America’s Affordable Health Choices Act

I remind you that this bill this not the final bill, which will ultimately require presidential signature to pass into law.

And that I’m not a journalist nor a lawyer.

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IN THE HOUSE OF REPRESENTATIVES

Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. GEORGE MILLER

of California, Mr. STARK, Mr. PALLONE, and Mr. ANDREWS) introduced

the following bill; which was referred to the Committee on _____.

A BILL

 

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,SHORT TITLE.—This Act may be cited as the ‘‘America’s Affordable Health Choices Act of 2009’’.

GENERAL DEFINITIONS.

PURPOSE.—

IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.

BUILDING ON CURRENT SYSTEM.—This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken.

INSURANCE REFORMS.—This division enacts strong insurance market reforms; creates a new Health Insurance Exchange, with a public health insurance option alongside private plans; includes sliding scale affordability credits; and initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits.

((“alongside private plans” means this most certainly is not a government takeover of health insurance. “sliding scale affordability“ means that lower income individuals on the government option will pay less, unlike private insurance plans.))

Subtitle A—General Standards

IN GENERAL.—The premium rate charged for an insured qualified health benefits plan may not vary except as follows:

LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.

BY AREA.—By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).

BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.

((At this stage the bill puts a great many stipulations unto the Commissioner while retaining the existing powers of State law and insurance regulators.))

SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.

DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:

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.

HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.

INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.

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.

COMPLIANCE EXAMINATION AND AUDITS.—

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.

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.

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

SANCTIONS AUTHORITY.—

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

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; 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;SEC. 2714.

ENSURING VALUE AND LOWER PREMIUMS.

IN GENERAL.—Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.

(“ensure adequate participation by issuers” is the key concept to understand.)

UNIFORM DEFINITIONS.—The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate the medical loss ratio. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans.The provisions of section 2714 shall apply to health insurance coverage offered in the individual market in the same manner as such provisions apply to health insurance coverage offered in the small or large group market.

IMMEDIATE IMPLEMENTATION.—The amendments made by this section shall apply in the group and individual market for plan years beginning on or after January 1, 2011.SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE

TRANSACTIONS.STANDARDS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—

IN GENERAL.—The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).

(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—The goals for standards under paragraph (1) are that such standards shall be unique with no conflicting or redundant standards; be authoritative, permitting no additions or constraints for electronic transactions, including companion guides; be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications; enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; enable, where feasible, near real-time adjudication of claims; provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary; describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and harmonize all common data elements across administrative and clinical transaction standards.

TIME FOR ADOPTION.—Not later than years after the date of implementation of the X12 Version 5010 transaction standards implemented under this part, the Secretary shall adopt standards under this section.

REQUIREMENTS FOR SPECIFIC STANDARDS.—The standards under this section shall be developed, adopted and enforced so as to— (A) clarify, refine, complete, and expand, as needed, the standards required under section 1173; (B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version; (C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice; (D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing; (E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; and (F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stake holders.

BUILDING ON EXISTING STANDARDS.—In developing the standards under this section, the Secretary shall build upon existing and planned standards.

IMPLEMENTATION AND ENFORCEMENT.—Not later than 6 months after the date of the enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards under this section.

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Bernanke On The Record

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“My goal is to talk to people outside the Beltway to hear what they are thinking, and do the best I can to explain what’s happening in the economy.”

Many people who care very little for facts have been saying a great deal of nonsensical words in regards to conspiracies and wild theories. In this time of historic actions being done by the government in what amounts to an expanse in federalism it is important to understand the truth of the matter and not allow yourself to be lead astray by people who care nothing for the truth and only seek to promote their own twisted agendas.

Federal Reserve Chairman Ben Bernanke recently did a open forum event hosted by PBS in which the public could ask him questions in regards to his job and the state of the American economy.

Reality Check: Economics in America

1.globe_and_moneyLet it be said that I am not bought off and not invested in how much money you make one way or the other.

I am one of last people on the web that is willing to tell the truth and attempt to remove all the shadowing and spin that resides over all that is the media.

Allow me to be plain:

We are headed for a depression.

I repeat this as a man with three businesses and a successful career in marketing said this statement to me.

A math teacher of high credentials has said to same to me in the past year.

You won’t hear this from the bought and paid for economists who sat on their hands and let our economy crumble beneath us as they remained mute.

While the word ‘depression’ in regards to economics is about to appear on the FFC Banned Words List there is much to be understood about what awaits us.

I’ll remove as much jargon as I can.

The economy will go up. But then it will come back down again.

They call me a “W” in terms of my economic perspective in that I believe we will regain strength in the market in coming quarters. But I think these will be temporary gains and ultimately we will fall back into a recession cycle that will lead to a depression.

Most media economists tell you that they are a “V” which to me just denotes that they are blindly optimistic or much more likely bought and paid for.

Some maintain that there will be no improvement and they are labeled the “L‘s”.

And some still think we will have gradual and slow recovery that is unhampered and they are labeled as “U‘s”.

Anyone like myself who speaks of a forthcoming American Depression would squarely fit into the “W” or the “L” camps.

However, the notion that all hope is lost is a false one.

Most of us ‘money-savvy’ people already know that fortunes can be made in depressions and that the wealth of the nation will not dissolve into thin air but rather will be distributed down to the people who have the intelligence and the foresight to take advantage of the downturn.

This is just a sliver-lining though. Each family should take real steps right away to build up the value of your home, maximize your portfolio and be prudent about major expenses.

But it’s important to realize that if we are going to prove me, a math teacher and a successful business man wrong that this nation will have to refocus itself on consumer spending.
If all of America continues to tighten it’s belt in this endless fashion then you begin to see why some predict this outcome at a latter date. Most say about three years and I would estimate a little longer span of time but the same end result.

The Joy of Passive Aggressive Post-It Notes

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Post-it note.1

Does anyone else have this little problem?

I have no tolerance for it. If you have something to say to me, you come and say it to my face.

Part of the issue is that I wasn’t living in the shameful situation of being back at home after having failed at striking out on my own, but the matter is old and frankly I’m sick of being nice to passive aggressive people and their evasive, elusive little hints.

I am officially a ‘mean guy’ because I’m not going to reduce myself down to this whimpering and pathetic note passing.

I’ll just tell you I think your a social coward and don’t have what it takes to cut it in the real world.

Or you could stop leaving your stupid, unhelpful notes around…

Partisanship Revisited

It occurs to me that many people in America care little to perceive and discern political partisanship in both the media and coming from representatives of their party.

Partisanship, better described as political hatred, is the driving force in the televised media and has been the bread and butter of radio broadcasting for as long as one cares to recall.

No person who advocates bipartisan coverage in the media is asking others to forego their own conclusions nor to silence their tongue in terms of political commentary.

Those who request a more bipartisan government and a more bipartisan media are only asking that the rancor and untruths spread by both sides be called out as such. We only ask that a person of any political stance be mindful of the simple fact that using slander, propaganda, and biased reporting does not contribute to the body politic of the nation.

The need to declare one’s self as part of any group is also an element of bipartisanship known as ‘full disclosure.’ This fact does not allow any person to call themselves ‘balanced’ and ‘fair’ in their dialogue while they proceed to make vast assumptions and baseless assertions about another group that they do not belong to nor share any common ideologies with.

The value to the nation is lost. These endless left versus right debates with no mutual respect and no interest in reviewing facts in the process is only serving to tear the nation further away from attaining mutual goals.

We the people did this to ourselves, lest someone feels the urge to blame the media.

The people of America seem to enjoy staying perfectly ‘safe’ within their respective spheres of politics and dare not to stray away from the ‘status quo’ generated by whatever biased programming they choose to absorb.

The media only responds to what it perceives the public wants. The public seems to want to drowned in slanderous, untrue, and vague reporting coming from pundits who make their careers off of lying and obfuscating facts about politics.

The bottom line is that media pundits have tied their own noose around their neck. If even one of them were to admit that they say these slanderous remarks and hateful comments to boost their ratings or book sales they would be thrown away by the very people who currently pay them respect.

I assert that if true honesty and true patriotism were to be included in the modern political media that people would reject these current figures in the media and exchange them so others who would not ever be honest and straight forward with the public could take their place.

In a world where each political camp is dedicated to the notion that the other is ‘evil’ and ‘immoral’ we shall never do anything worthy of the name American in this country.

We shall forever be a nation divided and shall never be a nation united.

The Sotomayor Hearings: Day One

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Following is the prepared text of Judge Sonia Sotomayor’s opening statement before the Senate Judiciary Committee on Monday, as released by the White House:

Thank you, Mr. Chairman. I also want to thank Senators Schumer and Gillibrand for that kind introduction.

In recent weeks, I have had the privilege and pleasure of meeting eighty-nine gracious Senators, including all the members of this Committee. I thank you for the time you have spent with me. Our meetings have given me an illuminating tour of the fifty states and invaluable insights into the American people.

There are countless family members, friends, mentors, colleagues, and clerks who have done so much over the years to make this day possible. I am deeply appreciative for their love and support. I want to make one special note of thanks to my mom. I am here today because of her aspirations and sacrifices for both my brother Juan and me. Mom, I love that we are sharing this together. I am very grateful to the President and humbled to be here today as a nominee to the United States Supreme Court.

The progression of my life has been uniquely American. My parents left Puerto Rico during World War II. I grew up in modest circumstances in a Bronx housing project. My father, a factory worker with a third grade education, passed away when I was nine years old.

On her own, my mother raised my brother and me. She taught us that the key to success in America is a good education. And she set the example, studying alongside my brother and me at our kitchen table so that she could become a registered nurse. We worked hard. I poured myself into my studies at Cardinal Spellman High School, earning scholarships to Princeton University and then Yale Law School, while my brother went to medical school. Our achievements are due to the values that we learned as children, and they have continued to guide my life’s endeavors. I try to pass on this legacy by serving as a mentor and friend to my many godchildren and students of all backgrounds.

Over the past three decades, I have seen our judicial system from a number of different perspectives – as a big-city prosecutor, a corporate litigator, a trial judge and an appellate judge. My first job after law school was as an assistant District Attorney in New York. There, I saw children exploited and abused. I felt the suffering of victims’ families torn apart by a loved one’s needless death. And I learned the tough job law enforcement has protecting the public safety. In my next legal job, I focused on commercial, instead of criminal, matters. I litigated issues on behalf of national and international businesses and advised them on matters ranging from contracts to trademarks.

My career as an advocate ended—and my career as a judge began—when I was appointed by President George H.W. Bush to the United States District Court for the Southern District of New York. As a trial judge, I decided over four hundred and fifty cases, and presided over dozens of trials, with perhaps my best known case involving the Major League Baseball strike in 1995.

After six extraordinary years on the district court, I was appointed by President William Jefferson Clinton to the United States Court of Appeals for the Second Circuit. On that Court, I have enjoyed the benefit of sharing ideas and perspectives with wonderful colleagues as we have worked together to resolve the issues before us. I have now served as an appellate judge for over a decade, deciding a wide range of Constitutional, statutory, and other legal questions.

Throughout my seventeen years on the bench, I have witnessed the human consequences of my decisions. Those decisions have been made not to serve the interests of any one litigant, but always to serve the larger interest of impartial justice.

In the past month, many Senators have asked me about my judicial philosophy. It is simple: fidelity to the law. The task of a judge is not to make the law – it is to apply the law. And it is clear, I believe, that my record in two courts reflects my rigorous commitment to interpreting the Constitution according to its terms; interpreting statutes according to their terms and Congress’s intent; and hewing faithfully to precedents established by the Supreme Court and my Circuit Court. In each case I have heard, I have applied the law to the facts at hand.

The process of judging is enhanced when the arguments and concerns of the parties to the litigation are understood and acknowledged. That is why I generally structure my opinions by setting out what the law requires and then by explaining why a contrary position, sympathetic or not, is accepted or rejected. That is how I seek to strengthen both the rule of law and faith in the impartiality of our justice system. My personal and professional experiences help me listen and understand, with the law always commanding the result in every case.

Since President Obama announced my nomination in May, I have received letters from people all over this country. Many tell a unique story of hope in spite of struggles. Each letter has deeply touched me. Each reflects a belief in the dream that led my parents to come to New York all those years ago. It is our Constitution that makes that Dream possible, and I now seek the honor of upholding the Constitution as a Justice on the Supreme Court.

I look forward in the next few days to answering your questions, to having the American people learn more about me, and to being part of a process that reflects the greatness of our Constitution and of our nation. Thank you.

***

The Washington Post has coverage of the live blogging from the hearings themselves.

Should Cheney Be Investigated?

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“I agree with the president. We should move forward.”

— Sen. John McCain – Meet The Press – July 13th 2009

I disagree with both Senator McCain and President Obama in regards to complete investigations into any violations of US Law during the previous administration.

In a country of laws and values there must be consequences for violating those standards set forth by this nation. If we will not so much as investigate any illegalities that may, or may not, have been committed by former Vice-President Richard Cheney while in office then we as a nation stand for nothing but protecting the powerful at the cost to the whole.

It is clear to me that Republicans want to avoid the pursuit of justice. If there was no illegal actions done, then I would think Cheney and those who support him would enjoy having their day in court to exonerate the claims that violations of the law took place. The investigations would serve as a chance to rebuff the claim that all their actions were within the bounds of the law during their terms.

The fact that these individuals are so vehemently opposed to any investigations seems to denote that they in fact may believe that something might arise from said investigations.

I believe, in justice for all. There is no position in our society that is beyond reproach of the law. If the Bush White House, or any person in the government services, broke the standards of law they should be punished for this violation.

To state otherwise, is to stand against justice.

The O’Reilly Factor Disgraces The Nation

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Lara Ingram just referred to the President of The United States as having a “notoriously anti-life agenda.”

I am sick of these disgraceful and partisan pundits using their platforms to sling arrows and rocks instead of intelligent commentary.

The war-mongering and anti-gay agendas of conservatives aside, this is a perfect example of what equates to simply irresponsible broadcasting on behalf of FOX News.

If this is the standard of debate set upon me I would like to restate myself that The O’Reilly Factor is a format that supports domestic terrorism against US citizens by means of untrue and inflamatory rhetoric designed to specifically urge Americans toward acts of violence against other Americans.

 They are not only Anti-Choice, they are Anti-Freedom.

Let the true patriots stand tall against this dangerous and unintelligent programming.

 Whatever opinion a person holds of President Barack Obama, there is no excuse for this kind of hateful and untrue horse-play. Shame on the network.

Tracking The Stimulus Money

The most obvious choice for a tax-payer who is interested in learning more about the stimulus money and how it is being spent is Recovery.Gov.

There is also the addition of the website Recovery.Org to the mix.

But the most open-sourced transparency and best place, in my opinion, to address this issue while using the internet as a source would be at the George Mason Unversity’s Mercatus Center who recently released the website StimulusWatch.Org.

If you desire to take a more direct approach to tracking the funds you should visit ShovelWatch.Org.

Druge Report Cover Slanders Obama

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Today on The Drudge Report we see the latest example of bias and slander against the president by means of using a misleading photo of Barack Obama above the title of the wbsite.

ABC has the whole video, in which you can see what truly transpired.

Yahoo News is where the link provided by Drudge leads you, but the headline “The Second Stimulus” has nothing to do with the article on Yahoo from which this image originated from.

Mike Drudge knows exactly what he is doing by only posting that photo above and then linking into an article that not enabled with the video version thus the ‘whole story.’

It is clear to me, and everyone who did more than giggle at the cover piece, that Drudge will use any excuse to slander and degrade the image of President Barack Obama. Even at the cost of his own credibility.

Todd Venezia of The Washington Post managed to squeeze the truth of the matter into the very last paragraph of his piece.

It was in fact Sarkozy taking a look at the young lady’s behind, and not Obama. But such facts mean nothing to people care to do nothing but demean Obama’s character with their every breath.

The only person affliated with FOX News to accurately report on this issue has been Greta Van Susteren. Further enforcing the concept that FOX News is a network mainly dedicated to this style of misleading coverage of news events and utterly biased content.