Friday, October 23, 2009

Vital Healthcare Act

A BILL

To provide affordable government funding for vital healthcare services to all legal American citizens while keeping intact market competitiveness and quality of care in both the public and private sectors, and preventing such healthcare services from funding, or participating with in any way abortions or abortion providers.
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Be it enacted by the Senate and the House of Representatives in the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; GENERAL DEFINITIONS
(a) SHORT TITLE.—This Act may be referred to as the "Vital Healthcare Act".
(b) TABLE OF CONTENTS.—The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents; general definitions
Sec. 2. General effective date
TITLE I—ABORTION EXCLUSION
Sec. 101. No Abortions Clause
TITLE II—PUBLIC SECTOR
Part A—Defining Basic Healthcare Rights
Sec. 201. Definition of a Healthcare Recipient
Sec. 202. Methodology for Determination of Essential Healthcare Services
Sec. 203. Essential Healthcare Services Defined
Sec. 204. Non-Essential Healthcare Services Defined
Sec. 205. Reimbursed Healthcare Services Defined
Sec. 206. Healthcare Service Restrictions
Part B—Grant Process for Hospital Providers of Basic Healthcare
Sec. 207. Vital Healthcare Agencies
Sec. 208. Starting Grants
Sec. 209. Process of Determining Starting Grant Allowances
Sec. 210. Extended and Diminished Grants
Sec. 211. Compiling Cumulative Rating Averages
Sec. 212. Additional Fiscal Reimbursements to VHAs
Part C—Forming of a Regulating Committee for Basic Healthcare
Sec. 213. Design of the Committee on Vital Healthcare
Sec. 214. Voting Process of the Committee on Vital Healthcare
Sec. 215. Duties of the Committee on Vital Healthcare
Sec. 216. Bureau of Vital Healthcare
Sec. 217. Server for Vital Healthcare
Sec. 218. Confidentiality
Part D—Process of Providing Basic Healthcare
Sec. 219. Medical Feedback Centers
Sec. 220. Duties of the Feedback Center Representative
Sec. 221. Healthcare Recipient Cards
Sec. 222. Healthcare Entrance Machines
Sec. 223. Healthcare Voting Machines
Part E—Public Accountability Structure
Sec. 224. Feedback Center Surveillance as Assurance of Proper Voting Process
Sec. 225. Process of Making Video Surveillance Publicly Accessible
Sec. 226. Encouragement of Citizen Watchdog Groups
TITLE III—PRIVATE SECTOR
Sec. 301. Maintaining the Current Private Sector
TITLE VI—TORT REFORM
Sec. 401. Hospital Lawsuits
Sec. 402. Employee Hours
Sec. 403. Accountability for Public Officials
Sec. 404. Judicial Transparency Website
TITLE V—PROVIDING SUBSIDIES FOR MEDICAL EDUCATORS
Sec. 501. Subsidies for Medical Instructors
Sec. 502. Subsidy Formulation for Medical Instructors
Sec. 503. Cap On Subsidy-Increased Salaries
Sec. 504. Federal Aid for Medicals Professionals Seeking To Become Educators
TITLE VI—HEALTH INSURANCE REGULATION
Sec. 601. Ban On Ownership in Tobacco and Nicotine Companies
Sec. 602. Restrictions On Pre-Existing Conditions
TITLE VII-APPROPRIATIONS
Sec. 701. The Vital Healthcare Fund

(c) GENERAL DEFINITIONS.—Except as otherwise provided, in this Act:
(1) HOSPITAL.—The term "Hospital" as defined in this Act has the meaning assigned in section 1861(e) of the Social Security Act [42 U.S.C. 1395x].
(2) VITAL HEALTHCARE AGENCY.—The term "Vital Healthcare Agency" or "VHA" has the meaning given such term under section 207(a).
(3) HEALTHCARE RECIPIENT.—The term "Healthcare Recipient" has the meaning given such term under section 201(a).
(4) BUREAU OF VITAL HEALTHCARE.—The term "Bureau of Vital Healthcare" as it is used in this Act refers to the regulating bureau overseeing Vital Healthcare Agencies, which has as its leadership the Committee of Vital Healthcare, and the purpose and duties of which are outlined in section 216.
(5) HEALTHCARE SERVICES.—The term "healthcare services" as it is used in this Act refers specifically to the Essential Healthcare Services and Reimbursed Healthcare Services for which Vital Healthcare Agencies are federally funded by this Act to provide.
(6) MEDICAL FEEDBACK CENTER.—The term "Medical Feedback Center" or "MFC" has the meaning given such term under section 219(a).
(7) FEEDBACK CENTER REPRESENTATIVE.—The term "Feedback Center Representative" has the meaning given such term under section 220(a).
(8) COMMITTEE OF VITAL HEALTHCARE.—The term "Committee of Vital Healthcare" as it is used in this Act refers to the leadership committee regulating and overseeing the Bureau of Vital Healthcare and established for the purposes listed in section 213(a).
(9) SERVER FOR VITAL HEALTHCARE.—The term "Server for Vital Healthcare" or "SVH" has the meaning given such term under section 217(a).
(10) HEALTHCARE ENTRANCE MACHINE.—The term "Healthcare Entrance Machine" or "HEM" has the meaning given such term under section 222(a).
(11) HEALTHCARE VOTING MACHINE.—The term "Healthcare Voting Machine" has the meaning given such term under section 223(a).
(12) ESSENTIAL HEALTHCARE SERVICES.—The term "Essential Healthcare Services" refers to those services specified in section 203(a).
(13) NON-ESSENTIAL HEALTHCARE SERVICES.—The term "Non-Essential Healthcare Services" refers to those services specified in section 204(a).
(14) REIMBURSED HEALTHCARE SERVICES.—The term "Reimbursed Healthcare Services" refers to those services specified in section 205(a).
(15) HEALTHCARE RECIPIENT CARD.—The term "Healthcare Recipient Card" has the meaning given such term under section 221(a).
(16) STARTING GRANT.—The term "Starting Grant" has the meaning given such term under section 208(a).
(17) DIMINISHED GRANT.—The term "Diminished Grant" has the meaning given such term under section 210(a).
(18) EXTENDED GRANT.—The term "Extended Grant" has the meaning given such term under section 210(a).
(19) VHA DISTRICT.—The term "VHA District" has the meaning given such term under section 209(a).
(20) CUMULATIVE RATING AVERAGE.—The term "Cumulative Rating Average" or "CRA" has the meaning given such term under section 211(a).
(21) VHA APPROVAL RATING.—The term "VHA Approval Rating" has the meaning given such term under section 210(b)(1).
(22) PUBLIC SECTOR.—The term "Public Sector" as used in this Act refers specifically to U.S. Government-funded healthcare services.
(23) PRIVATE SECTOR.—The term "Private Sector" as used in this Act refers specifically to healthcare services that are not funded by the U.S. Government.
(24) FEEDBACK CENTER SURVEILLANCE SYSTEM.—The term "Feedback Center Surveillance System" or "FCSS" has the meaning given such term under section 224(a).
(25) PERSONALLY IDENTIFIABLE INFORMATION.—The term "Personally Identifiable Information" or "PII" has the meaning given such term under section 218(b).
(26) IDENTIFICATION NUMBER.—The term "identification number" refers to the unique system-assigned identification number for a given Healthcare Recipient upon receiving a Healthcare Recipient Card as specified in section 221(b)(2).
(27) BARCODE.—The term "barcode" refers to the unique system-assigned identification number for a given Healthcare Recipient upon receiving a Healthcare Recipient Card as specified in section 221(b)(3).
(28) PUBLIC TRANSPARENCY WEBSITE.—The term "Public Transparency Website" refers to the publicly accessible website to be created for purposes of easy-access voting on received healthcare services and viewing FCSS video footage for purposes of system accountability, as specified in section 225(a).

SEC. 2. GENERAL EFFECTIVE DATE
Except as otherwise specified within this act, all committees, bureaus, services, grants, laws, etc. set forth within this act are to take effect on the exact date on which this Act is enacted into law.

TITLE I—ABORTION EXCLUSION

SEC 101. NO ABORTIONS CLAUSE
(a) IN GENERAL.—Nothing in this Act or this Act's language may be construed as providing additional government funding for abortion services. Abortion, for purposes of this Act alone, will not be considered healthcare for all of the reasons stated in section 202(a)(3).
(b) STATED BOUNDARIES. —All committees, bureaus, services, grants, laws, etc. that are funded by, created by, or instituted by this Act are to remain free of and separate from abortion providers and abortion services. Hospitals and Vital Healthcare Agencies that choose to fund abortions must not do so in facilities or upon grounds funded by this Act. Under no conditions are any committees, bureaus, or grants instituted by this Act to coordinate with abortion groups.
(c) EMPLOYEE RESTRICTIONS.—The following restrictions are to apply to all employees of the Bureau of Vital Healthcare and its departments, which Bureau excludes Vital Healthcare Agencies but not Medical Feedback Centers and Feedback Center Representatives:
(1) No employees of the Bureau of Vital Healthcare may have in their work history employment by an organization whose primary purpose was to provide abortions, or have past affiliation with such an organization through volunteer activities for said organization or a daughter organization of such an organization whose primary purpose was to provide abortions, without signing the following statement: "I publicly denounce my former cooperation with organizations who provided abortions and agree not to use my employment with the Bureau of Vital Healthcare to support organizations who provide abortions, or to endorse abortions or organizations whose primary purpose is to provide abortions, while in representation of or employment by the Bureau of Vital Healthcare." Employees or potential employees of the Bureau of Vital Healthcare Employees of the Bureau of Vital Healthcare discovered with such past history who refuse to sign this statement are to be fired or not employed.
(2) New employees of the Bureau of Vital Healthcare must sign the following statement prior to employment by the Bureau of Vital Healthcare: "I agree not to use my employment as a representative of the Bureau of Vital Healthcare to endorse organizations whose primary purpose is to provide abortions, or to endorse abortion to members of the general public while an employee of the Bureau of Vital Healthcare. I agree not to involve myself with organizations whose primary purpose is to provide abortions while I am employed by the Bureau of Vital Healthcare, either during work hours or outside of my workplace, and to disclose in writing to the Bureau of Vital Healthcare any such past instances of said involvement. I understand that violation of these terms will mean termination of my employment with the Bureau of Vital Healthcare."
(3) Employees discovered to be supporting organizations that provide abortions either during work hours for the Bureau of Vital Healthcare or outside the Bureau of Vital Healthcare though employed by the Bureau of Vital Healthcare, or to be endorsing abortion activities to the general public during work hours for the Bureau of Vital Healthcare are to be immediately fired, with no provision for re-employment so long as evidence of innocence in such matter is not clearly evidenced.
(d) CLAUSE INHERENT TO ACT AND NOT TO AFFECT ROE V. WADE.—Nothing in this Act or this Act's language may be construed as affecting Roe v. Wade outside of and apart from this Act and the services, governing bodies, laws, etc. instituted by it. Federal services, laws, governing bodies, etc. in place before the institution of this Act shall remain unaffected by this Act.
(e) NECESSARY AND CONDITIONED SECTION.—Removal of, or changes to this section require that this entire Act become null and void, along with all committees, bureaus, services, grants, laws, etc. that are instituted and/or funded by this Act. This Act is to avoid all involvement with organizations that seek to provide abortions. The word 'all' as used in the previous sentence refers to all points in time, past, present, and future.

TITLE II—PUBLIC SECTOR

PART A—DEFINING BASIC HEALTHCARE RIGHTS
 
SEC. 201. DEFINITION OF A HEALTHCARE RECIPIENT
(a) IN GENERAL.—For purposes of this Act, a Healthcare Recipient shall be defined as a legalized American citizen, and thus eligible to receive U.S. government-funded services from a Vital Healthcare Agency.
(b) PROCESS OF PROVING CITIZENSHIP.—The process for establishing citizenship referred to in section 220(b)(1) shall use those forms required by the U.S. Census Bureau's BC-170D as of May 3, 2006, namely the provision of one document from List A or List B, and one document from List C, as found within the section titled "Identification you need to bring to the testing site".
(1) Upon presentation of the adequate documents by a prospective Healthcare Recipient to the Feedback Center Representative in a Medical Feedback Center, the Feedback Center Representative shall use electronic means to verify the data provided and establish identity.
(2) Upon the establishment of a person's identity via presentation of acceptable documents and electronic verification, the Feedback Center Representative of a Medical Feedback Center shall fingerprint the Healthcare Recipient; which fingerprints shall then be scanned into the Server for Vital Healthcare for future use with Healthcare Entrance Machines.
(c) RIGHT TO SERVICES.—All Healthcare Recipients shall have the rights to receive the medical services specified within this Act, and to provide feedback on said services so long as it does not constitute a violation of section 206 or section 224. Discrimination that results in a denial of healthcare services, or intentional tampering with a Healthcare Recipient's right to receive said healthcare services and/or provide feedback about such services so long as it does not violate section 204 or section 206, shall be considered a violation of Federal law and punishable by a fine of up to $5,000 and/or up to 5 years in jail.

SEC 202. METHODOLOGY FOR DETERMINATION OF ESSENTIAL HEALTHCARE SERVICES
(a) METHODOLOGY FOR DETERMINING ESSENTIAL HEALTHCARE SERVICES DEFINED.—As defined by this Act, such vital healthcare services are based on the following principles (for purposes of this Act, these principles apply solely to the language of this Act, without affecting other U.S. law or federal services, including Roe v. Wade):
(1) NO FAULT.—High-risk lifestyle choices such as alcoholism and smoking are controllable and thus whose consequence, i.e. related healthcare treatment, should be borne by the individual, and not the society.
(2) ESSENTIAL RIGHTS.—To what degree does the healthcare assist in the Constitutional, inalienable rights of the individual, first life, then liberty, and finally the pursuit of happiness? Healthcare that is based upon choice as opposed to inalienable rights, e.g. cosmetic surgery, shall not be borne by American taxpayers, for with choices must come personal consequence and responsibility.
(3) NO HARM.—Healthcare that harms another's Constitutional, inalienable rights in the process apart from their consent should not be borne by society, but by the individual, if allowed at all (e.g. abortion). For purposes of this Act, the U.S. government shall err on the side of caution when potentially taking another human being's life, with the burden of proof upon the party seeking to potentially infringe upon another individual's inalienable rights that, as stated by the Declaration of Independence, are dependent upon a Creator and no other individual's opinion, desire for said individual, or estimation.
(4) EFFICIENCY AND CONSISTENCY.—Essential services must have a proven track record of consistently providing measurable, consistent, and curative gains in the quality of a person's basic health; i.e. healthcare which is clearly beneficial. Rarely tested drugs of dubious, highly varying, or ill-tested effect, or whose outcome is difficult to quantify, e.g. medicinal depression treatments, are not reliably effective enough for cost sharing by American taxpayers until proven otherwise.

SEC 203. ESSENTIAL HEALTHCARE SERVICES DEFINED
(a) DEFINITION.—The term "Essential Healthcare Services" as defined in this Act refers to the following healthcare services which must be provided by all Vital Healthcare Agencies. Hospitals that cannot or will not provide such services to all legal American citizens will not be recognized as Vital Healthcare Agencies eligible for Starting Grants:
(1) Vaccinations required by U.S. Law, recommended by the Center for Disease Control and Prevention, or recommended by the American Medical Association
(2) Basic medical checkups (maximum of 1 per fiscal year per individual)
(3) Physicals as required by a public school
(4) Intensive Care
(5) Well baby and well child exams (maximum of 3 visits per child)
(6) Prenatal and Postnatal Care
(7) Treatment of broken and fractured bones
(8) Treatment of torn ligaments
(9) Treatment of damaged tendons
(10) Treatment for damaged muscles
(11) Treatment for deafness/damaged hearing
(12) Treatment for blindness/damaged eyesight
(13) Treatment for hemorrhaging
(14) Treatment for paralysis
(15) Treatment for choking
(16) Treatment for Stroke
(17) Treatment for Epilepsy
(18) Treatment for Fetal Alcohol Syndrome Disorders
(19) Breast cancer treatment
(20) Lung cancer treatment
(21) Colorectal cancer treatment
(22) Gynecologic cancer treatment
(23) Skin cancer treatment
(24) Prostate cancer treatment
(25) Liver disease treatment
(26) Heart disease treatment
(27) Arthritis treatment
(28) Diabetes treatment
(29) Hepatitis treatment
(30) Asthma treatment
(31) Bronchitis treatment
(32) Heart bypass surgery
(33) Treatment of Trichomoniasis (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(34) Treatment of Chlamydia (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(35) Treatment of Gonorrhea (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(36) Treatment of Genital Herpes and Herpes Simplex Virus 1 and 2 (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(37) Treatment of Syphilis (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(38) Treatment of Pelvic Inflammatory Disease (to consist of a maximum of 2 separate dosages of prescription drugs for treatment each 15 years)
(39) Treatment of Acanthomoeba infection
(40) Treatment of African Trypanosomiasis
(41) Treatment of Alveolar Echinococcosis
(42) Treatment of Amebiasis
(43) Treatment of Anaplasmosis
(44) Treatment of Anisakiasis
(45) Treatment of Arenaviruses
(46) Treatment of Ascariasis
(47) Treatment of Aspergillosis
(48) Treatment of Avian influenza virus
(49) Treatment of B Virus
(50) Treatment of Babesiosis
(51) Treatment of Bacterial Vaginosis
(52) Treatment of Balantidiasis
(53) Treatment of Baylisascaris infection
(54) Treatment of Botulism
(55) Treatment of Capillariasis
(56) Treatment of Chronic Obstructive Pulmonary Disease
(57) Treatment of Clonorchis Infection
(58) Treatment of Clostridium Difficile
(59) Treatment of Dipylidium Infection
(60) Treatment for E. Coli
(61) Treatment for Giardiasis
(62) Treatment of H1N1 Flu
(63) Treatment of Klebsiella Pneumoniae
(64) Treatment of Lyme disease
(65) Treatment for Meningitis
(66) Treatment of Pneumoconioses
(67) Treatment of Pneumonia
(68) Treatment for Staphylococcus aureus and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus
(69) Treatment for Scabies
(70) Treatment for Salmonella
(71) Treatment of Tetanus
(72) Treatment for Tuberculosis
(73) Prescription drugs for the above approved purposes that have been approved by the FDA
(b) PROVISION FOR UPDATING.—The list in section 203(a) may be updated by the Committee on Vital Healthcare as outlined in section 215(a)(2)(A).
(c) LIFE-SAVING CARE.—Emergency life-saving care is to be provided on the assumption that an individual is a Healthcare Recipient regardless of status of an individual as a Healthcare Recipient, and as such will be federally reimbursed regardless of whether an individual is a Healthcare Recipient or not. Use of emergency vehicles for said purpose will also be considered an Essential Healthcare Service.

SEC. 204. NON-ESSENTIAL HEALTHCARE SERVICES DEFINED
(a) DEFINITION.—The following healthcare services will not be federally paid for using government funds distributed to Vital Healthcare Agencies:
(1) In Vitro Fertilisation
(2) Alcoholism treatment
(3) Gastric Bypass Surgery
(4) Cosmetic Surgery
(5) Midwives
(6) Depression treatment
(7) Reconstructive Surgery
(8) Treatment for Alzheimer's Disease
(9) Chronic Fatigue Syndrome
(b) PROVISION FOR UPDATING.—The list in section 204(a) may be updated by the Committee on Vital Healthcare as outlined in section 215(a)(2)(B).
(c) CONDITIONS.—In the cases of cancers/tumors and unintended appearance-altering emergencies (e.g. facial damage as the result of 3rd-degree burns) Reconstructive Surgery may be considered an aspect of treatment and in such event that it is necessary for reconstruction, to correct an abnormality caused by a cancer, tumor, or accident, an Essential Healthcare Service and funded as such.
(d) REQUIREMENTS FOR CHANGE TO ESSENTIAL HEALTHCARE SERVICE.—Treatments of Depression and Alzheimer's Disease may not be added to section 203(a) and the list of Essential Healthcare Services, save for those treatments indisputably shown to provide substantial curative effects within 2 months in at least 80% of cases diagnosed.


SEC. 205. REIMBURSED HEALTHCARE SERVICES DEFINED
(a) DEFINITION.—The following healthcare services are not required for Vital Healthcare Agencies to provide, if said Vital Healthcare Agencies do not have the technology or personnel needed to perform such services, however, if provided, they are to be reimbursed in the same way that Essential Healthcare Services under section 203 are reimbursed, including the provision of prescription drugs:
(b) PROVISION FOR UPDATING.—This list in section 205(a) may be updated by the Committee on Vital Healthcare as outlined in section 213(a)(2)(C).
(c) OBLIGATION TO PROVIDE.—A Vital Healthcare Agency that at any time after January 1st, 2011 provides any of the services specified in section 205(a) is required to afterwards make available such service(s) previously provided to a Healthcare Recipient to all Healthcare Recipients. By providing at any time after January 1st, 2011, one of the section 205(b) Reimbursed Healthcare Services to a Healthcare Recipient, a Vital Healthcare Agency will demonstrate its capability of providing said service and have as its obligation to make said service available in the future, so that such a service will not be discriminatorily provided in select circumstances.


SEC. 206. HEALTHCARE SERVICE RESTRICTIONS
(a) PURPOSES.—The purpose for restricting treatment is to avoid an unnecessary burden upon American taxpayers and the American government in treating those who violate the section 202(a)(1) "NO FAULT" rule. The purpose for an effective date is to allow those currently indulging in high-risk behaviors time to reform their lifestyles and avoid the penalties of this section.
(b) EFFECTIVE DATE.—Beginning on January 1st, 2015, and not before, the entirety of this section shall take effect.
(c) RESTRICTED TREATMENT FOR TOBACCO/NICOTINE USERS.—Healthcare recipients determined to be using tobacco or nicotine products by a Vital Healthcare Agency that are not for cessation purposes, as evidenced by clear symptoms during medical diagnosis, will not be eligible for the following healthcare services, that would otherwise be federally paid for using government funds distributed to Vital Healthcare Agencies, for a period of 3 years, beginning on the date which said determination was made, after which time tobacco/nicotine use will be re-evaluated upon request by the Vital Healthcare Agency:
(1) Lung cancer treatment
(2) Heart disease treatment
(3) Heart bypass surgery
(4) Diabetes treatment
(5) Bronchitis treatment
(6) Colorectal cancer treatment
(7) Treatment of Chronic Obstructive Pulmonary Disease
(d) RESTRICTED TREATMENT FOR ALCOHOL USERS.—Healthcare recipients determined to be drinking alcohol by a Vital Healthcare Agency will not be eligible for the following healthcare services, that would otherwise be federally paid for using government funds distributed to Vital Healthcare Agencies, for a period of 3 years, beginning on the date which said determination was made, after which time alcohol use will be re-evaluated upon request by the Vital Healthcare Agency:
(1) Heart disease treatment
(2) Heart bypass surgery
(3) Prostate cancer treatment
(4) Liver disease treatment
(5) Treatment for Stroke
(6) Colorectal cancer treatment
(e) ALLOWANCE FOR CITIZENS TO DISPUTE FINDINGS.—Healthcare recipients who wish to dispute such findings may:
(1) Ask the Vital Healthcare Agency who made the initial determination to re-evaluate them, which decision shall be up to the Vital Healthcare Agency in question, and/or
(2) Choose evaluation via a different Vital Healthcare Agency (who must render testing and a decision within 3 months of the request).
(f) LIMITATIONS UPON REQUESTS FOR RE-EVALUATION.—Vital Healthcare Agencies do not need to accept more than 1 re-evaluation request per Healthcare Recipient's 3-year ban period. Healthcare Recipients may not request re-evaluations from more than 1 additional Vital Healthcare Agency during the 3 year period in which they are excluded from certain healthcare services.

PART B—GRANT PROCESS FOR HOSPITAL PROVIDERS OF BASIC HEALTHCARE

SEC. 207. VITAL HEALTHCARE AGENCIES
(a) DEFINITION.—The term "Vital Health Agency" or "VHA" as defined in this Act refers to the U.S. Hospitals meeting the requirements for a VHA who, upon being approved by the Committee on Vital Healthcare, gain funding from the U.S. government in the form of a Starting Grant to provide basic healthcare services to Healthcare Recipients.
(b) REQUIREMENTS FOR A VHA.—To become a government-funded, Vital Healthcare Agency, a Hospital must certify in writing to the Bureau of Vital Healthcare that it meets the following requirements of a Vital Healthcare Agency:
(1) Be at all times partitioned/walled from all areas of the Hospital not part of the Vital Healthcare Agency and meet all specifications for Medical Feedback Centers stated in section 219. All points of public entry must be through Medical Feedback Centers, save those allowed for emergency use as specified in section 219(c)(1)(A).
(2) Meet the requirements of a Starting Grant as specified in section 208(b).
(3) Provide the Essential Healthcare Services specified in section 203(a).
(4) Provide any applicable Reimbursed Healthcare Services specified in section 205(c).
(5) Submit on a yearly basis to the Bureau of Vital Healthcare the following information for the Hospital/VHA for the fiscal year:
(A) Total Healthcare Recipients served.
(B) Total expenses and operating expenses incurred, with treatment expenses classified as Essential, Non-Essential, or Reimbursed, as relating to sections 203, 204, and 205 respectively.
(C) Total grant monies received.
(6) Require medical personnel to track the number of checkups, visits, or dosages for those items listed in section 203(a) as having a 'maximum' provision requirement, and ensure this data is recorded in the Server for Vital Healthcare as specified in section 216(b).
(7) Comply with the re-evaluation requests of Healthcare Recipients according to the process specified in section 205(e) and section 205(f).
(8) Fulfill such additional duties as may be specified by the Committee on Vital Healthcare.
(c) CERTIFICATION AS A VHA.—Upon being approved as a VHA by the Bureau of Vital Healthcare the Bureau of Vital Healthcare shall list the new VHA on the www.bvh.gov website as an approved Vital Healthcare Agency, as specified in section 225(b)(3).
(d) ALLOWANCE FOR CHARITY CARE.—A Vital Healthcare Agency is permitted to provide free healthcare services to non-Healthcare Recipients, provide the Non-Essential Healthcare Services listed in section 204(b) to Healthcare Recipients, and provide the Restricted Healthcare Services listed in section 206(c) and section 206(d) to the respective Healthcare Recipients who, because of their lifestyle choices are according to said section denied Federally reimbursed treatment, so long as it is recognized that a Vital Healthcare Agency which does so will not be Federally reimbursed for such non-funded healthcare services, and does so wholly of its own accord.
(e) ENDING STATUS AS A VHA.—A Vital Healthcare Agency reserves the right to end its status as a Vital Healthcare Agency at the end of any fiscal year, notwithstanding it shall still be accountable for any fiscal obligations relating to its term as a Vital Healthcare Agency.

SEC. 208. STARTING GRANTS
(a) DEFINITION.—The term "Starting Grant" as defined in this Act refers to the initial funding for a newly approved Hospital as a Vital Healthcare Agency, without which said Hospital may not become a Vital Healthcare Agency.
(b) ELIGIBILITY FOR A STARTING GRANT.—A given Hospital may only become eligible for a Starting Grant through the following two methods:
(1) Receive certification by the Centers For Medicare and Medicaid Services (CMS) as a Vital Healthcare Agency and have said certification intact at the time of application for a Starting Grant.
(2) Present a petition consisting solely of the following language and signed by no less than 5% of the residents in the Hospital's district to the Committee on Vital Healthcare: "We, the residents of [name of Hospital's district] affirm our support for [name of Hospital] to become a government-funded Vital Healthcare Agency."
(c) REAPPLICATION PROCESS FOR A STARTING GRANT.—Hospitals that had VHA status but lost it are not eligible to reapply for a 5-year period. Upon reapplying, a Hospital must obtain signatures from an additional 5% of district residents than in the previous 5-year period, e.g. 5% for the 1st attempt, 10% for the 2nd attempt, 15% for the 3rd attempt, etc. Previous signers of a petition must re-sign for each new petition for their support of a given Hospital's new petition to be recognized and counted by the Committee on Vital Healthcare.

SEC. 209. PROCESS OF DETERMINING STARTING GRANT ALLOWANCES
(a) DEFINITION OF VHA DISTRICT.—The term "VHA District" refers to the area occupied by a given Vital Healthcare Agency, and which it is considered to share with other Vital Healthcare Agencies. If a Vital Healthcare Agency is in a Metropolitan Statistical Area or a Micropolitan Statistical Area, the Metropolitan or Micropolitan Statistical Area shall be considered the VHA District for the Vital Healthcare Agencies that inhabit it. If a Vital Healthcare Agency does not occupy a Metropolitan or Micropolitan Statistical Area the Congressional District will instead be considered the VHA District.
(b) FORMULAIC PROCESS FOR VALUING A STARTING GRANT.—The monetary value of a Starting Grant shall be provided to a given VHA that has met the requirements of section 208(b), based on the Bureau of Vital Healthcare's application of the following formula to a given Vital Healthcare Agency:
(1) Multiply the number of residents in the VHA District by $1,000. $1,000 is to be the base starting cost of healthcare for a given Healthcare Recipient in a VHA District.
(2) Divide the result by the 'Total establishments' in said Metropolitan or Micropolitan Statistical Area. The 'Total establishments' can be found in the Census Bureau's 'County Business Patterns (NAICS)' report for Industry Code 622; 'Hospitals'. Dividing by 'Total establishments' establishes the allotment share for a specific Hospital or VHA
(3) If the VHA is not in a Metropolitan or Micropolitan Statistical Area, an estimation of residents and Hospital establishments within the Congressional district may instead be substituted. This effectually determines the average residents served by a Hospital in a given Metropolitan or Micropolitan Statistical Area.
(b) PROCESS FOR CHANGING FORMULATION.—The Committee on Vital Healthcare shall have the power to change this formula after January 1st, 2013.
(c) ADJUSTMENT FOR INFLATION.—The base starting cost for a given Healthcare Recipient, $1,000, is to be adjusted for inflation by the Bureau of Vital Healthcare for each fiscal year beginning January 1st, 2012.


SEC. 210. EXTENDED AND DIMINISHED GRANTS
(a) IN GENERAL.—The Bureau of Vital Healthcare shall use data collected from Medical Feedback Centers to re-define the levels of what were originally Starting Grants, that either by increasing they become Extended Grants, or by decreasing, Diminished Grants.
(b) FORMULAIC PROCESS FOR RE-DEFINING GRANTS.—The following basic process shall be utilized by the Bureau of Vital Healthcare as a framework to ultimately set new grant levels as of January 1st, 2013, and every 2 years subsequent to this; e.g. January 1st, 2015, January 1st, 2017, etc:
(1) The Bureau of Vital Healthcare shall determine the Cumulative Rating Averages for the three segments of a given Vital Healthcare Agency as specified in section 211. The separate CRAs are to be weighted by multiplying the CRA for Healthcare Recipients inside the VHA District by 65%, the CRA for Healthcare Recipients in adjoining VHA Districts by 30%, and the CRA for all other Healthcare Recipients by 5%. The separate resulting totals, now weighted, are to be added together to attain the "VHA Approval Rating", which expresses the voting approval of Healthcare Recipients, primarily as relating to the immediate VHA District and surrounding area for the VHA in question.
(2) The VHA Approval Ratings are to be compared among Vital Healthcare Agencies in the VHA District. For purposes of determining Extended and Diminished Grants, the formula used shall be identical to that specified in section 209(b) for valuing Starting Grants, but the value of the base starting cost of a given Healthcare Recipient in the VHA District specified in section 209(b)(1) as $1,000 is to be changed; higher for Extended Grants, and lower for Diminished Grants. If not changed from the value of $1,000, the VHA with such a value shall be esteemed to maintain the status of a Starting Grant.
(c) SPECIFIC SCENARIOS.—
(1) VHAs with VHA Approval Ratings at or above 3.75 and below 4.25 are to remain at Starting Grant status or improve to receive Extended Grant status. If a given VHA, which meets such a condition, has a VHA Approval Rating above the average VHA Approval Rating of all VHAs in the VHA District, that VHA is to receive an Extended Grant with a gain in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulation as specified in section 210(b)(2), equivalent to the difference between its own VHA Approval Rating and the average VHA Approval Rating of all VHAs in the VHA District, divided by 5.0, added to 1.0, and multiplied by $1,000 to receive the new Extended Grant value for the VHA. If a given VHA, which meets such a condition, has a VHA Approval Rating at or below the average VHA Approval Rating of all VHAs in the VHA District, it is to maintain its Starting Grant status. This new value shall be the base starting cost per Healthcare Recipient for the VHA.
(2) VHAs with VHA Approval Ratings at or above 4.25 are to receive Extended Grant status. A given VHA, which meets this condition, is to receive a gain in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulations as specified in section 210(b)(2), equivalent to the difference between the VHA Approval Rating of said VHA and 2.50, divided by 5.0, added to 1.0, and multiplied by $1,000 to receive the new Extended Grant value for the VHA. This new value shall be the base starting per Healthcare Recipient for the VHA.
(3) VHAs with VHA Approval Ratings below 3.75 are to receive Diminished Grant status. A given VHA, which meets this condition, is to receive a loss in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulations as specified in section 210(b)(2), equivalent to the difference between its VHA Approval Rating and the top VHA Approval Rating in its VHA District, divided by the number of VHAs in the VHA District, divided by 5.0, added to 1.0, and multiplied by $1,000 to receive the new Extended Grant value for the VHA. If such a VHA also meets the qualifications of section 210(d)(2), that formula shall instead take precedence.
(d) EXCEPTIONS.—
(1) A VHA with the best VHA Approval Rating in its VHA District is to always receive Extended Grant status unless it is the only VHA in its VHA District in which case the formula in section 210(d)(2) shall instead be used. If there are at least 2 VHAs in the VHA District, the VHA with the best VHA Approval Rating is to become an Extended Grant and receive a gain in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulation as specified in section 210(b)(2), equivalent to the difference between the best VHA Approval Rating in the VHA District and the average VHA Approval Rating of the other VHAs in the VHA District, divided by 5.0, added to 1.0, and multiplied by $1,000 to receive the new Extended Grant value for the VHA (e.g. for a VHA with the top VHA Approval Rating of 4.5, and all other VHAs in the VHA District whose average VHA Approval Rating was 3.7, the difference would be .8 which when divided by 5.0 would equal .16, upon addition to 1.0 would become 1.16, and then by multiplying by $1,000 would result in a new base starting cost of $1,160 per Healthcare Recipient for the aforementioned VHA with the best VHA Approval Rating in the VHA District). This new value shall be the base starting cost per Healthcare Recipient for the VHA. If such a VHA also meets the qualifications of section 210(c)(2), the formula in section 210(c)(2) shall instead take precedence.
(2) A VHA without other VHAs or Hospitals within a 30-mile radius, or without another VHA in its VHA District, is not to receive a Diminished Grant for its first 5 years from the time of receiving its initial Starting Grant. If the VHA over those 5 years has VHA Approval Ratings averaging below 2.50 the Bureau of Vital Healthcare is to seek creation of a new VHA in a 15-mile radius of the VHA in question, whether by expansion by a present VHA to a second location, seeking relocation by another Hospital or VHA, or another method. Until such occurrence, the VHA shall receive a gain in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulation as specified in section 210(b)(2), only if either its VHA Approval Rating is above the average VHA Approval Rating of all VHAs in the state, in which case it shall receive an increase in the base starting cost of a Healthcare Recipient in the VHA District, for purposes of its grant funding formulations as specified in section 210(b)(2), equivalent to the difference between the VHA Approval Rating of said VHA and the average VHA Approval Rating of all VHAs in the state, divided by 5.0, added to 1.0, and multiplied by $1,000 to receive the new Extended Grant value for the VHA. This new value shall be the base starting per Healthcare Recipient for the VHA.

SEC. 211. COMPILING CUMULATIVE RATING AVERAGES
(a) DEFINITION.—The term "Cumulative Rating Average" or "CRA" refers to the averaging of the ratings for the first two questions asked on the Healthcare Voting Machines in the Medical Feedback Centers for a given Vital Healthcare Agency, as specified in paragraphs (c)(5)(A) and (c)(5)(B) of section 223. This shall result in three different CRAs for a given Vital Healthcare Agency, each for a different segment of the Healthcare Recipients who responded.
(b) SEGMENTS OF HEALTHCARE RECIPIENTS TO BE TRACKED.—Cumulative Rating Averages are to be maintained for each Vital Healthcare Agency, and for each Vital Healthcare Agency, to be tracked for the following three segments of Healthcare Recipients:
(1) Healthcare Recipients inside the VHA District.
(2) Healthcare Recipients in VHA Districts adjoining the VHA District in question; not including the VHA District in question itself.
(3) All other Healthcare Recipients; those Healthcare Recipients outside of both the VHA District in question and its adjoining VHA Districts.
(c) PROCESS OF DETERMINING A CRA.—Cumulative Rating Averages are to be compiled for each segment, for each Vital Healthcare Agency, and account for voter ratings taken specifically over the 2-year periods specified in section 210(b), as follows:
(1) Add the ratings that resulted from answers to the two questions from paragraphs (c)(5)(A) and (c)(5)(B) of section 223 for Healthcare Recipients in the given segment, and divide by the number of Healthcare Recipients who provided ratings in that segment. This shall result in two rating averages, one for ratings by Healthcare Recipient in the given segment to the question in section 223(c)(5)(A), and one for ratings by Healthcare Recipients in the given segment to the question in section 223(c)(5)(B).
(2) Add the two rating averages that resulted together, and divide by 2. This shall produce a Cumulative Rating Average for one of the segments of Healthcare Recipients specified in section 211(b), for a specific Vital Healthcare Agency.


SEC. 212. ADDITIONAL FISCAL REIMBURSEMENTS TO VHAS
(a) IN GENERAL.—VHAs that report additional costs for approved healthcare service expenses in a fiscal year such as for Essential Healthcare Services, Reimbursed Healthcare Services, or for a cost associated with necessary running of a Vital Healthcare Agency - which costs associated with necessary running of a Vital Healthcare Agency may be specified by the Committee on Vital Healthcare as well as the acceptable range as stated in section 215(b)(8), are to be reimbursed the additional amount specified, so long as there is a thorough accounting of the reason for the expense.
(b) PROCESS FOR PAYMENT.—The additional costs for approved healthcare service expenses in a fiscal year specified in section 212(a) are to be provided each fiscal year in addition to the grant monies, as specified in section 216(b)(6).

PART C—FORMING OF A REGULATING AGENCY FOR BASIC HEALTHCARE

SEC. 213. DESIGN OF THE COMMITTEE ON VITAL HEALTHCARE
(a) PURPOSES.—The Committee on Vital Healthcare shall be created upon passage of this Act for purposes of oversight, regulation, direction, and leadership of the Bureau of Vital Healthcare, and shall be considered the leadership committee for the Bureau of Vital Healthcare.
(b) MEMBERSHIP.—The membership of the Committee on Vital Healthcare shall consist of representatives from recognized medical institutions and non-profit groups. The following groups, and specifically, the leaders afterwards indicated, shall choose their respective representatives by whatever method they see fit:
(1) American Board of Medical Specialties - President and CEO of the American Board of Medical Specialties
(2) American Medical Association – President of the American Medical Association
(3) American College of Physicians – President of the American College of Physicians
(4) American Dental Association – President of the American Dental Association
(5) American Medical Student Association – National President of the American Medical Student Association
(6) American Osteopathic Association – President of the American Osteopathic Association
(7) AARP Foundation – President of the AARP Foundation
(8) American Board of Medical Specialties – President and CEO of the American Board of Medical Specialties
(9) American Board of Internal Medicine – President and CEO of the American Board of Internal Medicine
(10) American College of Emergency Physicians – President of the American College of Emergency Physicians
(11) American Academy of Family Physicians – President of the American Academy of Family Physicians
(12) American Nurses Association – President of the American Nurses Association
(c) MEMBERSHIP REGULATIONS.—The following bylaws apply to the selection process for representatives serving on the Committee on Vital Healthcare:
(1) Each group indicated in section 213(b) shall have exactly one representative every 3 years. This representative is to be selected by the leader indicated and be a member of the group/organization involved.
(2) The first representatives are to be chosen on January 1st, 2011. The second round of representatives will be chosen by their respective organizations on January 1st 2014, the third round of representatives chosen by their respective organizations on January 1st, 2017, etc.
(3) The organization leaders indicated in section 213(b)(1) as having the right to choose representatives for their respective organizations are free to select themselves.
(4) The designated leaders of their respective organizations listed in section 213(b)(1), and who have the right to pick the representative for their organization, are to mail a signed letter stating their selections for their respective organization's representative on the Committee on Vital Healthcare to the Clerk of the House for archiving and evidentiary purposes.
(5) No organization may elect the same individual as its representative for 2 consecutive terms, although that individual may be elected an unlimited number of times. However, no individual person may serve in 2 consecutive sessions for the Committee on Vital Healthcare, either by being elected twice in a row by one organization, or via election by separate organizations.
(6) A member's views on any issue or issues may not disqualify them from sitting on the Committee on Vital Healthcare, as diversity of thought is welcomed, and the primary concern for each organization should be the sufficiency of the representative to represent their best interests, a choice the designated leader of that organization will be free to make wholly within their own discretion.


SEC. 214. VOTING PROCESS FOR THE COMMITTEE ON VITAL HEALTHCARE
(a) VOTING.—The Committee on Vital Healthcare is to have as its leader the Chair of the Committee on Vital Healthcare, who shall take recommendations from Committee of Vital Healthcare members on issues and potential courses of action.
(b) SELECTION OF THE CHAIR OF THE COMMITTEE ON VITAL HEALTHCARE.—The Chair of the Committee on Vital Healthcare shall be responsible for bringing up issues, as they are suggested by members of the Committee on Vital Healthcare, before the Committee on Vital Healthcare for a vote, as well as keeping order of the proceedings of the Committee on Vital Healthcare and ensuring all members are given equal rights to speak for their organizations. The selection process for the Chair on the first meeting shall be based upon the reverse alphabetical order of last names. The Chair for January of 2011 will be the member with the last name in the alphabet. A different Committee of Vital Healthcare member shall hold the Chair each month of the fiscal year (January, February, March, etc.), with the order passing from the member with the last name ranked last via alphabetical ranking, to the member with the last name ranked 2nd to last via alphabetical ranking, to the member with the last name ranked 3rd to last via alphabetical ranking, and so on until finally reaching the member with the last name ranked 1st via alphabetical ranking. After this happens, the order will begin once more with the member with the last name ranked last via alphabetical ranking, and the process shall repeat. In this way all Committee of Vital Healthcare members and their respective organizations should hold the Chair at some time during the 3-year period before new Committee of Vital Healthcare members are chosen.
(c) ALLOWANCE FOR ADDING ORGANIZATIONS.—Additional organizations may be added to the list in 213(b) and as such have representatives on the Committee on Vital Healthcare only by vote by formal vote of the Committee on Vital Healthcare, and subsequent approval by 75% of all members.
SEC. 215. DUTIES OF THE COMMITTEE ON VITAL HEALTHCARE
(a) DUTIES.—The duties of the Committee on Vital Healthcare shall be as follows:
(1) Provide Starting Grants to Hospitals who meet the qualifications of section 208(b).
(2) Update the following lists annually on March 1st:
(A) Essential Healthcare Services as specified in section 203(a).
(B) Non-Essential Healthcare Services as specified in section (204)(a).
(C) Reimbursed Healthcare Services as specified in section 205(a).
(3) Specify standards for:
(A) Healthcare Entrance Machines as specified in section 222(b).
(B) Healthcare Voting Machines as specified in section 223(b).
(4) Update the base starting cost for a given Healthcare Recipient to account for inflation as specified in section 209(c).
(5) Begin work on authorizing the creation of a research team as of January 1st, 2016, which team is to provide its findings to Congress no later than January 1st, 2018, on the impact of the Bureau of Vital Healthcare and related agencies, departments, and laws upon the U.S. healthcare system, including but not limited to, the impact on Medicaid and Medicare costs and continuing necessity or lack thereof, the impact on SCHIP costs and continuing necessity or lack thereof, and the possibility and feasibility of merging other U.S. departments which provide healthcare services with the Bureau of Vital Healthcare or its related departments.
(b) ADDITIONAL POWERS GRANTED.—The Committee on Vital Healthcare will have the capability, but not the obligation, to carry out the following tasks:
(1) Designate a required room size for Medical Feedback Centers as specified in section 219(b)(1).
(2) Meet with Healthcare Recipients and concerned parties, as well as hold meetings specifically for members of the Committee on Vital Healthcare.
(3) Designate a new value formulation for Starting Grants as specified in section 209(b).
(4) Oversee and regulate, unless otherwise specified, all aspects of the Bureau of Vital Healthcare mentioned in section 216. The Committee on Vital Healthcare, unless otherwise specified, shall have the power to exercise all duties and powers of the Bureau of Vital Healthcare if it so chooses.
(5) Specify changes to the standardized training process for Feedback Center Representatives mentioned in section 216(b)(7), or creation of a new training process for any employees or department of the Bureau of Vital Healthcare.
(6) Establish such departmental classifications as are necessary to improve efficiency, simplicity, and transparency of the Bureau of Vital Healthcare and its departments.
(7) Adapt the process for re-defining Starting Grants as Extended or Diminished Grants specified in section 210(b) to more accurately reflect new data pertaining to which Vital Healthcare Agencies are performing well as opposed to poorly, so long as said process continues to be based upon the weighting of the Cumulative Rating Averages specified in section 211.
(8) Specify necessary costs, or expenses, for Vital Healthcare Agencies that are essential to the upkeep of Vital Healthcare Agencies in general, or in that area or given circumstance, such as expenses resulting from building/property taxes or damage not covered by insurance due to disasters, maintenance and janitorial expenses, costs for Medical Feedback Centers, payroll, etc., as well as ranges for these different operating expenses to fall into, or be reimbursed for. These costs should in turn be tied to other variables, such as cost per Healthcare Recipient, or cost as a portion of the VHA's total operating expenses; rather than being inflexible. Furthermore, this is not to allow rationing of healthcare services, and to involve solely expenses that do not qualify as healthcare services; which expenses are to be reimbursed as per section 212.

SEC. 216. BUREAU OF VITAL HEALTHCARE
(a) PURPOSE.—The purpose of the Bureau of Vital Healthcare is to oversee the practical, day to day regulation of Vital Healthcare Agencies as well as the structure by which said VHAs exist, and to enforce the statutes of the Committee on Vital Healthcare.
(b) DUTIES.—The following duties are to be fulfilled by the Bureau of Vital Healthcare:
(1) Collect on an annual basis, for the year ending December 31st, the following information for each Medical Feedback Center, using the Server for Vital Healthcare:
(A) Total Healthcare Recipients served.
(B) Cumulative rating averages for the two questions evaluating VHA performance, collected for each VHA from the Server for Vital Healthcare, as specified in section 217(b)(8).
(2) Collect on an annual basis, for the year ending December 31st, the following information from each Vital Healthcare Agency:
(A) Total expenses and operating expenses incurred.
(B) Total grant monies provided.
(3) Determine which Hospitals are eligible to receive Starting Grants according to the process enumerated in section 208.
(4) Specify grant allowances of Starting Grants to each new Vital Healthcare Agency as per section 209.
(5) Specify new grant allowances, by which Starting Grants may become Extended or Diminished Grants, according to the process specified in section 210.
(6) Send the grant amount allotted for a given Vital Healthcare Agency to it on an annual basis, no later than January 31st of each year, taking into account any additional fiscal reimbursements to be provided as stated in section 212.
(7) Oversee a standardized, effective training process for Feedback Center Representatives whereby each is knowledgeable of:
(A) His or her duties, and how to perform them, as laid out in section 220.
(B) The role of a Medical Feedback Center as specified in section 219.
(C) The role of a Vital Healthcare Agency as specified in section 207.
(D) The operation of the Feedback Center Surveillance System, as specified in section 224.
(E) Operation and maintenance of both Healthcare Entrance Machines and Healthcare Voting Machines.
(F) General info about:
(i) Starting Grants
(ii) Diminished Grants
(iii) Extended Grants
(iv) The Bureau of Vital Healthcare
(v) The Server for Vital Healthcare
(vi) The Public Transparency Website
(G) Confidentiality requirements as specified in section 218.
(H) Any security procedures the Committee of Vital Healthcare or Bureau of Vital Healthcare may adopt.
(I) Definition of Healthcare Recipients as specified in section 201.
(J) The signing of all applicable agreements pertaining to abortion specified in section 101(c).
(K) Contact information necessary for assistance from the Bureau of Vital Healthcare.
(8) Enforce, or aid in enforcing penalties specified in this title in conjunction with all applicable federal agencies.
(9) Establish fact-checking processes to ensure funds for Starting Grants, Diminished Grants, and Extended Grants are going to the correct Vital Healthcare Agencies, and that all federal monies funded to the Bureau of Vital Healthcare, Committee of Vital Healthcare, and Vital Healthcare Agencies are being properly used.
(10) Ensure proper accounting procedures are in place for Vital Healthcare Agencies, the Bureau of Vital Healthcare, and the Committee of Vital Healthcare.
(11) Oversee regulations and duties of Vital Healthcare Agencies, Medical Feedback Centers, Feedback Center Surveillance Systems, and the Server for Vital Healthcare to ensure said regulations and duties are being fulfilled.
(12) Ensure Medical Feedback Centers are provided with all materials necessary for operation, including working Healthcare Entrance Machines and Healthcare Voting Machines.
(13) Regulate creation and distribution processes of Healthcare Entrance Machines and Healthcare Voting Machines to ensure quality.
(14) Such other duties as the Committee on Vital Healthcare shall specify.

SEC. 217. SERVER FOR VITAL HEALTHCARE
(a) DEFINITIONS.—The term "Server for Vital Healthcare" or "SVH" refers to the online server(s) and the secure facility or facilities housing said server(s), as well as a backup server(s), used for housing and maintaining in all confidentiality the feedback records, Visit Status, and Personally Identifiable Information of Healthcare Recipients for purposes of evaluating grant monies of Vital Healthcare Agencies, coordinating information for use by HEMs and HVMs, and generally providing quality healthcare services to qualified Healthcare Recipients. For purposes of oversight, this shall be considered a department of the Bureau of Vital Healthcare.
(b) DATA COLLECTED, DEFINED.—The following minimal data is to be collected and stored on the Server for Vital Healthcare for purposes of verifying valid Healthcare Recipients and setting levels of Extended Grants and Diminished Grants:
(1) Patient names as specified in section 218(b)(1), 219(b)(2), and section 220(b)(2).
(2) Patient identification numbers as specified in section 218(b)(2).
(3) Barcodes for Healthcare Recipient Cards as specified in section 221(b)(3).
(4) Patient Date of Births as specified in section 218(b)(4) and section 220(b)(2).
(5) Patient Housing Addresses as specified in section 218(b)(2) and section 220(b)(2).
(6) Patient Fingerprint Records as specified in section 201(b)(2).
(7) Patient Visit Status as specified in section 220(b)(5).
(8) Cumulative Average Ratings for the three segments of Healthcare Recipients that voted via Healthcare Voting Machines, as tracked for each and every Vital Healthcare Agency; which process is specified in section 211, and to be separated by the 2-year periods specified in section 210(b).
(9) The number of basic checkups received per fiscal year, as specified in section 203(a)(2).
(10) The number of Well baby and well child exams received per child, as specified in section 203(a)(5).
(11) The number of dosage treatments provided for each individual Sexually Transmitted Disease over a 15-year period, as well as the data of the first dosage treatment, which shall mark the beginning of the 15-year period, as specified in section 203(a)(33) through section 203(a)(38).
(c) DATA TRANSFER.—An important aspect of the Server for Vital Healthcare will be its transmission of data to Healthcare Entrance Machines, Healthcare Voting Machines, and reception areas of Medical Feedback Centers. The Server for Vital Healthcare is to ensure to the best of its ability the constant functioning and accessibility of its data housing and transfer aspects.

SEC. 218. CONFIDENTIALITY
(a) IN GENERAL.—Any employee of the Bureau of Vital Healthcare or its departments, Committee of Vital Healthcare, Medical Feedback Centers, or any other person with access to the storage by such groups of Personally Identifiable Information of Healthcare Recipients, or who assists in the communication with the public on behalf of said organizations for purposes of receiving such Personally Identifiable Information of Healthcare Recipients, who is discovered to be unlawfully disclosing the information of said Personally Identifiable Information of Healthcare Recipients shall be subject to the penalties described in section 552(i) of the Privacy Act of 1974 [5 U.S.C. 552i].
(b) DEFINITION OF PERSONALLY IDENTIFIABLE INFORMATION.—The term "Personally Identifiable Information" or "PII" refers to information that can be used to distinguish or trace an individual's identity and includes, but is not limited to, the following forms of data:
(1) Names, as specified in section 219(b)(2) and section 217(b)(1).
(2) Housing addresses as specified in section 217(b)(5) and section 220(b)(2)..
(3) Fingerprints as specified in section 201(b)(2) and section 217(a)(6).
(4) Date of births as specified in section 217(b)(4) and section 220(b)(2)..
(5) Identification numbers as specified in section 221(b)(2).
(6) Barcodes as specified in 217(b)(3), section 221(b)(3)
(c) TRAINING REQUIREMENT.—All employees of the Bureau of Vital Healthcare, Committee on Vital Healthcare, Server for Vital Healthcare, and Medical Feedback Centers are to be trained on the standards of the Privacy Act of 1974 [5 U.S.C. 552] as relating to data confidentiality and protection of PII, including penalties for disclosure of PII as specified in section 215(b)(6)(G) of the Privacy Act of 1974. The training process shall be determined by the Committee on Vital Healthcare as specified in section 215(b)(5).

PART D—PROCESS OF PROVIDING BASIC HEALTHCARE

SEC. 219. MEDICAL FEEDBACK CENTERS
(a) DEFINITION.—A "Medical Feedback Center" or "MFC" as defined in this Act refers to the public reception area separating a given Vital Healthcare Agency from entrances to the outside of the building. This reception area exists primarily to:
(1) Provide Healthcare Recipient Cards to Healthcare Recipients
(2) Ensure only eligible Healthcare Recipients receive services from the Vital Healthcare Agency in question, and
(3) Provide voting services whereby Healthcare Recipients can evaluate the care received.
(b) DESIGN OF A MEDICAL FEEDBACK CENTER.—The design for the Medical Feedback Centers is to have the following minimum features:
(1) 4-sided as a room, and square or rectangular in shape, with only the opposing ends having accessible entrances. One end is to serve as entrance to the outside, and the other accessing that area of the building containing the Vital Healthcare Agency. There is to be no restriction on required room size for a Medical Feedback Center unless so designated by the Committee on Vital Healthcare.
(2) A reception desk area in the center of the room with at least one working computer terminal, blank Healthcare Recipient Cards, a device for generating names, identification numbers, and barcodes on said Healthcare Recipient Cards, and a fingerprint kit.
(3) An aisle or aisles on the left side of the reception desk area as looking towards the entrance adjoining the Vital Healthcare Agency. This aisle or aisles will be used for entering the Vital Healthcare Agency, and contain at least 2 working and publicly accessible Healthcare Entrance Machines during all operating hours for a given Medical Feedback Center. These machines are to be clearly visible in the entrance aisle(s) to Healthcare Recipients in the Medical Feedback Center.
(4) An aisle or aisles on the right side of the reception desk area as looking towards the entrance adjoining the Vital Healthcare Agency. This aisle or aisles will be used for exiting the Vital Healthcare Agency, and contain at least 2 working and publicly accessible Healthcare Voting Machines during all operating hours for a given Medical Feedback Center. These machines are to be clearly visible in the exit aisle(s) to Healthcare Recipients in the Medical Feedback Center, although obscuring objects are allowed for placement between the HVMs and the Feedback Center Surveillance System, as specified in section 224(b)(2).
(5) Posters stating in both English and Spanish, "Vote here on your Hospital experience with your Healthcare Recipient Card", are to be placed in plain view on the wall of a Medical Feedback Center beside each Healthcare Voting Machine.
(c) ADDITIONAL SPECIFICATIONS.—The following specifications must be met by Vital Healthcare Agencies:
(1) Medical Feedback Centers must be placed at all public entrances, excluding those used for emergency room entrance purposes.
(A) Additional entrances are allowed for emergency use, so long as they are reserved for Healthcare Recipients requiring ambulatory care, and those well enough to leave through a Medical Feedback Center are directed to leave through a Medical Feedback Center, provided a Healthcare Recipient Card if they do not already have one, and informed of the voting booths on their way out.
(2) A Medical Feedback Center may serve as both a lobby and a Medical Feedback Center so long as all requirements of section 207(b) are met.
(A) Multiple entrances from the outside into a Medical Feedback Center are permitted so long as they are along the wall opposing the entrance into the Vital Healthcare Agency.
(B) A Medical Feedback Center dually serving as a lobby for its Vital Healthcare Agency (it may not serve as a lobby or have inter-connecting access ways to for any area of the building serving as a Hospital, as opposed to a Vital Healthcare Agency) is free to ask additional questions of Healthcare Recipients for the intent of providing healthcare services.
(3) A Medical Feedback Center's outside entrance or entrances are not required to directly access the outside part of the building. Up to one room is allowed between each entrance and the outside part of the building, provided that the only doorways in these rooms are to the outside part of the building and to the Medical Feedback Center.
(4) Additional security personnel and/or security measures may be utilized as necessary.

SEC. 220. DUTIES OF THE FEEDBACK CENTER REPRESENTATIVE
(a) DEFINITION.—A "Feedback Center Representative" or "FCR" as defined in this Act refers to an on-site representative of the Bureau of Vital Healthcare overseeing a Medical Feedback Center for purposes of ensuring quality healthcare services are being provided.
(b) DUTIES.—A Feedback Center Representative's desk is to be located in the center of a Medical Feedback Center, staffed by no less than one Feedback Center Representative and have all materials ascribed to it in section 219(b)(2). The job duties of the Feedback Center Representative or Representatives are as follows:
(1) Check citizenship status for those without Healthcare Recipient Cards via the process stated in section 201(b)(1). Those who are verified as U.S. citizens are to be given a personalized Healthcare Recipient Card as specified in section 221.
(2) Record into the Server for Vital Healthcare the full Name, Date of Birth, and Housing Address of the Healthcare Recipient receiving a new Healthcare Recipient Card.
(3) Fingerprint those who receive a Healthcare Recipient Card and have said fingerprints scanned into the Server for Vital Healthcare according to the process specified in section 201(b)(2).
(4) Provide Healthcare Recipient Cards to patients who entered through an emergency exit, and inform them of their right to vote with those cards as specified in section 219(c)(1)(A).
(5) If the patient will be receiving healthcare services during the visit, record the Healthcare Recipient's Visit Status as 'Active' as opposed to 'Inactive' on the Server for Vital Healthcare.
(6) If dually serving as a lobby, ask for and record/input any additional information required by the Vital Health Agency, as specified in section 219(c)(2)(B).

SEC. 221. HEALTHCARE RECIPIENT CARDS

(a) DEFINITION.—The term "Healthcare Recipient Card" refers to the card issued to a Healthcare Recipient entering a VHA through a Medical Feedback Center that will allow him or her to evaluate the services received upon leaving and quickly receive medical access in the future.
(b) DESIGN.—Healthcare Recipient Cards are to be 3.5 inches long and 2 inches wide. Healthcare Recipient Cards are to have machine-inscribed upon them the following information for each individual patient:
(1) The patient's name,
(2) A unique system-assigned identification number, and
(3) A scannable barcode specific to each Healthcare Recipient.

SEC. 222. HEALTHCARE ENTRANCE MACHINES

(a) DEFINITION.—The term "Healthcare Entrance Machine" or "HEM" refers to those machines in the entrance aisle of a Medical Feedback Center allowing for rapid access to services via scanning of a Healthcare Recipient Cards and fingerprint scans.
(b) DESIGN.—The Committee on Vital Healthcare shall no later than December 31st, 2012 specify a standard design for Healthcare Entrance Machines. The Committee on Vital Healthcare shall have the right to update this standard at any time.
(c) STANDARD FEATURES.—All Healthcare Entrance Machines are to have the following features:
(1) A user-friendly interface.
(2) Language selection upon startup.
(3) Card reading device for insertion and subsequent reading of Healthcare Recipient Cards for purposes of verifying identity as a Healthcare Recipient.
(4) Fingerprint-scanning device for purposes of verifying identity as the valid bearer of said Healthcare Recipient Card.
(5) Screen verification in the language selected upon startup of either accepted card verification and subsequent access to healthcare services, or rejected card verification and subsequent denial to healthcare services.
(6) Data transfer capability for ready transfer of data to Healthcare Voting Machines of Visit Status and to the Server for Vital Healthcare for the time of visit.
SEC. 223. HEALTHCARE VOTING MACHINES
(a) DEFINITION.—The term "Healthcare Voting Machine" or "HVM" refers to those machines in the exit aisle of a Medical Feedback Center allowing for easy access to voting and feedback services via scanning of a Healthcare Recipient Card.
(b) DESIGN.—The Committee on Vital Healthcare shall no later than December 31st, 2012 specify a standard design for Healthcare Voting Machines. The Committee on Vital Healthcare shall have the right to update this standard at any time.
(c) STANDARD FEATURES.—All Healthcare Voting Machines are to have the following features:
(1) A user-friendly interface.
(2) Language selection upon startup.
(3) Card reading device for insertion and subsequent reading of Healthcare Recipient Cards for purposes of verifying the bearer recently received healthcare services that warrant feedback.
(4) Data transfer capability for ready transfer of collected information to the Server for Vital Healthcare for the time of visit and from Healthcare Entrance Machines for acknowledgement of a Healthcare Recipient's current Visit Status.
(5) Upon verification of a valid Healthcare Recipient Card for a Healthcare Recipient and selection of a language, submission of the following questions in the designated language:
(A) "Did this Vital Healthcare Agency/Hospital provide you with good healthcare service?" This question is to be accompanied with the following voting options; each assigned a rating of 1-5, with (i) being 1 point and (v) being 5 points, and is to be the first question asked:
(i) "Definitely not, the VHA provided horrible healthcare service to me."
(ii) "No, the VHA provided bad healthcare service to me."
(iii) "I am not sure."
(iv) "Yes, the VHA provided good healthcare service to me."
(v) "Very much so, the VHA provided excellent healthcare service to me."
(B) "Should this VHA/Hospital receive more or less government funding?" This question is to be accompanied by the following voting options; each assigned a rating of 1-5, with (i) being 1 point and (v) being 5 points, and is to be the second question asked:
(i) "Yes, the VHA should receive more government funding."
(ii) "No, the current funding level for this VHA is appropriate."
(iii) "No, this VHA should have less government funding."
(iv) "I am not sure."
(C) Any additional questions that the Bureau on Vital Healthcare may choose to ask of all Healthcare Recipients across the United States or a given region, such as "Should illegal immigrants have access to healthcare services?" or "Should abortion be government-funded by this healthcare system?"
(6) An additional form for purposes of allowing Healthcare Recipients to submit complaints and/or feedback to the Bureau of Vital Healthcare.

PART E—PUBLIC ACCOUNTABILITY STRUCTURE

SEC. 224. FEEDBACK CENTER SURVEILLANCE AS ASSURANCE OF PROPER VOTING PROCESS
(a) DEFINITION.—The term "Feedback Center Surveillance System" or "FCSS" refers to the video camera or system of video cameras stationed within a Medical Feedback Center for purposes of ensuring Vital Healthcare Agencies, staff of said Vital Healthcare Agencies, or other obstacles are not interfering with the rights of Healthcare Recipients to medical access and feedback pertaining to that access.
(b) CAMERA SYSTEM REQUIREMENTS.—The following requirements apply to Feedback Center Surveillance Systems:
(1) Every Medical Feedback Center is required to have at least two video camera angled to view the reception desk, the Healthcare Entrance Machines, and the Healthcare Voting Machines.
(2) There must not be visibility of Healthcare Voting Machines such that the screens and thus information/feedback of Healthcare Recipients is visible. The primary objective is ensuring that Healthcare Recipients are able to access the HEMs and HVMs, not to observe the HVM itself. If screens of HVMs will otherwise be visible, either the camera locations should be changed or an obscuring object placed between the camera and the screens of the Healthcare Voting Machines in question.
(3) The FCSS is required to record footage of the designated area of the Medical Feedback System during all operating hours of the Vital Health Agency.
(4) Camera footage must show the real-time info for the date and time of footage as it was being recorded.
(c) PENALTIES.—Tampering of this system by a Vital Healthcare Agency, an employee of a Vital Healthcare Agency, or any other person may be subject to the fines and term of imprisonment specified in section 201(c).
(d) WEBSITE UPLOAD.—All footage must be uploaded to the Server for Vital Healthcare no later than one month from the time of the oldest recorded footage yet to be uploaded.



SEC. 225. PUBLIC TRANSPARENCY WEBSITE
(a) IN GENERAL.—The Server for Vital Healthcare and Bureau of Vital Healthcare shall oversee creation of a new government website, www.bvh.gov, for purposes of allowing Healthcare Recipients to review FCSS video footage that the processes in this Act might be kept publicly transparent and accountable, of providing Healthcare Recipients with an additional, accessible voting option, and providing such other information sources as may prove beneficial for the public understanding of the Bureau of Vital Healthcare.
(b) DESIGN.—The website is to have the following features:
(1) An online version of the Healthcare Voting Machine's format, with the language selection feature specified in section 223(c)(2), the questions specified in section 223(c)(5), and the feedback form specified in section 223(c)(6). For verification purposes, the website should require input by a Healthcare Recipient of their name, identification number (which number is specified in section 221(b)(2)), and date of visit to the Vital Healthcare Agency.
(2) Online storage of video surveillance footage for each Medical Feedback Center as specified in section 224(d). This footage is to be freely accessible to the public. Additionally, there is to be a search engine that will allow online users to easily locate their Vital Healthcare Agency, and thus its video footage archives, by zip code search.
(3) An updated list of current Vital Healthcare Agencies, searchable by zip code and entering a given street address and search radius to receive a list of VHAs within that radius.
(4) An updated list of the Hospitals currently applying to become Vital Healthcare Agencies that are not yet approved.

SEC. 226. ENCOURAGEMENT OF CITIZEN WATCHDOG GROUPS
Citizen watchdog groups and the general public are encouraged to provide oversight, comments on, and accountability for the public transparency website. As such, comments, opinions, and public participation are to be strictly protected from regulation apart from removing comments for purposes of profanity, pornography, racism, sexism, spamming, hacking, advertising/solicitation, and comments suggesting or supporting illegal activities.

TITLE III. PRIVATE SECTOR

SEC. 301. MAINTAINING THE CURRENT PRIVATE SECTOR
All Hospitals and providers of healthcare or social services currently authorized to operate under U.S. law are free to continue offering medical services. Public sector/Private Sector Hospitals, as defined in this Act, can operate in the same building, so long as both areas are definitively separated from each other per section 207(b)(1).

TITLE VI—TORT REFORM

SEC. 401. HOSPITAL LAWSUITS
(a) EFFECTIVE DATE.—Upon passage of this Act as law, the losing party in a lawsuit against a Hospital or Hospital employee will be required to pay the other's legal fees in addition to any court sentencing, with such sum not to exceed $5,000.
(b) SHARING OF RESPONSIBILITY FOR A VHA BASED UPON HOURS WORKED.—Employees of a Vital Healthcare Agency found at fault by a court of law for malpractice are to have the cost of such court-decided fees shared by the Vital Healthcare Agency they worked for at the time of the incident in the following manner:
(1) 5% of the malpractice fees will be paid for by the VHA for whom the employee worked at the time of the incident if the employee at fault worked at least 60 hours in the 7 day period involving the incident (with the last day the day of the incident, and then counting the 6 days previous).
(2) An additional 5% of the malpractice fees are to be paid by the VHA for whom the employee worked at the time of the incident for each additional 5 hours that the employee worked above 60 hours. 10% of the malpractice fees are to be paid if the employee worked 65 hours in the 7 day period, 15% if the employee worked 70 hours in the 7 day period, etc.

SEC. 402. EMPLOYEE HOURS
(a) RESTRICTION AGAINST OVERWORK REQUIREMENTS.—To avoid overwork, and subsequent dangers to a patient, no employee at a Vital Healthcare Agency may be required to work more than 16 hours in a day.
(b) VIOLATION PENALTIES.—VHA supervisors/employers found to be coercing and/or requiring VHA employees to work beyond this time period will be subject to a $10,000-$100,000 fine and/or 1 year in prison if convicted by a court of law.
SEC. 403. ACCOUNTABILITY FOR PUBLIC OFFICIALS
(a) BAN ON PUBLIC OFFICE FOR CONVICTED OFFICIALS.—Any judge, district attorney, or prosecutor henceforth found guilty of any crime above a misdemeanor shall be barred from running for public office for a period of 15 years, unless the decision is overturned.
(b) HARSHER SENTENCING FOR CASE MISHANDLING.—Any judge, district attorney, or prosecutor found guilty of mishandling a case so that an innocent person is convicted will be subject to cumulative prison terms of those persons wrongfully convicted, and those found innocent pardoned and paid $50,000 per year of imprisonment. This monetary fee will be first exacted from the estate of the judge(s)/prosecutor(s)/district attorney(s) found guilty, and the remainder to be paid by the federal government.
(c) ALLOWANCE FOR JUDGES TO SPEAK PUBLICLY ON BELIEFS.—Judges running for reelection will be henceforth allowed to speak publicly about their opinions on political issues and general mindset towards judicial decision-making for purposes of providing voters with the information necessary to make educated decisions about whether or not to re-elect them. No rule by the American Bar Association or any other organization outside of the U.S. government may be esteemed as punishing a judge for expressing their opinions on judicial philosophy or political or religious beliefs given the need for the American people to understand the nature of their judges, and the simple facts that impartiality neither includes nor implies lack of human opinions, and no purely human, judicial law is so thorough as to remove the elements of interpretation and thus opinion and personal conviction.


SEC. 404. JUDICIAL TRANSPARENCY WEBSITE
(a) NEW WEBSITE SECTIONS.—This section authorizes the creation of new website pages on www.uscourts.gov, www.uscourts.gov/judgelinks and www.uscourts.gov/prosecutorlinks, whereby citizens can search for a judge via name, court type, or geographic location, and for a prosecutor by name, court type, or geographic location. These website pages shall appear in substance similar to the page at www.uscourts.gov/courtlinks, but instead provide as search results links to the profiles of judges and prosecutors. This system is to have the following features:
(1) Profiles for judges are to show hyperlinks to recent court decisions made by the judge and hyperlinks of all overturned court decisions in which that judge had made the initial decision only to have it later overturned in a retrial. Each case shown should be hyperlinked to the respective case summary for it on www.pacer.psc.uscourts.gov.
(2) Profiles for prosecutors are to show as a percentage the number of cases won out of total cases, hyperlinks to recent cases, and hyperlinks to recently lost cases. Each case shown should be hyperlinked to the respective case summary for it on www.pacer.psc.uscourts.gov.

TITLE V—PROVIDING SUBSIDIES FOR MEDICAL EDUCATORS

SEC. 501. PREREQUISITES FOR MEDICAL INSTRUCTORS TO RECEIVE SUBSIDIES
(a) PURPOSE.—The purpose of this section is to provide suitable payment for instructors in medical education.
(b) REQUIREMENTS.—To be eligible for a government subsidy, an educator must first meet the following requirements:
(1) Either be:
(A) Currently certified as a CNA (Certified Nursing Assistant), or
(B) Currently certified as a medical professional by the ABMS (American Board of Medical Specialties)
(2) Be certified to teach at the college level.

SEC. 502. SUBSIDY FORMULATION FOR MEDICAL INSTRUCTORS
(a) IN GENERAL.—Medical instructors who meet the requirements of section 501(b) to be eligible for a government subsidy shall be eligible to receive from the Department of Labor one of the following amounts, annually, based upon experience in their field, so long as they remain employed by a college as an instructor in medical education for a given year:
(1) If having 2-3 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $30,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $35,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $40,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(2) If having 4-5 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $40,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $45,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $50,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(3) If having 5-6 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $50,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $55,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $60,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(4) If having 6-7 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $60,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $65,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $70,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(5) If having 7-8 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $70,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $75,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $80,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(6) If having 9-10 combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $80,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $85,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $90,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(7) If having 11 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, a subsidy of $90,000 is to be provided by the Department of Labor for those with less than 4 years of education towards a teaching degree, a subsidy of $95,000 is to be provided by the Department of Labor for those with 4-7 years of education towards a teaching degree, and a subsidy of $100,000 is to be provided by the Department of Labor for those with 8 or more years of education towards a teaching degree.
(b) ADMINISTRATION.—The Department of Labor is hereby mandated, upon passage of this Act, to begin creation of an office by which those medical professionals specified in this section may receive the aid specified herein, as well as those measures necessary to adequately provide the amounts to those individuals who qualify to receive them.


SEC. 503. CAP ON SUBSIDY-INCREASED SALARIES
The subsidies mentioned in section 502 may only bring an educator's before taxes net earnings to $200,000, no more. Any educator who receives subsidy amounts above said level will be required to return it for collection by the Internal Revenue Service, which is hereby authorized to collect it and take such measures as are normatively appropriate for such collection.

SEC. 504. FINANCIAL AID FOR MEDICAL PROFESSIONALS SEEKING TO BECOME EDUCATORS
(a) IN GENERAL.—A Certified Nursing Assistant, or medical professional currently certified by the American Board of Medical Specialties, that has 2 or more years of experience in his or her respective medical professions, will henceforth be eligible to receive federal aid of up to 70% towards a bachelor's degree in teaching or a BSN, so long as he or she maintains a GPA of 2.50 or higher.
(b) ADMINISTRATION.—The Federal Student Aid office of the U.S. Department of Education is hereby mandated, upon passage of this Act, to begin creation of a form by which those medical professionals specified in this section may receive the aid specified herein, as well as those measures necessary to adequately provide the amounts to those individuals who qualify to receive them.
(c) FORMULATION OF AMOUNTS.—Those medical professionals meeting the qualifications of section 504(a) are eligible to receive aid through the method determined by the U.S. Department of Education specified in section 504(b), and to receive one of the following amounts if eligible:
(1) If having 2 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 20% financial aid towards tuition.
(2) If having 4 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 30% financial aid towards tuition.
(3) If having 6 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 40% financial aid towards tuition.
(4) If having 8 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 50% financial aid towards tuition.
(5) If having 10 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 60% financial aid towards tuition.
(6) If having 12 or more combined years of experience as a CNA or as a medical professional certified by the American Board of Medical Specialties, 70% financial aid towards tuition.
(d) CONDITIONS.—The amounts specified in section 504(c) shall apply at full value to those postsecondary institutions and programs considered accredited by the U.S. Department of Education, and at half value to all other institutions and programs.

TITLE VI—HEALTH INSURANCE REGULATION

SEC. 601. BAN ON OWNERSHIP IN TOBACCO AND NICOTINE COMPANIES
(a) IN GENERAL.—All health insurance companies are hereby banned from stock ownership of all tobacco and nicotine companies that exist for non-cessation purposes.
(b) PENALTIES.—Beginning on January 1st, 2012, companies who violate this rule will be subject to a fine equivalent to half the stock value in U.S. dollars of that held in all combined tobacco and nicotine companies which exist for non-cessation purposes, as enforced by the U.S. Department of Commerce.
SEC. 602. RESTRICTIONS ON PRE-EXISTING CONDITIONS
Upon passage of this Act, health insurance companies may not discriminate against those seeking coverage on the basis of pre-existing conditions, apart from those conditions that have occurred via willful, high-risk lifestyle choices to indulge in partaking of harmful extraneous substances such as tobacco, nicotine, marijuana, and alcohol.

TITLE VII—APPROPRIATIONS

SEC. 701. THE VITAL HEALTHCARE FUND
(a) ESTABLISHMENT OF FUND.—Subchapter A of chapter 98 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
"(1) IN GENERAL—There is established within the Treasury of the United States a trust fund for healthcare services and related costs specified and authorized by this Act to be known as the "Vital Healthcare Fund", consisting of such amounts as may be appropriated or credited to the Vital Healthcare Fund.
"(2) TRUSTEES.—The trustees of the Vital Healthcare Fund shall be the Secretary of the Treasury, the Secretary of Labor, and the Under Secretary of Education.
"(b) ALLOCATION OF FUNDS.—There are hereby appropriated to the Vital Healthcare Fund from the Treasury of the United States, out of any moneys not appropriated elsewhere, amounts equivalent to:
"(1) $450,000,000,000 for fiscal year 2010.
"(2) $500,000,000,000 for fiscal year 2011.
"(3) $525,000,000,000 for fiscal year 2012.
"(4) $550,000,000,000 for fiscal year 2013.
"(5) $575,000,000,000 for fiscal year 2014.
"(6) $600,000,000,000 for fiscal year 2015.
"(7) $625,000,000,000 for fiscal year 2016.
"(8) $650,000,000,000 for fiscal year 2017.
"(9) $675,000,000,000 for fiscal year 2018.
"(10) $700,000,000,000 for fiscal year 2019.".

Tuesday, September 1, 2009

JZ's Critical Analysis of the Accusations Against the Healthcare Bill

Alright, I get some conservative newsletters, including one from Human Events.com, who just sent me the following article, titled "I Read the Heath-Scare Bill & Obama Is Lying!", apparently in turn from something called 'AMERIPAC', or American Political Action Committee. Oddly enough, I could only find the article posted on the internet here and here, although it was just sent out recently.

At any rate, they were decent enough to cite page sources, but unfortunately I also disagree with their interpretations of what the bill actually says, and since I am reading the bill myself as well, will post their comments and evaluate them for accuracy, or make my own observations about the bill's truly negative elements.

It is imperative that any false claims about the bill be called out and debunked by conservatives, so that when the truth inevitably comes out about their falseness, people do not assume the valid claims (such as the bill's pro-abortion agenda - see my earlier post, 'Obama v. Obama on Abortion in Healthcare Bill') are false as well.

Unfortunately many of the claims being leveled by the conservative crowd against the bill have some basis for objection, but are clouded in exaggerative language that turns them into half-truths.

Follow me on a tour through this bill's exact wording and the very real criticisms, and exaggerations, surrounding it.


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

From the newsletter:
"1. Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory! He will control your living wills"

Status: Partially True.

What the Bill Actually Says:


‘‘Advance Care Planning Consultation
‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
‘‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
‘‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
‘‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
‘‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
‘‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
‘‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—
‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
‘‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
‘‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—
‘‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
‘‘(III) provides training for health care professionals across the continuum of care
about the goals and use of orders for life sustaining treatment; and
‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.


Analysis: Do you see what they did? The bill says,

"regarding advance care planning... Such consultation shall include the following... An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses."

From that they assumed that because living wills are being explained to you in a consultation the government will 'control' them. The government will 'control' them in that they are presenting you with the information every 5 years, and it is a bit concerning that government officials are presenting you with information about how to live the end of your life (gee - hopefully they don't show too much bias in suggesting care for poor old people as opposed to rich ones).

However, it is a bit misleading to state that simply by presenting the information about living wills they are controlling the whole process.

From a simple reading of the bill's language as I understand it, the aim is only to guide Americans in making informed decisions about end of life care and to help them have instructions in place, possibly to prevent another Terry Schiavo situation resulting from a lack of proper documentation about one's end of life wishes. Whether the government having control of that is a good idea or even will work, is a whole other matter.

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From the newsletter:
"2. Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get (Unions are EXEMPTED)"

Status: Mostly True.

What the Bill Actually Says:


SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(2) CHAIR.—The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.
(3) MEMBERSHIP.—The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:
(A) 9 members who are not Federal employees or officers and who are appointed by the President.
(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.
(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint. Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.
(4) TERMS.—Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.
(5) PARTICIPATION.—The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.
(b) DUTIES.—
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(2) DEADLINE.—The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) PUBLIC INPUT.—The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED.—In this subtitle, the term ‘‘benefit standards’’ means standards respecting—
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).
(5) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS.—
(A) ENHANCED PLAN.—The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(B) PREMIUM PLAN.—The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(c) OPERATIONS.—
(1) PER DIEM PAY.—Each member of the
Health Benefits Advisory Committee shall receive travel expenses, including per diem in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code, and shall otherwise serve without additional pay.
(2) MEMBERS NOT TREATED AS FEDERAL EMPLOYEES.—Members of the Health Benefits Advisory Committee shall not be considered employees of the Federal government solely by reason of any service on the Committee.
(3) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the Health Benefits Advisory Committee.
(d) PUBLICATION.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.


Analysis: Yes, there is a government committee. However, the key word in the bill's language is 'recommend'. It does not decide the benefits, but knowing government systems, it is quite possible that it could end up being looked to as authoritative so that government systems simply defer to accepting their opinion in almost all cases.

Nevertheless, it is misleading to say the Committee will decide the benefits. According to the bill's language, they will only make recommendations... which as the bill states will then be publicized in the following manner: "The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section."

Look, does it disturb me that the president, an unabashedly pro-choice President who supports the most immoral form of abortion, murdering new-born children who survive late-term abortions, is supporting a bill that gives him the right to appoint 2/3 of a committee that in turn would carry major weight in determining medical plans, and the committee head, Kathleen Sebelius (head of the Department of Health and Human Services) was also appointed by him?

Yeah. You can bet your bottom dollar it bugs me. Knowing Obama, he's probably letting Planned Parenthood submit their merry list of applicants and is just waiting to approve whatever names they send him, given his close companionship with their agency of death.

However, to be fair, this claim was a bit misleading.

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

From the newsletter:
"3. Pg 42 of HC Bill - The Health Choices Commissioner will choose your HC Benefits for you. You have no choice! Government, not you, will decide what health care you are allowed."

Status: Somewhat True.

What the Bill Actually Says:


SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.
(a) DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.

(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
(b) PROMOTING ACCOUNTABILITY.—
(1) IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange.
(2) COMPLIANCE EXAMINATION AND AUDITS.—
(A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance.
(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.
(c) DATA COLLECTION.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services.
(d) SANCTIONS AUTHORITY.—
(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
(2) REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—
(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act;
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;
(C) in the case of an Exchange-participating health benefits plan, suspension of payment to the entity under the Health Insurance Exchange for individuals enrolled in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur; or
(D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title.
(e) STANDARD DEFINITIONS OF INSURANCE AND MEDICAL TERMS.—The Commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.
(f) EFFICIENCY IN ADMINISTRATION.—The Commissioner shall issue regulations for the effective and efficient administration of the Health Insurance Exchange and affordability credits under subtitle C, including, with respect to the determination of eligibility for affordability credits, the use of personnel who are employed in accordance with the requirements of title 5, United States Code, to carry out the duties of the Commissioner or, in the case of sections 208 and 241(b)(2), the use of State personnel who are employed in accordance with standards prescribed by the Office of Personnel Management pursuant to section 208 of the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728).


Analysis: Does the bill really say you don't get to pick your benefits? I am sure plans will still be available allowing you to mix and match benefits. However, it is true that the Commissioner would be able to 'set the standards', or in other words the essential requirements that all healthcare plans must have. In this sense, he is controlling the benefits you can have, which is why I label this claim 'somewhat' true.

And as Obama has already said, he considers abortion an 'essential benefit' or standard, and is very likely to appoint a commissioner who shares those and other radical views. If you're prepared for a lot of ideological liberal agendas as part of a government system determining what medical benefits are available to you, by all means support Obama's bill. I on the other hand will refrain from doing so.

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

From the newsletter:
"4. PG 50 Section 152 in HC bill - HC will be provided to ALL non US citizens, illegal or otherwise Obama wants illegal aliens covered, with YOU paying"

Status: False, with some concerns.

What the Bill Actually Says:


SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE.
(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(b) IMPLEMENTATION.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance
coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.


Analysis: Pretty straightforward. The authors of the conservative newsletter jumped to the conclusion that the phrasing about providing healthcare 'without regard to personal characteristics' was so inclusive as to include illegal immigrants.

However, the bill specifically states later in Sec. 246,

"SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."

So there goes that theory... Almost. Like I said though, there are still a few concerns. For a bill that goes out of its way to clarify the exact ways of enforcing things with the exact rules of how many members a committee should have, what their job duties are, and how to carry them out, it completely left out any kind of enforcement legislation here on HOW this is to be accomplished.

As Mariano Castillo of CNN in her article, "Health care bill has curious coverage for illegal immigrants", points out about the findings of a recent federal study, "While the report found that federal subsidies to obtain health coverage would be restricted to U.S. citizens and legal residents, it also noted that the bill does not specify a citizenship verification system, something that critics say creates a loophole for undocumented immigrants to receive subsidies anyway."

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

From the newsletter:
"5. Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Only Americans will pay) Illegal aliens get health care FREE."

Status: True about tax exemptions, false about free health care.

What the Bill Actually Says:


‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.
‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed
a tax equal to 2.5 percent of the excess of—
‘‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over
‘‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
‘‘(b) LIMITATIONS.—
‘‘(1) TAX LIMITED TO AVERAGE PREMIUM.—
‘‘(A) IN GENERAL.—The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.
‘‘(B) APPLICABLE NATIONAL AVERAGE PREMIUM.—
‘‘(i) IN GENERAL.—For purposes of subparagraph (A), the ‘applicable national average premium’ means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.
‘‘(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL.—In the case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting ‘family coverage’ for ‘self-only coverage’.
‘‘(2) PRORATION FOR PART YEAR FAILURES.— The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the 10amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as—
‘‘(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to
‘‘(B) the entire taxable year.
‘‘(c) EXCEPTIONS.—
‘‘(1) DEPENDENTS.—Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as 24
such taxable year.
‘‘(2) NONRESIDENT ALIENS.—Subsection (a) shall not apply to any individual who is a non-resident alien.
‘‘(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES.—Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.
‘‘(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES.—Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.
‘‘(5) RELIGIOUS CONSCIENCE EXEMPTION.—
‘‘(A) IN GENERAL.—Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
‘‘(B) EXEMPTION.—An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate.
‘‘(d) ACCEPTABLE COVERAGE REQUIREMENT.—
‘‘(1) IN GENERAL.—The requirements of this subsection are met with respect to any individual for any period if such individual (and each qualifying child of such individual) is covered by acceptable coverage at all times during such period.
‘‘(2) ACCEPTABLE COVERAGE.—For purposes of this section, the term ‘acceptable coverage’ means any of the following:
‘‘(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan (as defined in section 100(c) of the America’s Affordable Health Choices Act of 2009).
‘‘(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER GRANDFATHERED EMPLOYMENT-BASED HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America’s Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).
‘‘(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
‘‘(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act.
‘‘(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).— Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
‘‘(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran’s Affairs and the Health Choices Commissioner, based on the individual’s priority for services as provided under section 1705(a) of such title.
‘‘(G) OTHER COVERAGE.—Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.
‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.—
‘‘(1) QUALIFYING CHILD.—For purposes of this section, the term ‘qualifying child’ has the meaning given such term by section 152(c).
‘‘(2) BASIC PLAN.—For purposes of this section, the term ‘basic plan’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009.
‘‘(3) HEALTH INSURANCE EXCHANGE.—For purposes of this section, the term ‘Health Insurance Exchange’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009, including any State-based health insurance exchange approved for operation under section 208 of such Act.
‘‘(4) FAMILY COVERAGE.—For purposes of this section, the term ‘family coverage’ means any coverage other than self-only coverage.
‘‘(5) MODIFIED ADJUSTED GROSS INCOME.— For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income—
‘‘(A) determined without regard to section 911, and
‘‘(B) increased by the amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.
‘‘(6) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for 18
purposes of section 55.
‘‘(f) REGULATIONS.—The Secretary shall prescribe such regulations or other guidance as may be necessary or appropriate to carry out the purposes of this section, including regulations or other guidance (developed in coordination with the Health Choices Commissioner) which provide—
‘‘(1) exemption from the tax imposed under subsection (a) in cases of de minimis lapses of acceptable coverage, and
‘‘(2) a process for applying for a waiver of the application of subsection (a) in cases of hardship.’’.
(b) INFORMATION REPORTING.—
(1) IN GENERAL.—Subpart B of part III of subchapter A of chapter 61 of such Code is amended by inserting after section 6050W the following new section:


Analysis: Yes, the bill says no taxes on illegal immigrants. Obviously the assumption is that because they don't get the healthcare, they can't be taxed for it. As the previous point showed, they aren't supposed to get affordability credits for the healthcare under this bill. However, the lack of provision in the bill for verifying their citizenship means some might be able to pass themselves off as citizens and then not pay taxes.

Logically you'd think they'd still get caught. And I don't think Obama had any ulterior motive here for allowing this either. They just didn't really care about stopping illegal immigrants from getting it and just made a half-hearted attempt to prevent it to silence future criticism, unless I miss my guess, and this potential loophole is the result. Logically, if Obama doesn't care about unborn children, what possible affinity could he have for illegal immigrants? Unless of course you buy into the theory that he is one I suppose.

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

From the newsletter:
"6. Pg 241 Line 6-8 HC Bill - Doctors, doesn't matter what specialty you have, you'll all be paid the same Government gets to set pay rates-this guarantees fewer specialized doctors, mandating a lower quality of care. "

Status: False about paying physicians the same, but is instead creating a new category to ensure payment of abortion doctors.

What the Bill Actually Says:


Subtitle B—Provisions Related to Part B
PART 1—PHYSICIANS’ SERVICES
SEC. 1121. SUSTAINABLE GROWTH RATE REFORM.
(a) TRANSITIONAL UPDATE FOR 2010.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) is amended by adding at the end the following new paragraph:
‘‘(10) UPDATE FOR 2010.—The update to the single conversion factor established in paragraph (1)(C) for 2010 shall be the percentage increase in the MEI (as defined in section 1842(i)(3)) for that year.’’.

(b) REBASING SGR USING 2009; LIMITATION ON CUMULATIVE ADJUSTMENT PERIOD.—Section 1848(d)(4) of such Act (42 U.S.C. 1395w–4(d)(4)) is amended—
(1) in subparagraph (B), by striking ‘‘subparagraph (D)’’ and inserting ‘‘subparagraphs (D) and (G)’’; and
(2) by adding at the end the following new subparagraph: ‘‘(G) REBASING USING 2009 FOR FUTURE UPDATE ADJUSTMENTS.—In determining the update adjustment factor under subparagraph (B) for 2011 and subsequent years—
‘‘(i) the allowed expenditures for 2009 shall be equal to the amount of the actual expenditures for physicians’ services during 2009; and
‘‘(ii) the reference in subparagraph (B)(ii)(I) to ‘April 1, 1996’ shall be treated as a reference to ‘January 1, 2009 (or, if later, the first day of the fifth year before the year involved)’.’’.
(c) LIMITATION ON PHYSICIANS’ SERVICES INCLUDED IN TARGET GROWTH RATE COMPUTATION TO SERVICES COVERED UNDER PHYSICIAN FEE SCHEDULE.—Effective for services furnished on or after January 1, 2009, section 1848(f)(4)(A) of such Act is amended striking ‘‘(such as clinical’’ and all that follows through ‘‘in a physician’s office’’ and inserting ‘‘for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services)’’.
(d) ESTABLISHMENT OF SEPARATE TARGET GROWTH RATES FOR CATEGORIES OF SERVICES.—
(1) ESTABLISHMENT OF SERVICE CATEGORIES.—Subsection (j) of section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended by adding at the end the following new paragraph:
‘‘(5) SERVICE CATEGORIES.—For services furnished on or after January 1, 2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’:
‘‘(A) Evaluation and management services that are procedure codes (for services covered under this title) for— ‘‘(i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009, and as subsequently modified by the Secretary); and ‘‘(ii) preventive services (as defined in section 1861(iii)) for which payment is made under this section.
‘‘(B) All other services not described in subparagraph (A).




Analysis: Tough to tell what's really going on here, isn't it? This will be tough to follow, as this gets into some serious legalese and mumbo jumbo; but I will try to break it down. First, some definitions:

-SGR, or Sustainable Growth Rate, according to Investopedia, means "The maximum growth rate that a firm can sustain without having to increase financial leverage."

-MEI, or Medicare Economic Index, according to Medtronic, is defined as "Used to update Medicare payments, the MEI is a measure of general and medical inflation. Under the new system the MEI is used to update the conversion factors used to transform relative value units into dollar payment amounts. The increases are subject to limits imposed by the Medicare Volume Performance Standards which require payment cuts if service volume grows beyond a certain point."

Now, why would they be talking about the MEI and Physician Fee Schedules? The CMS (Centers for Medicaid and Medicare Services) have an article on their website titled "EFFECT OF THE MEDICARE ECONOMIC INDEX (MEI) ON THE PHYSICIAN UPDATE" that helps those of us who aren't medical professions understand the issue, and states:

"The Medicare Physician Fee Schedule (MPFS) is updated on an annual basis according to a formula specified by statute. The formula specifies that the update for a year is equal to the Medicare Economic Index (MEI) adjusted up or down depending on how actual expenditures compare to a target rate, called the sustainable growth rate, or SGR. The SGR in turn is calculated based on medical inflation, the projected growth in the domestic economy, projected growth in the number of beneficiaries in fee-for-service Medicare, and changes in law or regulation.
The MEI is a measure of inflation faced by physicians with respect to their practice costs and general wage levels. The MEI includes a bundle of inputs used in furnishing physicians’ services such as physician’s own time, non-physician employees’ compensation, rents, medical equipment, etc. The MEI measures year-to-year changes in prices for these various inputs based on appropriate price proxies."

So it seems the bill is setting new categories indeed for how physicians can be paid. However, if you check (d)(1) in the above language, you'll note the key word is 'amended'. They are looking to change one specific part of a part of the U.S. Code and adding some language about making new categories for 'Evaluation and Management' and 'preventive services', and then what appears a catch-all for any other services of 'all other services not described in subparagraph(A)'.

Here is the wording of that section from the U.S. Code mentioned in the bill, which you can read for yourself here (Hint: It's about 3/4 down the page):


(j) Definitions.—In this section:

(1) Category.—For services furnished before January 1, 1998, the term “category” means, with respect to physicians' services, surgical services (as defined by the Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)), and all other physicians' services. The Secretary shall define surgical services and publish such definitions in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians.

(2) Fee schedule area.—The term “fee schedule area” means a locality used under section 1842(b) for purposes of computing payment amounts for physicians' services.[250]

(3) Physicians' services.—The term “physicians' services” includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(oo)(2)), (2)(R) (with respect to services described in subparagraphs (B), (C), and (D) of section 1861(pp)(1)), (2)(S), (2)(W), 2(AA),[251] (3), (4), (13) (14) (with respect to services described in section 1861(nn)(2)), and (15) of section 1861(s) (other than clinical diagnostic laboratory tests and, except for purposes of subsections (a)(3), (g), and (h) such other items and services as the Secretary may specify).

(4) Practice expenses.—The term “practice expenses” includes all expenses for furnishing physicians' services, excluding malpractice expenses, physician compensation, and other physician fringe benefits.

So, why would Obama be trying to add a new paragraph below this? Apparently it goes back to his abortion agenda. If the U.S. Code did not previously allow for those providing 'preventive services' or abortions to be paid with government money; or at least mandate it, Obama would want to change that, right?

And how will they be paid? They will be lumped in together with the salaries of "Evaluation and management" according to the bill above. Sneaky Obama, he really cares about his abortion services, doesn't he? It appears Obama was worried that the U.S. Code's language was being used to prevent payments to doctors performing abortions, or would be used, and took steps to change the law's wording.

Then, just in case there was any way that still wasn't enough, he threw in an ambiguous phrase at the end, 'all other services', to provide a basis for them to dispute any attempt not to pay them with government funds.

However, with regards to the original subject, this does not appear to be about paying all physicians the same, but rather creating a new payment category for those who perform abortions to be paid at the same rate of those in Evaluation or Management.


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

From the newsletter:
"7. PG 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing! City of Hope and other cancer hospitals controlled by government--very young and elderly, due to other parts of Obamacare, will be forced to die since they will not be allowed health care."

Status: Completely false.

What the Bill Actually Says:


SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
‘‘(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.—
‘‘(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).
‘‘(B) AUTHORIZATION OF ADJUSTMENT.—
Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.’’.



Analysis: The specified Section of the U.S. Code, 1833(t), which this bill wants to add a new paragraph to, is a very lengthy section called "(t) Prospective Payment System for Hospital Outpatient Department Services" that goes into detail about how hospitals are to be funded. It is about 60% of the way down the page as seen here.

The specified section of the U.S. Code, 1886(d)(1)(B)(v), which this bill wants to be looked at in the study, has the following text as seen here (about 25% of the way down the page):


(v)(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause[626], is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer,

(II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1814(b), that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before the date of the enactment of this subclause), that as of the date of the enactment of this subclause, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or

(III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998, that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1814(b), that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of the date of the enactment of this subclause, is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E);


However, unless I misread this, when the bill says "Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011." what it is actually saying is that cancer hospitals will be paid MORE if their costs are higher - not less.

There may be valid criticisms of the bill, but this certainly does not appear to be one.


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From the newsletter:
"8. They will teach you to die. PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens and end of life."

Status: False.

What the Bill Actually Says:


‘‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
‘‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).


Analysis: I already addressed this in point 1, so I won't belabor this. However, I disagree with the interpretation that a consultation about "life sustaining treatment... to make informed decisions... so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes" is the same thing as "They will teach you to die."

Again, I think this may have been included with the Terry Schiavo case in mind, so that those who reach such a situation will already have expressed their views.
I can only imagine the people who wrote this bill put such inflammatory and exaggerated statements because they secretly like the idea of willing euthanasia, and allowing anyone to refuse life-sustaining treatment, regardless of the circumstances.

Which is a whole other issue, whether physician-assisted suicide should be permitted. While government officials could give inappropriate advice, ideally you would think such instances would ensure government punishment. Simply from the bill's wording, there is no reason to think this is anything but an attempt to have a person's wishes expressed about end of life care.

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From the newsletter:
"9. They will stop assistance to special needs children. Pg 354 Sec 1177 - Government will RESTRICT enrollment of Special needs people!"

Status: Completely False.

What the Bill Actually Says:


SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT.
(a) IN GENERAL.—Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘January 1, 2011’’ and inserting ‘‘January 1, 2013 (or January 1, 2016, in the case of a plan described in section 1177(b)(1) of the America’s Affordable Health Choices Act of 2009)’’.
(b) GRANDFATHERING OF CERTAIN PLANS.—
(1) PLANS DESCRIBED.—For purposes of section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)), a plan described in this paragraph is a plan that had a contract with a State that had a State program to operate an integrated Medicaid-Medicare program that had been approved by the Centers for Medicare & Medicaid Services as of January 1, 2004.
(2) ANALYSIS; REPORT.—The Secretary of Health and Human Services shall provide, through a contract with an independent health services evaluation organization, for an analysis of the plans described in paragraph (1) with regard to the impact of such plans on cost, quality of care, patient satisfaction, and other subjects as specified by the Secretary. Not later than December 31, 2011, the Secretary shall submit to Congress a report on such analysis and shall include in such report such recommendations with regard to the treatment of such plans as the Secretary deems appropriate.


Analysis: As the title suggests, this is just the extension of an already-existent piece of legislation. The first part is clearly just changing the time period by a few more years for something about to expire in 2011 so that it lasts 2-5 more years.

Now, why there's a restriction on enrollment I have no idea. It could've been legislated for good reasons or bad. Until some news piece can be found for why this legislation was introduced, it's tough to say. However, this bill itself is just extending the legislation's term of enforcement and requiring some report on the findings.

UPDATE: After some searching, I found this very thorough and understandable article on the website of the Department of Health and Human Services, "FEDERAL AUTHORITY FOR MEDICAID SPECIAL NEEDS PLANS AND THEIR RELATIONSHIP TO STATE MEDICAID PROGRAMS".

As the article states,


"In response to concerns that many SNPs have not, in fact, been offering specialty models of care, federal legal authority has been amended twice recently, first in December 2007 as part of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007, and again by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 in July 2008.2 The Congressional actions of December 2007 and July 2008, coming less than a year apart, resulted in a one-year freeze in the program, but also extended the program’s authority from the original sunset date of December 31, 2008 to the current end date of December 31, 2010. When the Centers for Medicare and Medicaid Services (CMS) resumes accepting applications in 2009 for contract year 2010, new requirements will be in place, but unless federal authority is further extended, the revised program will have only one year to run. Figure 1 provides major points in the evolution of SNP authority."


In other words, legislation created SNPs, or Special Needs Plans for the disabled, but due to some complications and difficulties with them, they were not going to be extended beyond 2010. For them to continue, federal authority would have to be extended so they could keep going.

In short, the bill does not appear to be removing funding for Special Needs Plans, but on the contrary to be extending the life of legislation that created them.

Political Reason