Medicare for All

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Medicare for All
Medicare for All.
Everybody In. Nobody Out.

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March 2010 Law: Section-by-Section Analysis
of the Affordable Care Act of 2010

PPACA/HCERA (“Affordable Care Act” or “Obamacare”)

This is the detailed analysis.
Also see the main web page about the March 2010 Law

 

Costs. In the tables below, we documented in column "Impact = Higher Costs" (that is, Higher Insurance Premiums and/or Higher Out-of-Pocket Cost) the actions that are either definitely going to increase those costs or likely going to increase those costs.

Taxes. Similarly, we have documented in column "Impact = Higher Taxes" the actions that are either definitely going to increase taxes or likely going to increase taxes.

 

Introduction to the Analysis

Scope. This report is based primarily on the almost 300 provisions in Parts 1 through 5  out of the roughly 390 provisions of so-called Affordable Care Act.. There is also some analysis of Parts 6 through 10.

            What this report is: an evaluation of the impact of the law on costs and taxes.

            What this report is not: an explanation of the timeline of the law’s implementation,
                                   which started in 2010,
                                   implements major changes in 2014 and
                                   is scheduled to be completed by 2018/2019.

Column 1: Section
The section’s title
… plus an excerpt of the section’s summary description, if we included an excerpt
… plus Our added comment in italics and parentheses, if we added a comment.

   [X]: About sections marked with an [X] in the first column:
          These are for sections that are clearly NOT required for
          either the implementation of or operation of Medicare for All
          (More of the sections might find into this category. The sections marked [X] make up a bare minimum group of over 130 examples, which include sections that are clearly going to increase costs and/or increase taxes.)

Column 2: Impact of Higher Costs
Insurance premiums and out-of-pocket costs will increase due to insurance companies following over 50 sections of the law, since they must have increased revenues in order to balance their increased costs of operation.

Column 3: Impact of Higher Taxes
… due to the enforcement responsibilities of the government (federal or federal plus 50 states) to enforce (meaning enforce, manage or monitor/report) almost all of the sections of the law.
… due to the expansion of the Internal Revenue Service (IRS) to handle the sections of the law that require action by the IRS.
… due to the responsibilities of the government and the states to perform roles and responsibilities as defined in most sections of the law.
… due to the government having over 150 programs, funds (and funding programs), commissions, advisory boards, councils, offices, centers and other government or government-supported entities that are either added or renewed/continued by the new law.

Intrusions: sections marked with an [A] in the third colum
       
These are actions that may be considered by some people as government intrusions on citizens’ lives.
        To review these do a search for [A] via your web browser. For example, Ctrl-F to find [A].

Special notes: sections marked with an [N] in any of this report
       
These are special notes of explanation.
        To review these do a search for [N] via your web browser. For example, Ctrl-F to find [A].
        An example of this is the identification of "Cadillac" health insurance plans,
        a term that is heavily used about the law, but is not mentioned in the law.

Summary Regarding the Tables Below. The tables of information below document the reasons: what sections of the Affordable Care Act of 2010 will cause burdens of higher costs and higher taxes on Americans due to an incredible increase of complexity to an already complex way for a nation to pay for health care. Note: this combination of higher costs and higher taxes will significantly increase the interest in most companies to transfer their business needs and operations to countries other than the United States.

If this is your first time here, please review the Guide and Glossary
Examples from Guide and Glossary
  Govt. = federal government or federal and state governments
  HHS = Health and Human Services, often referenced as "Secretary" for the HHS Secretary
  Ins. cos. = health insurance companies
  resp. = responsibility defined in the section
  States = state governments
  For remaining information go to the Guide and Glossary

Section-by-Section Analysis
 
of the March 2010 Law ("Obamacare")

Sections of the law and their impact:
Part 1    Part 2    Part 3    Part 4    Part 5    Parts 6-10


Affordable Care Act Part 1
(officially named "Title I")

Quality, Affordable Health Care for All Americans

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums
and/or Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
"A" in [brackets]: Actions that may be considered by some people as government intrusions on citizens’ lives.
Sec. 2711. No lifetime or annual limits.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.(2)
Govt. via HHS must fulfill resp.
Sec. 2712. Prohibition on rescissions.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2713. Coverage of preventive health services.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2714. Extension of dependent coverage
— until age 26, on parent’s health insurance..
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2715. Development of uniform explanation of coverage documents and standardized definitions.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 2715A. Provision of additional information.
 [X]
Ins. cos. must fulfill resp.
 
Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 2716. Prohibition of discrimination in favor of highly compensated individuals.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Sec. 2717. Ensuring quality of care.
 [X]

Requires ins. cos. to report information to HHS.
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— reporting to the govt.
Sec. 2718. Bringing down the cost of health care coverage.
 [X]
Ins. cos. must follow regulation:
— spend 80-85% of premium dollars on paying for health care services (see details in law)
Hospitals must follow regulation:
— publish standard charges.
Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 2719. Appeals process.
 [X]
 
Ins. cos. must fulfill resp.
(new plans)
Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 2719A. Patient protections.
— related to selection of providers and the use of emergency service
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 1002. Health insurance consumer information.
 [X]
  States must fulfill resp.
Govt. program with grants:
— consumer assistance
Sec. 1003. Ensuring that consumers get value for their dollars.
 [X]
Ins. cos. must fulfill resp. Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt. program with grants:
— review premium increases.
Govt. reimbursement data centers.
Sec. 1101. Immediate access to insurance for people with a preexisting condition.
 [X]
Ins. cos. must fulfill resp. Govt. program: temporary insurance
Sec. 1102. Reinsurance for early retirees.
 [X]
Ins. cos. must fulfill resp. Govt. program: temporary insurance.
Sec. 1103. Immediate information that allows consumers to identify affordable coverage options.
 [X]
  Govt. project: a website to allow selection of  private health ins.
Sec. 1104. Administrative simplification
 [X]
(Our comment: Medicare already has this in place.)
Ins. cos. must fulfill resp.
Providers must fulfill resp.
Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— standards and rules for electronic transactions
Govt. committee to review standards
Sec. 2701. Fair health insurance premiums.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2702. Guaranteed availability of coverage.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2703. Guaranteed renewability of coverage.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
10 states must fulfill resp.
Govt. demo. program:
— prohibit discrimination
Sec. 2706. Non-discrimination in health care.
— regarding providers
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2707. Comprehensive health insurance coverage.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2708. Prohibition on excessive waiting periods.
 [X]  (This is waiting time to get covered by a health insurance plan.)
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 2709. Coverage for individuals participating in approved clinical trials.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 1251. Preservation of right to maintain existing coverage.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and group health plans.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Sec. 1253. Annual report on self-insured plans.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via Labor Sec. must fulfill resp.
Sec. 1254. Study of large group market.
 [X]
  Govt. via HHS must fulfill resp.
Govt. study: large group market
Sec. 1301. Qualified health plan defined.
 [X]
Ins. cos. must fulfill resp. Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 1302. Essential health benefits requirements.
— specifies details regarding: all plans; individual and group markets; and catastrophic plans in the individual market
 [X]
Ins. cos. must fulfill resp. Govt. via HHS must fulfill resp.
— defines the essential health benefits
Sec. 1303. Special rules (abortions).
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Sec. 1304. Related definitions.
— small group market: 1-100 employees
— large group market: over 100 employees
 [X]
  Govt. must enforce this section.
States must fulfill resp.
Sec. 1311. … choices of health benefit plans.
 [X]
(States must establish exchanges for the selection and purchase of health insurance plans.)
Ins. cos. must fulfill resp. Govt. program with grants
— help establish exchanges
States must fulfill resp.
Govt. program with grants.
— consumer navigators.
Govt. via HHS must fulfill resp.
Govt. via Labor Sec. must fulfill resp.
Sec. 1312. Consumer choice.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 1313. Financial integrity.
 [X]
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt. via GAO must fulfill resp.
Sec. 1321. State flexibility in operation and enforcement of Exchanges and related requirements.
 [X]
  Govt. via HHS must fulfill resp.
States must fulfill resp.
  — or else HHS will
Sec. 1322. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. [(Consumer Operated and Oriented Plan (CO-OP)].
 [X]
Member-run nonprofits must fulfill resp. Govt. must enforce this section.
Govt. advisory board.
Govt. program with grants and loans:
— CO-OP
Sec. 1323. Funding for the territories.
 [X]
  Govt. funding for territories increased.
Sec. 1324. Level playing field.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Sec. 1331. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt. program: state basic health plan programs.
Sec. 1332. Waiver for State innovation. (up to 5 years starting in 2017)
 [X]
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 1333. Provisions relating to offering of plans in more than one State.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 1334. Multi-State Plans. (Via this provision, FEHBP is maintained for federal employees, including members of Congress.)
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via OPM must fulfill resp.
States must fulfill resp.
Govt. program: FEHBP
Sec. 1341. Transitional reinsurance program for individual and small group markets in each State.
— regarding high-risk individuals
 [X]
  Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt program:
— state-based reinsurance.
Sec. 1342. Establishment of risk corridors for plans in individual and small group markets.
 [X]
(Our comment: This provision specifies that payments will be made from the federal government directly to health insurance companies and vice versa.)
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. program:
— risk corridors
Govt. via HHS must fulfill resp.
Govt. via HHS makes direct payments to ins. cos. and vice versa.
Sec. 1343. Risk adjustment.
 [X]
(Our comment: This provision specifies that payments will be made from the states directly to health insurance companies and vice versa.)
Ins. cos. must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Sec. 1401. Refundable tax credit providing premium assistance for coverage under a qualified health plan.
 [X]
Ins. cos. must fulfill resp. Govt. must amend IRS code.
Subsection of Sec. 1401:
Sec. 36B. Refundable credit for coverage under a qualified health plan.
 [X]
Ins. cos. must fulfill resp. Govt. tax credits.
Govt. program:
— premium assistance
States must fulfill resp.
Govt. study by Comptroller General.
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans.
 [X]
Ins. cos. must fulfill resp. Govt. via HHS must fulfill resp.
Govt. program:
— cost-sharing assistance: direct payments to ins. cos.
Sec. 1411. Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions.
 [X]
Ins. cos. must fulfill resp. Govt. via HHS must fulfill resp.
Govt. program:
— decide each person’s eligibility to participate in an exchange.
Sec. 1412. Advance determination and payment of premium tax credits and cost-sharing reductions.
 [X]
  Govt. must enforce this section.
States must fulfill resp.
Govt. program:
— decide each person’s eligibility to receive advance payment of premium tax credits and cost-sharing reductions
Sec. 1413. Streamlining of procedures for enrollment through an Exchange and State Medicaid, CHIP, and health subsidy programs.
 [X]
("… system shall ensure that if an individual applying to an Exchange is found through screening to be eligible … , (then) the individual is enrolled for assistance under such plan or program." bolding was added)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program:
— decide each person’s eligibility to participate in a state health subsidy program

[A] Automatic (mandated/forced) enrollment of citizens
— into Medicaid and CHIP
Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.
 [X]
  [A] Govt. disclosure of citizen tax info to whatever governmental departments, persons or databases that need to determine eligibility for this health-care-NOT-for-all system.
      
(See Guide and Glosssary).
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for Federal and Federally-assisted programs.
 [X]
  Govt. must enforce this section.
Sec. 1416. Study of geographic variation in application of FPL.
 [X]
  Govt. via HHS must fulfill resp.
Govt. study.
Sec. 1421. Credit for employee health insurance expenses of small businesses.
 [X]
  Govt. must amend IRS code.
Sec. 1421 sub-section:
Sec. 45R. Employee health insurance expenses of small employers.
 [X]

 
Govt. must enforce this section.
States must fulfill resp.
Govt. tax credits.
Sec. 1501. Requirement to maintain minimum essential coverage.
 [X]
  Govt. must enforce this section.
[A] Citizens mandated/forced to pay for health insurance, unless eligible for a government program, such as Medicaid or CHIP.
Sec. 1501 sub-section
Sec. 5000A. Requirement to maintain minimum essential coverage.
 [X]
  Citizens must have health insurance in 2014.
Govt. penalizes citizens who don’t.
Sec. 1502. Reporting of health insurance coverage.
 [X]
  Govt. must amend IRS code.
sub-section of Sec. 1502 
Sec. 6055. Reporting of health insurance coverage.
 [X]
Ins. cos. must fulfill resp.
Employers must fulfill resp.
Govt. must enforce this section.
States must fulfill resp.
Govt. via IRS must fulfill resp.
— receive health ins. coverage info.
Sec. 1511. Automatic enrollment for employees of large employers.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
[A] Automatic (mandated/forced) enrollment of new employees
— when more than 200 employees 
Sec. 1512. Employer requirement to inform employees of coverage options.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Sec. 1513. Shared responsibility for employers.
— related to employers who do not offer coverage
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Govt. via Labor Sec. must fulfill resp.
Sec. 1514. Reporting of employer health insurance coverage.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. via HHS collects citizen coverage info. from employers.
Sec. 1515. Offering of Exchange-participating qualified health plans through cafeteria plans.
 [X]
  Govt. must amend IRS code.
Sec. 1515 subsection:
Sec. 125(f)(3). Certain Exchange-participating health plans not qualified.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Sec. 1551. Definitions.
 [X]
  Govt. via HHS must fulfill resp.
Sec. 1552. Transparency in government.   Govt. via HHS must fulfill resp.
Sec. 1553. Prohibition against discrimination on assisted suicide.
 [X]
  Govt. via HHS must fulfill resp.
Sec. 1554. Access to therapies.
 [X]
  Govt. via HHS must fulfill resp.
Sec. 1555. Freedom not to participate in Federal health insurance programs.
 [X]
  Govt. must enforce this section.
Sec. 1556. Equity for certain eligible survivors.
 [X]
  Govt. funding expanded.
Sec. 1557. Nondiscrimination.
 [X]
Ins. cos.  must fulfill resp. Govt. must enforce this section.
Sec. 1558. Protection for employees.
 [X]
Employers must fulfill resp. Govt. must enforce this section.
Sec. 1559. Oversight.
 [X]
  Govt. via HHS must fulfill resp.
Sec. 1560. Rules of construction.
— including a special provision for Hawaii
 [X]
  Govt. via HHS must fulfill resp.
Sec. 1561. Health information technology enrollment standards and protocols.
 [X]
  Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt. program with grants:
— implementation of enrollment standards and protocols
Sec. 1562. GAO study regarding the rate of denial of coverage and enrollment by health insurance issuers and group health plans.
 [X]
  Govt. via GAO must fulfill resp.
Govt. study.
Sec. 1563. Conforming amendments.
 [X]
  Govt. must fulfill resp.
Sec. 1563. Small business procurement.
 [X]
  Govt. must enforce this section.

 

 

 


Affordable Care Act Part 2 
(officially named "Title II")

Role of Public Programs

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums and/or
Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
"A" in [brackets]: Actions that may be considered by some people as government intrusions on citizens’ lives.
Sec. 2001. Medicaid coverage for the lowest income populations.
 [X]-Medicaid
— "
Eligible individuals include: all non-elderly, non-pregnant individuals who are not entitled to Medicare (e.g., childless adults and certain parents). Creates a new mandatory Medicaid eligibility category for all such “newly-eligible” individuals with income at or below 133 percent of the Federal Poverty Level (FPL) beginning January 1, 2014. Also, as of January 1, 2014, the mandatory Medicaid income eligibility level for children ages six to 19 changes from 100 percent FPL to 133 percent FPL."
  Govt. must enforce this section.(2)
States must fulfill resp.
Govt. program:
— new state option
— specific eligibility requirements defined temporarily
Govt. funding expanded temporarily.
[A] Automatic (mandated/forced)
enrollment of citizens
— into Medicaid
Sec. 2002. Income eligibility for nonelderly determined using modified adjusted gross income.
(Comment: applies new regulations for  income disregards and asset tests.)
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
State program:
— premium assistance
Sec. 2004. Medicaid coverage for former foster care children.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
[A] Automatic (mandated/forced)
enrollment of former foster care
children — into Medicaid
Sec. 2005  was replaced with another provision (1323).. .  
Sec. 2006. Special adjustment to FMAP determination for certain States recovering from a major disaster.
 [X]-Medicaid


(FMAP = Federal Medical Assistance Percentage)
  Govt. via HHS must fulfill resp.
States must fulfill resp.
Govt. funding increased:
— FMAP
Sec. 2007. Medicaid Improvement Fund (MIF) rescission.
 [X]-Medicaid
  Govt. funding rescinded for 5 yrs.:
— MIF
States must fulfill resp.
Sec. 2101. Additional Federal financial participation for CHIP.
 [X]-CHIP
Ins. cos.  must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. funding increased:
— CHIP
Govt. program with grants:
— outreach and enrollment
Sec. 2102. Technical corrections.
 [X]-CHIP
  Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 2201. Enrollment simplification and coordination with State Health Insurance Exchanges.
(Comment: enrollments will occur at same website as the Exchanges.)
 [X]-Medicaid and CHIP
  Govt. must enforce this section.
States must fulfill resp.
Sec. 2202. Permitting hospitals to make presumptive eligibility determinations for all Medicaid eligible populations.
 [X]-Medicaid
Hospitals must follow regulation if option conducted. Govt. must enforce this section.
States must fulfill resp.
Sec. 2301. Coverage for freestanding birth center services.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Companies contracted by states to manage Medicaid  must fulfill resp.
Govt. via HHS must fulfill resp.
Sec. 2302. Concurrent care for children.
 [X]-Medicaid
(regarding hospice services)
  Govt. must enforce this section.
States must fulfill resp.
Sec. 2303. State eligibility option for family planning services.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Sec. 2304. Clarification of definition of medical assistance.   Govt. via HHS must fulfill resp.
States must fulfill resp.
Sec. 2401. Community First Choice Option.
— regarding beneficiaries with disabilities
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Sec. 2402. Removal of barriers to providing home and community-based services.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. program:
— HCBS
Sec. 2403. Money Follows the Person Rebalancing Demonstration.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. demo. project extended
Sec. 2404. Protection for recipients of home and community-based services against spousal impoverishment.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. program:
— HCBS
Sec. 2405. Funding to expand State Aging and Disability Resource Centers.
(ADRC = Aging and Disability Resource Center)
  Govt. via HHS must fulfill resp.
Govt. program expanded: ADRC
Sec. 2406. Sense of the Senate regarding long-term care.
(simply a statement by the U.S. Senate; not counted as a provision)
   
Sec. 2501. Prescription drug rebates.
 [X]-Medicaid
Drug manufacturers must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program expanded:
— drug rebates
Sec. 2502. Elimination of exclusion of coverage of certain drugs.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program expanded:
— additions to Medicaid drug list
Sec. 2503. Providing adequate pharmacy reimbursement.
 [X]-Medicaid
Pharmacies must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 2551. Disproportionate share hospital payments.
 [X]-Medicaid
Hospitals to receive more revenue. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. funding: planned decrease is reduced
Govt. program:
— DSH

Sec. 2601. 5-year period for demonstration projects.
 [X]-Medicaid
(
for Medicaid dual eligible beneficiaries).

 

  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project:
— dual eligible beneficiaries
Sec. 2602. Providing Federal coverage and payment coordination for dual eligible beneficiaries.
 [X]-Medicaid
(Our comment: This provision brings together officials of Medicare and Medicaid regarding the topic of dual eligible beneficiaries, who are persons who qualify for both programs).
 
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. office: (new)
— CMS Coordinated Health Care Office
Sec. 2701. Adult health quality measures.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— quality measurement
Sec. 2702. Payment adjustment for health care-acquired conditions.
(Comment: No Medicaid payments when the condition was acquired due to receiving health care.)
 [X]
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Sec. 2703. State option to provide health homes for enrollees with chronic conditions. [A health home is a team of medical professionals.]
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp. when option taken
Govt. via HHS must fulfill resp.
Govt. program: (new)
Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization.
 [X]-Medicaid
  Govt. must enforce this section.
8 States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— Medicaid bundled payments
Sec. 2705. Medicaid global payment system demonstration project.
 [X]-Medicaid
  Govt. must enforce this section.
5 States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— Medicaid global payment system
Sec. 2706. Pediatric Accountable Care Organization demonstration project.
(Medicaid)
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo project: (new)
— pediatric ACO
Sec. 2707. Medicaid emergency psychiatric demonstration project.
 [X]-Medicaid
  Govt. must enforce this section.
8 States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— Medicaid emergency psychiatric care
Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.
 [X]-Medicaid
(Medicaid and CHIP Payment Access Commission)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. commission MACPAC:
Sec. 2901. Special rules relating to Indians.
 [X]
Ins. cos.  must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
IHS and I/T/Us must fulfill resp.
Sec. 2902. Elimination of sunset for reimbursement for all Medicare Part B services furnished by certain Indian hospitals and clinics.
 [X]
  Govt. funding extended:
— IHS and I/T/U
States must fulfill resp.
Sec. 2951. Maternal, infant, and early childhood home visiting programs.   Govt. must enforce this section.
States must fulfill resp.
Tribes must fulfill resp.
Territories must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— home visiting
Sec. 2952. Support, education, and research for postpartum depression.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— postpartum depression
Sec. 2953. Personal responsibility education.
(abstinence and contraception)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— abstinence, contraception, related
Sec. 2954. — See 2953. — Funding for 2953.   See 2953.
Sec. 2955. Inclusion of information about the importance of having a health care power of attorney in transition planning for children
aging out of foster care and independent living programs.
  Govt. must enforce this section.
States must fulfill resp.

 

 


Affordable Care Act Part 3 
(officially named "Title III")

Improving the Quality and Efficiency of Health Care

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums
and/or Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
"A" in [brackets]: Actions that may be considered by some people as government intrusions on citizens’ lives.
Sec. 3001. Hospital value-based purchasing program. Hospitals must fulfill resp. Govt. must enforce this section.(2)
Govt. via HHS must fulfill resp.
Govt. program: (new)
— hospital VBP
Sec. 3002. Improvements to the physician quality reporting initiative. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program extended:
— PQRI
Govt. program: (new)
— Maintenance of Certification
Sec. 3003. Improvements to the physician feedback program. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— physician feedback
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, inpatient psychiatric hospitals and hospice programs. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— quality measure reporting
Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.

Specified provider must fulfill resp.

 

Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— quality measure reporting
Sec. 3006. Plans for a value-based purchasing program for skilled nursing facilities and home health agencies. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— value-based purchasing
Sec. 3007. Value-based payment modifier under the physician fee schedule.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— payment system (Medicare)
Sec. 3008. Payment adjustment for conditions acquired in hospitals.   Govt. must enforce this section.
Hospitals must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— Medicare payment penalties
Govt. report by HHS:
— possible expansion of this program
Sec. 3011. National strategy.
to improve the delivery of health care services, patient health outcomes, and population health.
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— national strategy with website
Sec. 3012. Interagency Working Group on Health Care Quality.   Govt. via the President must fulfill resp.
Govt. working group:(new)
— health care quality
Sec. 3013. Quality measure development.   States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. via AHRQ and CMS to fulfill resp.
Govt. program: (new)
— quality measures
Sec. 3014. Quality measurement.
— Medicare
  States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— quality measures
Sec. 3015. Data Collection; Public Reporting. Providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:  (new)
— data collection; public reporting
Sec. 3021. Establishment of Center for Medicare & Medicaid Innovation within CMS.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. center:  (new)
— control costs and improve care
Sec. 3022. Medicare shared savings program.
Regarding Accountable Care Organizations (ACO’s).
Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— rewards for cost-control and quality-of-care
Govt. study:
— possible implementation of payment models
Sec. 3023. National (voluntary) pilot program on payment bundling.
— to potentially improve patient care and reduce spending.
Providers who participate must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. pilot program: (new)
— payment bundling
Sec. 3024. Independence at home demonstration program.
— to potentially improve care and reduce spending for chronically-ill Medicare beneficiaries
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program:  (new)
— control costs and improve care (Medicare)
— home-based primary care teams
Sec. 3025. Hospital readmissions reduction program. Hospitals must fulfill their resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:  (new)
— hospital readmissions reduction
Sec. 3026. Community-based care transitions program.
— Medicare
Hospitals and community-based entities which participate must fulfill their resp.. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:  (new)
— transition services
Sec. 3027. Extension of gainsharing demonstration.
… evaluate arrangements between hospitals and physicians designed to improve the quality and efficiency of care
Hospitals and providers who participate must fulfill their resp.. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program:  (extended)
— improve quality and efficiency
Sec. 3101. was repealed and replaced.    
Sec. 3102. Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule.
— This increases practitioner fees in rural areas.
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:  (extended)
— geographic index (Medicare)
Sec. 3103. Extension of exceptions process for Medicare therapy caps.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:  (renewed)
— therapy (Medicare)
Sec. 3104. Extension of payment for technical component of certain physician pathology services.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:   (renewed)
— pathology services (Medicare)
Sec. 3105. Extension of ambulance add-ons.
— rural and other areas
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:  (renewed)
— ambulance (Medicare)
Sec. 3106. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:   (renewed)
— long-term care (Medicare)
Sec. 3107. Extension of physician fee schedule mental health add-on.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:
— mental health (Medicare)
Sec. 3108. Permitting physician assistants to order post-hospital extended care services.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3109. Exemption of certain pharmacies from accreditation requirements.
… until HHS develops specific standards
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.   Govt. must enforce this section.
Govt. via TRICARE must fulfill resp.
 
Sec. 3111. Payment for bone density tests.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding restored  (Medicare)
Sec. 3112. Revision to the Medicare Improvement Fund.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding: elimination of remaining amount (Medicare)
Sec. 3113. Treatment of certain complex diagnostic laboratory tests. Providers who participate must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program:  (new)
— complex diagnostic tests (Medicare)
Sec. 3114. Improved access for certified nurse-midwife services.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding increased:
— midwife services (Medicare)
Sec. 3121. Extension of outpatient hold harmless provision.
— Also expanded to include Sole Community Hospitals
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:   (expanded) (Medicare)
Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:  (renewed) (Medicare)
Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.
— Also expanded to additional states and additional rural hospitals
Hospitals which participate must fulfill resp. Govt. must enforce this section.
States that participate must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. program:  (expanded)
— rural comm. hospitals (Medicare)
Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program. Hospitals which participate must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. study:
— what hospitals should be in pgm.
Govt. program:   (extended)
— Medicare-dependent hospitals
Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Hospitals which participate must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program:  (expanded)
— payments to low-volume hospitals (Medicare)
Sec. 3126. Improvements to the demonstration project on community health integration models in certain rural counties. Providers which participate must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo.project:  (expanded)
— test new delivery models (Medicare)
Sec. 3127. MedPAC study on adequacy of Medicare payments for health care providers serving in rural areas.   Govt. must enforce this section.
Govt. via MedPAC must fulfill resp.
Govt. study:
— provider payments in rural areas (Medicare)
Sec. 3128. Technical correction related to critical access hospital services.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. funding: (extended)
— critical access hospitals (Medicare)
Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
 
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants:  (extended)
— delivery system reforms (Medicare)
Sec. 3131. Payment adjustments for home health care. Providers who participate must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. study:
— home health care
Govt. demo. program:
— home health care (Medicare)
Sec. 3132. Hospice reform. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— payment accuracy (Medicare)
Sec. 3133. Improvement to Medicare disproportionate share hospital (DSH) payments.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding decreased
Sec. 3134. Misvalued codes under the physician fee schedule.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. regular reviews:
— fee schedule rates (Medicare)
Sec. 3135. Modification of equipment utilization factor for advanced imaging services.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3136. Revision of payment for power-driven wheelchairs.
 [X]
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— payment no longer via lump-sum (Medicare)
Sec. 3137. Hospital wage index improvement.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:   (extended)
— wage index system (Medicare)
Sec. 3138. Treatment of certain cancer hospitals.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. study:
— then adjust payment if necessary
Sec. 3139. Payment for biosimilar biological products.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3140. Medicare hospice concurrent care demonstration program. Specified providers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program:
— hospice care
Sec. 3141. Application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor.  

 

Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— payment rate set (Medicare)
Sec. 3142. HHS study on urban Medicare-dependent hospitals.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. study:
— determine if added payments needed
Sec. 3143. Protecting home health benefits.
(This is simply a statement by the U.S. Congress.)
   
Sec. 3201. was repealed and replaced.    
Sec. 3202. Benefit protection and simplification.
(Medicare Advantage plans must charge appropriate amounts.)
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3203. was repealed and replaced.    
Sec. 3204. Simplification of annual beneficiary election periods.
— improve enrollment process
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3205. Extension for specialized MA plans for special needs individuals.
 [X]: no need for this privatized part of current Medicare
 
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:  (extended)
— Special Needs Plan
Sec. 3206. Extension of reasonable cost contracts.
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:   (extended)
— cost contracts
Sec. 3207. Technical correction to MA private fee-for-service plans.
 [X]
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— Medicare Advantage (a privatized part of Medicare)
Sec. 3208. Making senior housing facility demonstration permanent.
(Allows "senior housing facility plans.")
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
— Medicare Advantage (a privatized part of Medicare)
Sec. 3209. Authority to deny plan bids.
[Plans must not significantly increase cost sharing or (significantly?) decrease benefits that are offered.]
 [X]: no need for this privatized part of current Medicare
(Our comment: this is clearly an attempt by the government to control the likely sky-rocketing costs that will be required of insurance companies to follow all the law’s regulations and still stay in business.)
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— denial of changes to MA and prescription drug plans (a privatized part of Medicare)
Sec. 3210. Development of new standards for certain Medigap plans.
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS/NAIC must fulfill resp.
Sec. 3301. Medicare coverage gap discount program.
[X]: no need for this privatized part of current Medicare
Drug manufacturers must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— coverage gap discount
— Medicare Part D (a privatized part of Medicare)
Sec. 3302. Improvement in determination of Medicare part D low-income benchmark premium.
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3303. Voluntary de minimis policy for subsidy-eligible individuals under prescription drug plans and MA–PD plans.
 [X]: no need for this privatized part of current Medicare
"The process established … may include, in the case of a part D eligible individual who is a subsidy eligible individual (as defined in section 1860D-14(a)(3)) who has failed to enroll in a prescription drug plan or an MA-PD plan, for the enrollment in a prescription drug plan or MA-PD plan that has waived the monthly beneficiary premium for such subsidy eligible individual under section 1860D-14(a)(5). If there is more than one such plan available, the Secretary shall enroll such an individual under the preceding sentence on a random basis among all such plans in the PDP region. Nothing in the previous sentence shall prevent such an individual from declining or changing such enrollment.”.
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— Medicare Part D (a privatized part of Medicare)

[A] Automatic (mandated/forced) enrollment of citizens
— into a prescription drug plan
Sec. 3304. Special rule for widows and widowers regarding eligibility for low-income assistance.
 [X]
"Allows the surviving spouse … to delay LIS redetermination …"
(Medicare Part D LIS: a privatized part of Medicare)
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3305. Improved information for subsidy-eligible individuals reassigned to prescription drug plans and MA–PD plans.
 [X]
(Our comment: this provision specifies that a communication(s) will occur to subsidized citizens when their prescription drug plan is changed by the government.)
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3306. Funding outreach and assistance for low-income programs.
 [X]
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants:
— communications to citizens (SHIP)
Participating organizations (which have been awarded grants) must fulfill resp.
Sec. 3307. Improving formulary requirements for prescription drug plans and MA–PD plans with respect to certain categories or classes of drugs.
[X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries.
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. subsidies: lower subsidies for higher income
Sec. 3309. Elimination of cost sharing for certain dual-eligible individuals.
 [X]: no need for this privatized part of current Medicare
(Our comment: The law does not specify who will pay the drug costs for these individuals: an insurance company or the government. The answer to this is the government, as per a contact with a Congressional office.)
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. subsidies
Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in long-term care facilities under prescription drug plans and MA-PD plans.
… Requires Part D plans to develop drug dispensing techniques …
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— Medicare Part D and long-term care facilities
Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint system.
 [X]: no need for this privatized part of current Medicare
Requires the Secretary to develop and maintain a plan complaint system to handle complaints regarding Medicare Advantage and Part D plans or their sponsors.
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3312. Uniform exceptions and appeals process for prescription drug plans and MA–PD plans.
 [X]: no need for this privatized part of current Medicare
 
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3313. Office of the Inspector General studies and reports.
… study comparing prescription drug prices paid under … Medicare Part D … (compared to) … State Medicaid programs.
 [X]: no need for this privatized part of current Medicare
(Our comment: this provision is an example of the high degree of complexity resulting from as many as 52+ programs [federal, 50 states, District of Columbia plus territories] when the U.S. could have 1.)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via OIG must fulfill resp.
Govt. study: prices.
Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.
 [X]: no need for this privatized part of current Medicare
Ins. cos. must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 3315. was repealed and replaced.    
Sec. 3401. Revision of certain market basket updates and incorporation of productivity improvements into market basket updates that do not already incorporate such improvements.   Govt. via HHS must fulfill resp.
Govt. program:
— market basket updates (Medicare)
Sec. 3402. Temporary adjustment to the calculation of part B premiums.
 [X]
  Govt. via HHS must fulfill resp.
Sec. 3403. Independent Payment Advisory Board.   Govt. via fulfill resp. by taking action on board’s rec.
Advisory board:  (new)
— objective to control costs and improve care (Medicare)
Sec. 3501. Health care delivery system research; Quality improvement technical assistance.   Govt. must enforce this section.
Govt. via AHRQ must fulfill resp.
Govt. program with grants:  (expanded)
— health care delivery research
Sec. 3502. Grants or contracts to establish community health teams to support the patient-centered medical home.   Govt. must enforce this section.
Participating communities must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— community care teams
Sec. 3503. Grants to implement medication management services in treatment of chronic disease.   Govt. must enforce this section.
Participating health providers  must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants:  (new)
— medication mgmt. services
Sec. 3504. Design and implementation of regionalized systems for emergency care.
 
  Govt. must fulfill resp.
Govt. via Asst. Sec. for Preparedness and Response must fulfill resp.
Govt. pilot projects: (new)
— regional emergency and trauma care
Sec. 3505. Trauma care centers and service availability.   Govt. must enforce this section.
States and trauma centers must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants:
(extended)
— trauma care
Sec. 3506. Program to facilitate shared decisionmaking.
— develop, test, disseminate educational tools
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— educational tools
Sec. 3507. Presentation of prescription drug benefit and risk information.
 … evaluate and determine if use of drug fact boxes … is warranted.
  Govt. via FDA must fulfill resp.
Govt. study.
Sec. 3508. Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program: (new)
— see provision title
Sec. 3509. Office of women’s health. Provides for women’s health offices at various Federal agencies to improve prevention, treatment, and research for women in health programs.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. offices: (new)
— women’s health
Sec. 3510. Patient navigator program.
— assist patients in overcoming barriers to health services.
[X]
(Our comment: eliminate the barriers with Improved Medicare for All!)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. dem. programs with grants.:
(renewed)
— patient navigator services
Sec. 3511. Authorization of appropriations.
(This is simply a statement by the U.S. Congress.)
   
Sec. 3512. GAO study and report on causes of action.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. GAO study:
Sec. 3601. Protecting and improving guaranteed Medicare benefits.
(This is simply a statement by the U.S. Congress.)
   
Sec. 3602. No cuts in guaranteed benefits.
(This is simply a statement by the U.S. Congress.)
   

 

 

 

Affordable Care Act Part 4 (officially named "Title IV")

Prevention of Chronic Disease and Improving Public Health

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums
and/or Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
"A" in [brackets]: Actions that may be considered by some people as government intrusions on citizens’ lives.
Sec. 4001. National Prevention, Health Promotion and Public Health Council.

 

Govt. must enforce this section.(2)
Govt. via the President  must fulfill resp.
Govt. council: (new)
— see provision title
Govt. advisory group: (new)
Advisory Group on Prevention, Health Promotion, and Integrative and Public Health 
Sec. 4002. Prevention and Public Health Fund.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. fund: (new)
— Prevention and Public Health Fund
Sec. 4003. Clinical and community preventive services.
— U.S. Preventive Services Task Force
— Community Preventive Services Task Force
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. task forces’ roles expanded.
Sec. 4004. Education and outreach campaign regarding preventive benefits.
(including a particular focus on Medicaid enrollees in campaigns conducted by states)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. campaign: (new)
— national media campaign plus campaigns in every state re: Medicaid
Sec. 4101. School-based health centers.
 [X]
— for medically-underserved children and families

(Our comment: Only for 4 years. Only for those who apply for the grant and are awarded the grant and only until the program runs out of money within each of the 4 years.)
(Our comment: If such clinics are needed, then why fund them for only 4 years? Why not just let everyone show their card and get care with Improved Medicare for All. Then there will be NO medically-underserved children and families!)
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— school-based clinics
Sec. 4102. Oral healthcare prevention activities.   Govt. via CDC must fulfill resp.
Govt. campaign: (new)
Govt. demo. program: (new)
— oral health & surveillance
Sec. 4103. Medicare coverage of annual wellness visit providing a personalized prevention plan.
— No co-pays or deductibles
Ins. cos. must fulfill resp. for MA plans and Medigap plans Govt. via HHS must fulfill resp.
Sec. 4104. Removal of barriers to preventive services in Medicare.
— Medicare pays 100 percent of cost for most preventive services.
Ins. cos. must fulfill resp. for MA plans and Medigap plans Govt. via HHS must fulfill resp.
Govt. program: Medicare
Sec. 4105. Evidence-based coverage of preventive services in Medicare.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. GAO study.
Govt. program:
— outreach re: preventive services
Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.
— optional by state
 [X]-Medicaid
  Govt. must enforce this section.
States that participate must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program expanded:
— see provision title (Medicaid)
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant women in Medicaid.
 [X]-Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— see provision title (Medicaid)
Sec. 4108. Incentives for prevention of chronic diseases in Medicaid.
 [X]-Medicaid
 
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— chronic diseases
Sec. 4201. Community transformation grants.
 
  Govt. must enforce this section.
Communities that participate must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— prevent and reduce chronic diseases
Sec. 4202. Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. via CDC must fulfill resp.
Govt. pilot program: (new)
— prevention and wellness
Govt. study:
— self-management programs
Sec. 4203. Removing barriers and improving access to wellness for individuals with disabilities.
(ATBCB = Architectural and Transportation Barriers Compliance Board, sometimes called the "Access Board")
Persons responsible for any facility that is related to health care is responsible for following the regulation. Govt. must enforce this section.
Govt. via ATBCB must fulfill resp.
Sec. 4204. Immunizations.
[X]-only need one contract, not the complexity of Sec. 4204
  Govt. must enforce this section.
States which participate must fulfill resp.
Govt. via CDC must fulfill resp.
Govt. via GAO must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. study:
— coverage of vaccines under Medicare Part D
Govt. demonstration program with grants: (new)
— immunizations
State purchase under CDC contracts (expanded)
Sec. 4205. Nutrition labeling of standard menu items at chain restaurants. Businesses must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— nutrition labeling
Sec. 4206. Demonstration project concerning individualized wellness plan.
(for at-risk populations who use community health centers)
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— wellness plans
Sec. 4207. Reasonable break time for nursing mothers. Employers with 50 or more employees must fulfill resp. Govt. must enforce this section.
States must fulfill resp.
Sec. 4301. Research on optimizing the delivery of public health services.
— research, analyze, identify and report on effectiveness of delivering health care services
  Govt. must enforce this section.
Govt. via CDC must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. study: (new)
— best practices annual report
Sec. 4302. Understanding health disparities; data collection and analysis.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— data collection / analysis
Sec. 4303. CDC and employer-based wellness programs.   Govt. must enforce this section.
Govt. via CDC must fulfill resp.
Govt. study: (new)
— best practices
Govt. campaign: (new0
— promote benefits of wellness programs.
Sec. 4304. Epidemiology-Laboratory Capacity Grants.   Govt. must enforce this section.
States/local/tribe agencies must fulfill resp.
Govt. via CDC must fulfill resp.
Govt. program with grants: (new)
— monitor infectious diseases
— control infectious diseases
Sec. 4305. Advancing research and treatment for pain care management.   Govt. must enforce this section.
Govt. via IOM must fulfill resp.
Govt. via NIH must fulfill resp.
Govt. conference:
Govt. consortium: (new)
Govt. program with grants: (new)
— pain care mgmt.
Sec. 4306. Funding for childhood obesity demonstration project.
— relates to CHIP and Medicaid
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— childhood obesity reduction
Sec. 4401. (removed and replaced)    
Sec. 4402. Effectiveness of Federal health and wellness initiatives.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.

 


Affordable Care Act Part 5 
(officially named "Title V")

Health Care Workforce

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums
and/or Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
Actions that may be considered by some people as government intrusions on citizens’ lives.
Sec. 5101. National health care workforce commission.   Govt. must enforce this section.(2)
Govt. via HHS must fulfill resp.
Govt. commission: (new)
— health care workforce
Sec. 5102. State health care workforce development grants.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— plan health care workforce dev.
Govt. program with grants: (new)
— implement health care workforce dev.
Sec. 5103. Health care workforce assessment.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. regional centers: (new)
— primary care workforce analysis
Sec. 5104. Interagency task force to assess and improve access to health care in the State of Alaska.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. task force: (new)
— study Alaska health care
Sec. 5201. Federally supported student loan funds.
— primary care students
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program (expanded):
— primary care student loans
Sec. 5202. Nursing student loan program.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (expanded)
— nursing student loans
Sec. 5203. Health care workforce loan repayment programs.
– "… (for work in a) Health Professional Shortage Area, Medically Underserved Area or serving Medically Underserved Population."
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: loan repayment (new)
— pediatric; mental & behavioral health of children and adolescents
Sec. 5204. Public health workforce recruitment and retention program.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: loan repayment (new)
— public health workforce
Sec. 5205. Allied health workforce recruitment and retention program.
("… located in Health Professional Shortage Areas, Medically Underserved Areas or serving Medically Underserved Populations.")
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: loan repayment (new)
— allied health workforce
Sec. 5206. Grants for States and local programs.   Govt. must enforce this section.
Recipient group(s) must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with scholarships: (new)
— additional training in public or allied health fields
Sec. 5207. Funding for National Health Service Corps.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program expanded:
— Nat. Health Service Corps
Sec. 5208. Nurse-managed health clinics.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— health clinics
Sec. 5209. Elimination of cap on the Commissioned Corps.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program expanded:
— Commissioned Corps
Sec. 5210. Establishing a Ready Reserve Corps.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— Ready Reserve Corps
Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— training as noted in title
Sec. 5302. Training opportunities for direct care workers.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants:  (new)
— training long-term care workers
Sec. 5303. Training in general, pediatric, and public health dentistry.   Govt. must enforce this section..
Govt. via HHS must fulfill resp.
Govt. program with grants:  (new)
— support of dental schools
Sec. 5304. Alternative dental health care provider demonstration project.
— training programs
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. project: (new)
— alternative dental health care
Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric education.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program: (new)
— geriatric education & training
Sec. 5306. Mental and behavioral health education and training grants.
— child and adolescent mental health
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— mental health
Sec. 5307. Cultural competency, prevention, and public health and individuals with disabilities training.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. programs: (expanded)
— working with disabilities
Sec. 5308. Advanced nursing education grants.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants:
— advanced nursing education
Sec. 5309. Nurse education, practice, and retention grants.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— nursing education
Sec. 5310. Loan repayment and scholarship program.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with loans and scholarships:
— nursing faculty
Sec. 5311. Nurse faculty loan program.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: loan repayment  (new)
— nursing faculty
Sec. 5312. Authorization of appropriations for parts B through D of title VIII.
— Public Health Service Act
  Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding:
— nursing programs
Sec. 5313. Grants to promote the community health workforce.   Govt. must enforce this section.
States and other participants must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— community health workers
Sec. 5314. Fellowship training in public health.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants:
— public health
Sec. 5315. United States Public Health Sciences Track.
– Public Health Officers training program
  Govt. must enforce this section.
Govt. via SG must fulfill resp.
Govt. program: (new)
— two year commitment
Sec. 5316. Rural physician training grants.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— rural physicians training
Sec. 5317. Demonstration grants for family nurse practitioner training programs.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program with grants: (new)
— family nurse practitioners
Sec. 5401. Centers of excellence.
— for minority health students
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (extended)
— Centers of Excellence
Sec. 5402. Health professions training for diversity.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. loan repayment and scholarships (expanded)
— primary care providers
Sec. 5403. Interdisciplinary, community-based linkages.
— for awards to health professional students in medically-underserved communities
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
Sec. 5404. Workforce diversity grants.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (expanded)
— nursing support
Sec. 5405. Primary care extension program.   Govt. must enforce this section.
States must fulfill resp.
Govt. via AHRQ (HHS) must fulfill resp.
Govt. program with grants: (new)
— primary care extension
Sec. 5501. Expanding access to primary care services and general surgery services.
— Medicare payment bonus
  Govt. via HHS must fulfill resp.
Govt. funding:
— 10% payment bonus
Sec. 5502. Medicare Federally qualified health center improvements.
 
  Govt. via HHS must fulfill resp.
Govt. program: (new)
— prospective payment system (PPS) for FQHC’s
Sec. 5503. Distribution of additional residency positions.   Govt. via HHS must fulfill resp.
Govt. program:
— manage residency positions
Sec. 5504. Counting resident time in outpatient settings and allowing flexibility for jointly operated residency training programs. Hospitals must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 5505. Rules for counting resident time for didactic and scholarly activities and other activities. Hospitals must fulfill resp. Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Sec. 5506. Preservation of resident cap positions from closed hospitals.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program:
— manage residency positions
Sec. 5507. Demonstration project to address health professions workforce needs; extension of family-to-family health information centers.   Govt. must enforce this section.
Selected states must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. demo. program with grants:
— health info. centers
Govt. funding with grants:
— home care aides
Sec. 5508. Increasing teaching capacity.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants:
— primary care residency
Govt. program:
— training primary care residents
Sec. 5509. Graduate nurse education demonstration program.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. demo. program: (new)
— nurses training
Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs).   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. funding: (extended)
— FQHCs
Sec. 5602. Negotiated rulemaking for development of methodology and criteria for designating medically underserved populations and health professions shortage areas.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. project:
— develop methodology
Sec. 5603. Reauthorization of Wakefield Emergency Medical Services for Children Program.   Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program: (extended)
— children trauma treatment
Sec. 5604. Co-locating primary and specialty care in community-based mental health settings.   Govt. must enforce this section.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— mental health
Sec. 5605. Key national indicators.   National Academy of Sciences must fulfill resp.
Govt. commission: (new)
— regarding key indicators
Sec. 5606. State grants to health care providers who provide services to a high percentage of medically underserved populations or other
special populations.
  Govt. must enforce this section.
States must fulfill resp.
Govt. via HHS must fulfill resp.
Govt. program with grants: (new)
— providers for medically underserved

 

 

Affordable Care Act Parts 6-10 (officially named "Title VI through Title X")

6. Transparency and Program Integrity
7. Improving Access to Innovative Medical Therapies
8. Community Living Assistance Services and Supports
9. Revenue Provisions
10. Strengthening Quality, Affordable Health Care for All Americans

See the  Guide and Glossary for explanations and information that will help you read these tables of information.

Sections of the Law Impact = Higher Costs
Actions that will cause higher costs:
Higher Insurance Premiums
and/or Higher Out-of-Pocket Costs
Impact = Higher Taxes
Actions that will cause …
Higher Taxes
plus
"A" in [brackets]: Actions that may be considered by some people as government intrusions on citizens’ lives.
Examples of the impact of the sections within Parts 6 through 10 of the law are summarized in the next two columns: Additional requirement on health insurance companies to follow the regulations specified in this law.

Examples of the additional requirements:

— an excise tax of 40 percent for any health coverage plan that is employer-sponsored and considered to be high cost, such as over $27,500 for family coverage
[N] The above "high cost" plans are often referenced as "Cadillac plans" or "Cadillac health insurance plans"; one can consider these as an excellent set of health care benefits that are offered by an employer. The 40% is an EXTREMELY high tax.

— an annual fee paid to the government

— a limitation on the deductibility of executive compensation

65 additional government groups, roles and activities:

Examples of the types of groups, roles and activities::

grant programs, pilot programs, boards, councils, advisory panels, centers, offices, directors, funds and demonstration projects.

[N] As also noted on the left, the "excise tax" on employer-sponsored plans is an extremely high tax. The most likely result is to have many employers drop health insurance benefit coverage for their employees.


Selected Sections of the Affordable Care Act, Parts 6-10

Part 8:

Sec. 8002. Establishment of national voluntary insurance program for purchasing community living assistance services and support (CLASS program).
Note: this is the only section in Part 8.
   
     
Part 9.
Sec. 9001. Excise tax on high cost employer-sponsored health coverage.    

Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W-2. Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2..

   

Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical manufacturers and importers.
— An annual fee on the pharmaceutical manufacturing sector, starting with a fee of $2.8 billion in 2011.

   

Sec. 9010. Imposition of annual fee on health insurance providers.
— Starting with $8.0 billion in 2014.

   
     
     
     



Guide and Glossary

Guide to Reading the 2nd and 3rd Columns of the Tables

 
(1) Govt. must enforce, manage or monitor/report the elements of this provision.

— Govt: enforce regulation — means that the federal government will need to do whatever is required with respect to paying for resources, especially hiring and maintaining necessary personnel, that will enforce the regulation(s) of a provision.
— Govt. via HHS must fulfill resp. — means that the Health and Human Services department, as led by the HHS Secretary, has specific responsibilities defined in the specific provision and must fulfill those responsibilities. This responsibility often requires long-term responsibilities for which long-term staffing is required. In some cases the responsibility  may be a short-term project that must be completed, still requiring some degree of resources.
— Govt. via GAO must fulfill resp. — means that the Government Accounting Office has specific responsibilities defined in the specific provision and must fulfill those responsibilities.
— Govt. via Labor Sec. must fulfill resp. — means that the Secretary of Labor department has specific responsibilities defined in the specific provision and must fulfill those responsibilities.
— Ins. cos. must follow regulation — means that each health insurance company must follow the regulation(s) of that provision. In many or most cases that means a significant financial obligation to comply with the regulation. That significant financial obligation will then need to be offset with income from the company’s customers who buy the health insurance plans.

Govt. disclosure of citizen tax info. — This is disclosure of IRS tax information to whoever needs to determine eligibility, such as for the automatic (forced) assignment of a person into Medicaid or CHIP, where the IRS provides information to HHS personnel, who then notify the states of the persons who are eligible so that the system can ensure that they are enrolled..

Providers — health care providers



Glossary

AHRQ: Agency for Healthcare Research and Quality
Allied health:
CDC: Center for Disease Control
CHCO: Coordinated Health Care Office
CHIP: Children’s Health Insurance Program
cont.: continued
demo.: demonstration
educ.: education
HCBS: home and community based services
GAO: Government Accountability Office
Govt. = federal government or federal and state governments
HHS = Health and Human Services, often referenced as "Secretary" for the HHS Secretary
ins.: insurance
Ins. cos. = health insurance companies
LIS: low-income subsidy
MA-PD plans: Medicare Advantage Prescription Drug plans (a privatized part of Medicare)
Medicare Advantage Cost Contracts
MedPAC: Medicare Payment Advisory Commission
mgmt.: management
NAIC: National Association of Insurance Commissioners: website
OIG: Office of the Inspector General
pgm.: program
PPS: prospective payment system
prev.: preventive or prevention
rec.: recommendations
resp. = responsibility defined in the provision
rqmts.: requirements
SG: Surgeon General
States = state governments
temp. = temporary

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