to take advantage of this loophole, once the word begins to spread.  This is bothersome to me, and I hope this is clarified further as the bill progresses into committee discussion.


SEC. 206 (c)(1) (1) ESTABLISHMENT; APPOINTMENT.--There is hereby established the Office of the Special Inspector General for the Health Insurance Exchange, to be headed by a Special Inspector General for the Health Insurance Exchange (in this subsection referred to as the ''Special Inspector General'') to be appointed by the President, by and with the advice and consent of the Senate.

(2) DUTIES- The Special Inspector General shall--

(A) conduct, supervise, and coordinate audits, evaluations and investigations of the Health Insurance Exchange to protect the integrity of the Health Insurance Exchange, as well as the health and welfare of participants in the Exchange;

(B) report both to the Commissioner and to the Congress regarding program and management problems and recommendations to correct them;

(C) have other duties (described in paragraphs (2) and (3) of section 121 of division A of Public Law 110-343) in relation to the duties described in the previous subparagraphs; and

(D) have the authorities provided in section 6 of the Inspector General Act of 1978 in carrying out duties under this paragraph.

MY NOTE: I got excited while reading this section, because I thought it was finally going to provide for some accountability for the Commissioner, too.  Unfortunately, this extra position that the bill seeks to create would REPORT to the Commissioner.  Darn.  This attempt at accountability is also controlled by the Commissioner, it seems. 

Furthermore, the Inspector General position terminates completely after five years.  And yes, I am sure.  It doesn't say that it's a five-year term.  It states, "(5) TERMINATION- The Office of the Special Inspector General shall terminate five years after the date of the enactment of this Act."  Why is that?



(b) Payments From Trust Fund- The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange, including payments under subtitle C (relating to affordability credits).

MY NOTE: Again, this appears to give one person carte blanche to determine how much money is needed to run the exchange.

(c) Transfers to Trust Fund-

(1) DEDICATED PAYMENTS- There is hereby appropriated to the Trust Fund amounts equivalent to the following:

(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE- The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).

(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE- The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).

(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS- The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).

MY NOTES: Where do I start with this one?  In a nutshell, each subparagraph here appears to refer to something that is either repealed or that they are hoping to create with the bill itself.  Frankly, this seems to be lifted from a previous document, since some of the reference points are outdated.

Under section (A), it refers to amounts received under section 59B on the Internal Revenue Code of 1986.  Because of the intriguing title of that subparagraph, I wanted to see what the Code actually says in that section.  Based on my research today, it appears as though this section of the tax code was repealed on December 13, 1989.  How is it possible to collect funds under a law that no longer exists?

Here's a link to one place that I found this, on the Cornell University Law School website:

Under section (B), it refers to 3111 (c) of the same tax code.  This bill appears to create that section as part of the federal tax code(i.e. did not exist before).

As for section (C), it seems as though this would also create a new section within the tax code.  I found 4980G, but not H.



(b) Requirements for Approval -

(5) Such other requirements as the Commissioner may specify.

(2) TERMINATION; HEALTH INSURANCE EXCHANGE RESUMPTION OF FUNCTIONS- The Commissioner may terminate the approval (for some or all functions) of a State-based Health Insurance Exchange under this section if the Commissioner determines that such Exchange no longer meets the requirements of subsection (b) or is no longer capable of carrying out such functions in accordance with the requirements of this subtitle. In lieu of terminating such approval, the Commissioner may temporarily assume some or all functions of the State-based Health Insurance Exchange until such time as the Commissioner determines the State-based Health Insurance Exchange meets such requirements of subsection (b) and is capable of carrying out such functions in accordance with the requirements of this subtitle.

    MY NOTE: I think I am detecting a theme here.  What do you think?  This basically says that the Health Commissioner can dictate whatever requirements he/she feels are necessary for a state-based health insurance exchange to operate.  Then, it goes on in section (2) to state that the Commissioner can terminate an exchange with the same amount of unilateral power.  Basically, if this bill is passed, states will only be allowed to operate programs if the Health Commissioner approves the program.


I have read through 115 pages as of today.  I will return sometime soon with more of my input.  Thanks for reading!




Sec. 202 (h) (3) REPORT- Not later than January 1 of Y3, in Y6, and thereafter, the Commissioner shall submit... wrong year listed?

Sec. 207 (c)(1)(C) Presumably, the words, "of the Internal Revenue Code of 1986" need to be added, in order to make this section consistent.




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