What to Expect from Here on Out

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Thursday, October 20, 2011

Benefits Overhaul

Proposal USA Healthcare Overhaul as of 2012
written by Lisa Arguello
SUBJECT: USA Healthcare
Our broad insurance plan is lacking for all individuals in the USA. We are an industrialized nation that has our working people paying out of pocket to provide health services for all, and our health service system is deficient. It is not fiscally practical to provide the same structure of care to individuals without access to private benefits as those with access to private benefits. This does not mean that their health care will be inadequate; it simply means that an overhaul of the current Medicare system necessary to ensure stability in the future so no more individuals taxes or US manufacturers taxes will be raised. The reforms made The Patient Protection and Affordable Care Act (PPACA) along with the Health Care and Education Reconciliation Act of 2010 this proposal will take the financial aspects of these Acts and help put them to use. As of now the Acts will be funneling money into a perpetually dysfunctional system. The private health insurance industry and public health insurance programs should be separate. The only mandate for both the private and public health programs from federal government should be a cost cap on most common procedures performed within the USA based on data from 2008-2011. Other than that federal government should not intervene with the private sector health insurance and it should be up to individual states and their voters to improve coverage with additions payable by state taxes.
Rules for Public Health Program:
• Only government certified clinics will see recipients of public healthcare, if recipients visit any other clinic unless it’s a life threatening emergency, payment will not be made.
• No free car service to or from clinics
• Only long term care patients may warrant an ambulet
• Short term care is not permitted free transportation by ambulance unless ER visit was warranted
• No visits to ER unless emergency
• Eliminate methadone clinic payment for Medicare and any federally funded plan
• No free contraceptives of any type
• Must pay 10% toward their care on a monthly basis or opt for lump sum payment when filing taxes
• Recipient will carry debit card with picture ID and medical information; upon receipt of services the ID Med Card will be scanned, type of services will be inputted for payment.


SHORT TERM proposal: Group existing Medicaid recipients into short term and long term care. Criteria for determining short term/ long term care:
• Recipient must be examined at a Government Clinic to determine their medical needs (for guidelines see Appendix A).
• It is the people’s responsibility to follow up at government clinic if they want benefits to continue, give 8 month grace period for existing recipients.
• Long term care benefits can only be in the name of the individual recipient; not for use by any other member of the family or legal guardian.
-Short term care benefits will last 2 years; if recipient works (whether full or part-time) they must pay 10% toward their care on a monthly basis or opt for lump sum payment when filing taxes. Upon 2 year completion of short term benefits recipient cannot apply again for 1 year.
-Long term care benefits will last based on individual needs (see Appendix B).
Health Care Service Cost Cap (see Appendix C).

Summary of funding
These structural reforms will be funded by some of the PPACA Act's new provisions and existing taxes. Funds will be from tax on incomes over $200,000 and $250,000, and pharmaceuticals. Amendment to PPACA of no annual fee on insurance providers as care will be served through government run clinics. There should be no taxes on high-cost diagnostic equipment. If $78 billion will be realized before the end of fiscal 2014 (cite Wikipedia) then current hospital clinics and private doctors’ offices are able to apply to work solely as government clinics. This certification as a government clinic will come with rules, a set salary for doctors and staff, and base care payments.
PPACA lists the summary of revenue sources as follows:
• Broaden Medicare tax base for high-income taxpayers: $210.2 billion
• Annual fee on health insurance providers: $60 billion
• 40% excise tax on health coverage in excess of $10,200/$27,500: $32 billion
• Impose annual fee on manufacturers and importers of branded drugs: $27 billion
• Impose 2.3% excise tax on manufacturers and importers of certain medical devices: $20 billion
• Require information reporting on payments to corporations: $17.1 billion
• Raise 7.5% Adjusted Gross Income floor on medical expenses deduction to 10%: 15.2 billion
• Limit health flexible spending arrangements in cafeteria plans: $13 billion
• All other revenue sources: $14.9 billion
Proposed PPACA Amendment summary of revenue sources:
• Broaden Medicare tax base for high-income taxpayers: $210.2 billion
• Annual fee on health insurance providers: $60 billion
• 40% excise tax on health coverage in excess of $10,200/$27,500: $32 billion
• Impose annual fee on manufacturers and importers of branded drugs: $27 billion
• Impose 2.3% excise tax on manufacturers and importers of certain medical devices: $20 billion (no tax on US manufacturers)
• Require information reporting on payments to corporations: $17.1 billion
• Raise 7.5% Adjusted Gross Income floor on medical expenses deduction to 10%: 15.2 billion
• Limit health flexible spending arrangements in cafeteria plans: $13 billion
• All other revenue sources: $14.9 billion
In 2012 through 2014 funding will go toward renovating or creating clinics for public healthcare, this in turn creates jobs in public and private sector while building new or remodeling existing facilities.
Budget for ID Card and scanning machines will be based on how many major US cities will be home to government clinics. US cities where poll data shows income levels for the majority of the population are below minimum wage may need more than one clinic.
Example 1: if there are 275 major cities, demographics may show that 15 cities and surrounding areas have above average private healthcare then those cities will each receive one (1) government clinic closest to the area whose residents were polled with the lowest or no healthcare.
Example 2: If there are 275 major cities, and the demographics show that 57 of them have residents with below average or no coverage then three (3) or four (4) clinics should be placed in those cities based on residents average income, age, employment status.
Example 3: If out of 275 major cities, 203 have average healthcare based on resident’s average income, employment statistics then those cities should have two (2).
Implementation should include relevant training for personnel to decipher between short and longer-term changes on care recipients and a timeline for all updates. Follow-up studies should be made by congressional committee after 4 years of start of project.




APPENDIX A
Guidelines for Public Benefit Services Recipients
Initial review of benefit service will deem if short term or long term recipient (long term Appendix B)
It is the responsibility of the current recipient or applicant to visit the case worker at government clinic if they want benefits.
For current recipients as of January 2012 an 8 month grace period is permissible prior to dissolution of public benefit services.
Short term benefit services to be provided to laid off people with no option for benefits elsewhere
Short term benefit services for period not to exceed 2 years; upon completion services will not be reinstated until after 1 year an application is submitted for status review
Short term services rendered only at certified government clinics
Short term recipients that have a part time or full time job 10% of their regular gross pay must be submitted on a monthly basis or opt for lump sum payment when filing taxes
No surgeries or procedures for cosmetic value of any kind
No methadone approvals
Consent of background check for recipients if prior conviction or drug abuse no pre-paid cell phone under any circumstances

APPENDIX B
Guidelines for Long Term Recipients
Long term care benefits can only be in the name of the individual recipient
Not for use by any other member of the family or legal guardian.
Long term care benefits will last based on individual needs
Ambulet service will be provided if passenger license is approved and acquired
Only cover devices deemed to improve recipient’s quality of life (ie wheelchair, cane, walker, and prosthetics)

APPENDIX C
Health Care Service Cost Cap
(Data needs to be compiled based on current industry costs)


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WELFARE REFORMATION:
All current recipients of any Federal or State aide (excluding seniors receiving social security) must go to a Social Welfare Agency if other benefits apart from medical are needed, these benefits will be labeled cost of living expense (COLE). COLE includes:
• Housing/Rent
• Food/Food Stamps
• Necessary household items (see Appendix D)
Social case worker assigned to one person for initial determination of COLE. If no attempt by the individual is made to contact or visit the case worker, benefits will be lost after 5 months for existing recipients. Following initial determination individual may appeal if they do not agree with the COLE amount. Basis of appeal can only be based on federal state statistics.
Families on social aide should follow different criteria based on family dynamic (ex: single or two parent family/# of children/# of elderly)
TIMELINE TRAINING – visiting nurse service should attend home visit with Social worker no less than 6 months for families with children less than 13 years. This is to ensure all needs in the home and medically are being met for the children. Inform personnel of the changes and the reasons for them. Explain how the changes will benefit them and the citizens they serve.