22 Disreet Powers: the Health Choices Administration

The America's Affordable Health Choices Act of 2009, HR 3200 sponsored by John Dingell, D-MI, establishes a huge new bureaucracy within the executive branch, the Health Choices Administration which is led by a Commissioner with at least 22 clearly enumerated powers and responsibilities, including:

1. The establishment of qualified health benefits plan QHBP standards.
2. The establishment and operation of a Health Insurance Exchange.
3. The administration of individual affordability credits.
4. Promoting accountability of all QHBP offering entities in meeting Federal health insurance requirements.
5. Conducting audits (at the expense of the QHBP) of qualified health benefits plan compliance.
6. Collecting 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.
7. Assessing civil monetary penalties in case of non-compliance with Commission mandates (I love the smell of coercion in the morning, it smells like authority).
8. Suspending enrollment of individuals into non-compliant plans.
9. Suspending payments to any non-compliant entity under the Health Insurance Exchange.
10. Terminating plans for repeated failure by the offering entity to meet the requirements of the HCA.
11. Providing for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.
12. Issuing regulations for the effective and efficient administration of the Health Insurance Exchange.
13. Consulting with The National Association of Insurance Commissioners, State attorneys general, and State insurance regulators, including concerning the standards for insured qualified health benefits plans under the HCA and for the enforcement of such standards.
14. Seeking to achieve uniform standards that adequately protect consumers in a manner that does not unreasonably affect employers and insurers.
15. Conducting a study of the large group insured and self-insured employer health care markets.
16. Appointing, within the Health Choices Administration, a Qualified Health Benefits Plan Ombudsman who shall have expertise and experience in the fields of health care and education of (and assistance to) individuals.
17. Receiving complaints, grievances, and requests for information submitted by individuals (in a linquistically appropriate manner, i.e., in multiple languages).
18. Providing assistance with respect to complaints, grievances, and requests.
19. Helping individuals determine the relevant information needed to seek an appeal of a decision or determination.
20. Assisting individuals with any problems arising from disenrollment from such a plan.
21. Submitting annual reports to Congress and the Commissioner.
22. Establishing a national medical device registry, for pacemakers and the like (does that come with GPS?).
    

H.R. 3200 also establishes the position of the Assistant Secretary for Health Information and an Office of the National Coordinator for Health Information Technology. It refers to the Secretaries of HHS, Labor, Treasury and Veterans Affairs at least 1,226 times and uses the word “shall” 1,683 times. The bill also involves the Commissioner of Food and Drugs and the Administrator of the Centers for Medicare & Medicaid Services.

It reminds one of the world of Winston Smith, the civil servant protagonist in Orwell’s Nineteen Eighty-Four, where words were regularly redefined to suit the purposes of the government. A sign outside his miserable flat blared the three party slogans: “WAR IS PEACE. FREEDOM IS SLAVERY. IGNORANCE IS STRENGTH." Perhaps “government” now means “you and your doctor.”



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