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Billy F.

Norris

Research Paper

ENC 1102 01T1

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Obama Care The New National Health Care And Fraud


By Billy F. Norris

Billy F. Norris

Research Paper

ENC 1102 01T1

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Thesis Statement National Health Care has been an issue in this country since President Harry S. Truman Called upon Congress to come up with a National Health Care Bill in 1945.

Billy F. Norris

Research Paper

ENC 1102 01T1

Abstract The Patient Protection and Affordable Care Act (H. R. 3962) which is better known as Obama Care, is based on the premise of eliminating the Pre-existing Condition Clause, used by Page | 3 many health insurance industry companies to inflate insurance premiums, and / or deny individuals insurance coverage, and to make health insurance affordable to everyone. When the Supreme Court affirmed the constitutionality of Obama Care based on Congresses Tax Authority under Article I, section 8 of the Constitution, they (the Supreme Court) authorized the implantation of a doctrine based on Racketeering Influenced Criminal Originations (RICO).

When confronted with two courses of action I jot down on a piece of paper all the arguments in favor of each one, then on the opposite side I write the arguments against each one. Then by weighing the arguments pro and con and cancelling them out, one against the other, I take the course indicated by what remains. - Benjamin Franklin

Billy F. Norris

Research Paper

ENC 1102 01T1

In November of 1945, the Presidential Administration of Harry S. Truman sent a proposal to Congress arguing that the federal government should play a role in health care, saying, The health of American children, like their education, should be recognized as a definite public responsibility. President Trumans plan was to insure that all communities had access to doctors and hospitals and asserted that an estimated 15 million people, approximately 40 percent of the total U. S. population, had no local hospitals, or none that met the minimum standards of the national professional associations. President Truman saw that the earning capacity of rural and lower-income areas made it difficult for medical health professionals to make a living in these areas, and proposed to attract medical health care professionals to these areas with federal funding. Mr. Truman also proposed the creation of a national standard for hospitals and other health centers to ensure that only quality facilities where built across the country, and the creation of a board of doctors and public officials to ensure that these standards where met and would be responsible for directing federal funds into medical research. In President Trumans address to the American people on November 19, 1945, he proposed a national health insurance fund run by the federal government that would be open to all Americans. Participants would pay a monthly fee to join the plan that would cover any and all medical health costs and the government would pay the cost of services rendered by any doctor who chose to join the program. When the health proposals reached Congress in the form a
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Billy F. Norris

Research Paper

ENC 1102 01T1

Social Security expansion bill, it was co-sponsored by Senators Robert Wagner (D-NY) and Representative John Dingell (D-MI) and became popularly known as the W M D bill. Many employers provided health insurance to their employees this was initially offered to Page | 5 attract more employees into a companys work force due to the ruling made by the War Labor Board in 1943, to exclude certain work benefits from the periods wage and price controls including health insurance and gave labor unions negotiating power for better work and health benefits. (Kaiser Family Foundation, Focus on Health Reform 2009) With the end of World War II, the fear of Communism was in the forefront of the American peoples mind. The American Medical Association (AMA; 1945) who accused the Truman administration and White House staffers of being followers of the Moscow party line characterized the issue of national health insurance as socialized medicine and a key point of attack. This resulted in a loss of goodwill against Organized Labor, who was the main advocate for the bill, from the American people through a series of unpopular strikes. At the onset of the Korean War (June 1950), Truman was forced to abandon the W M D bill and was unsuccessful in creating the health program he desired but was successful in publicizing the issue of medical health care in America. The non-profit health insurance fund Blue Shield Blue Cross grow from 28 million policy holders to 61 million policy holders and this was a staggering 118 percent increase in medical health insurance policy holders of that era.

Billy F. Norris

Research Paper

ENC 1102 01T1

In 1961, President John F. Kennedy continued the pursuit of a national health insurance program and gave a televised speech on the need for Medicare on May 1962. Two years later, in 1964 President Lyndon B. Johnson called for Congress to create Medicare; in 1965 Medicare and Medicaid was passed in the form of the Social Security Amendments of 1965 by a 70 24 vote in Congress and a 307 116 vote in the Senate and signed into law by President Johnson on July 30, 1965. 19 million Americans enrolled in the Medicare program on July 1, 1966 and more than 51 million Americans are currently enrolled in the Medicare and Medicaid programs today, Medicare Turns 48 by Melissa Stanton, AARP (July 2013). Many Americans rely on the Medicare and Medicaid programs as their primary source of health insurance which medical health professionals will inflate costs through unnecessary medical testing, treatments administrative expenses while at the same time receiving kick backs from medical equipment and pharmaceutical companies for using their products for surgical and treatment procedures. On April 5, 2011 Gerald T. Roy, Inspector General of the Depart of Health and Human Services provided testimony to the United States House of Representatives Committee on Oversight and Government Reform in regards to the Waste, Abuse and Mismanagement in Government Health Care. In May 1995, Federal and State agencies tasked with protecting Medicare and Medicaid programs began sharing intelligence, coordinated law enforcement efforts and enhanced quality of care for program beneficiaries in Operation Restore Trust initiated by President Bill Clinton.
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Billy F. Norris

Research Paper

ENC 1102 01T1

Mr. Gerald T. Roy (1995) reported that sophisticated organized criminal enterprises facilitated unprecedented levels of fraud that severely affected Medicare on a nationwide basis. These criminal originations engage in durable medical equipment (DME) schemes, ambulance transportation fraud, billing for a higher level of services not provided or medically necessary, billing for a higher level service than provided, misreporting costs or data to increase payments, illegal kickbacks and stealing providers and beneficiaries identities. Racketeering Influenced Criminal Originations are the biggest culprits in corporate fraud and the constant reason for the ever-increasing cost in health care coverage (Levy, Phillips & Konigsberg, LLP (August 2013)). Due to a wide variety of schemes that range from off label marketing of prescription drugs, inflating Medicare and Medicaid charges, the distribution of faulty medical diagnostic test kits, cash-for-patient schemes, commission-based managed health care enrollment schemes, prescription drug-for-cash schemes and Phase IV marketing schemes. Healthcare Fraud Cases (2013) number in the hundreds, if not thousands, of False Claims filed with Medicaid and Medicare on an annual basis by major corporations. Such corporations are the likes of Abbot Laboratories, Amgen, Amerigroup, AstraZeneca, Aventis Pharmaceuticals, Baxter Healthcare, Bayer Healthcare, Bristol-Myers Squibb, Forest Pharmaceutical, GlaxoSmithKline, Healthfirst, HealthSouth, Johnson & Johnson, Ortho Biotech Products, Pfizer, Quest Diagnostics, Staten Island University Hospital, Walgreens, WellCare Health Plans and the corporate list continues.
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Billy F. Norris

Research Paper

ENC 1102 01T1

These corporations in one form or another all fall under the Health Care Industry umbrella that covers Biotechnology, Health and Medical Insurance, Home Healthcare Services, Hospitals, Managed Health Care Services, Medical Diagnostic Equipment, Medical Implant Devices, Pharmaceuticals, and other related health care industries. To date, August 2013, some $6.1 Billion in settlements have been made to Medicaid and Medicare for False Claims filed by these corporations. When Congress passed House Resolution 3962 The Patient Protection and Affordable Care Act that is better known as Obama Care, and signed into law by President Barrack Obama on March 23, 2010. The new health care law is in fact an act of reconciliation for the health care industry on a two-tier basis. The first tier is to force the American population to acquire health insurance either from their employer or privately and anyone not having health insurance coverage will be assessed fines and penalties in the form of taxes to be collected by the Internal Revenue Service (IRS). The second tier of this reconciliation act will allow insurance companies and the health care industry to inflate insurance premiums, product and service cost at the expense of the American public through the use of False Claims (Act of 1863 Amend.). According to an article published by Cathy Schoen, Michelle M. Doty, Sara R. Collins, and Alyssa L. Holmgren, Insured But Not Protected: How Many Adults Are Underinsured? (2005); In 2003, 61 million adults had no insurance, sporadic coverage or high deductibles and many American adults were faced with high insurance premiums and out-of-pocket medical expenses to the extent of inadequate financial protection in the event of illness.
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Billy F. Norris

Research Paper

ENC 1102 01T1

On January 1, 2014, many employers are opting to discontinue offering their employees health insurance but are willing to offer their employees access to health insurance while acting as a broker/agent for the insurance (Klein, October 2012). This is in large part because many employers will have to begin to offer their part-time employees health insurance or be fined $2000 for each employee who does not have insurance and employers will have to make matching contributions to any full-time employees health insurance plans. Taking into account that big and small businesses are entitled to tax subsidies, if they qualify, for employer based insurance many are choosing to opt out of the tax subsidies that are estimated at $150 billion a year (Krugman and Wells, 2006). In addition, the health insurance industry is looking to increase health insurance premiums by 100% nationwide (Young, 2013) based on the large fact that insurance companies will no longer be permitted to discriminate against people with pre-existing conditions or those with a high risk of needed and expensive medical treatment.
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The House of Representatives, other Congressional Members, and the Internal Revenue Service themselves are fighting having to participate in the Federal Health Insurance Exchanges because they would lose their life time medical health insurance coverage under the current Federal Employee Health Benefits (FEHB) Program ( Smith, August 2013). Being that American health care tends to divide the population into insiders and outsiders, government and federal employees consider themselves insiders and should not be required to participate in a program that would put them on the same level as everyone else.

Billy F. Norris

Research Paper

ENC 1102 01T1

When Obama Care goes into effect on January 1, 2014, many people are unaware of how much this new health law will affect them and their families economically and financially nor are these people even aware of how to acquire the needed health insurance coverage to even comply with the new law. Most of the federal exchanges are not even up and running and many of the health care centers and hospitals in Florida (Jameson, 2013) are currently providing some assistance in helping people in acquiring health care coverage.
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There are more than 3.5 million Florida residents who do not have health care coverage (Jameson, Marni, September 2013) and one million of those Florida resident will not qualify for the Medicaid, Medicare programs or the tax credits offered through the federal health insurance exchanges if they are single and earn less than 100 percent of poverty. Being that Florida opted out of expanding the Medicaid and Medicare programs those one million Florida residents are left with having to endure the full burden of their own health care coverage cost which I happen to be one of those one million Floridians who is employed part-time and a full-time college student.

As an individual who fails to meet the Medicaid, Medicare, and Tax Credit provisions under the Obama Care law and having to pay for my own health care coverage and medical expenses out-of-pocket, I have received numerous e-mails in all of my internet accounts that have offered affordable health care coverage. Most of these where frauds by individuals in pursuit to acquire my personal, financial, and medical information as denoted by Barnini

Billy F. Norris

Research Paper

ENC 1102 01T1

Chakraborty of Fox News (August 19, 2013) due to the big push for federal health care exchange registration on October 1, 2013.
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Many uninsured individuals and families who do not meet the minimum low-income requirements will have to circumvent the waters of the health care coverage frauds that are currently running rampant across the internet, and will increase when open health care coverage registration begins on October 1st (Chakraborty, August, 2013). This clearly demonstrates that Affordable Health Care (Obamacare) is not and never was intended to be affordable for everyone in the United States and establishes a contract of indenturement by law.

Billy F. Norris

Research Paper

ENC 1102 01T1

References
Chakraborty, Barnini, Obama Care launch creates opening for scammers; August 19, 2013,
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http://www.foxnews.com/politics/2013/08/19/obamacare-launch-openingscammers/#ixzz2exPIPOkd

False Claims Act of 1863, http://blowthewhistle.com/falseclaimsact/history2.html Health and Human Services, Department of; Health centers to help uninsured individuals gain affordable health insurance coverage, http://www.hhs.gov/news/press/2013pres/05/20130509a.html Health Care Fraud Cases, Levy Phillips and Konigsberg, LLP, (August 2013); http://www.fraudusa.com/healthcare-fraud-cases.php

Jameson, Marni, Florida Hospital enters health-insurance business, August 25, 2013, Orlando Sentinel, http://articles.orlandosentinel.com/2013-08-25/health/os-florida-hospital-healthinsurance-20130825_1_medicare-advantage-steve-johnson-hospitals

Jameson, Marni, Lack of Medicaid expansion puts some Floridians in new doughnut hole, September, 13, 2013 Orlando Sentinel, http://www.orlandosentinel.com/health/osmedicaid-expansion-obamacare-20130913,0,1277484.story

Billy F. Norris

Research Paper

ENC 1102 01T1

Henry J Kaiser Family Foundation, Focus on Health Reform 2009; http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7871.pdf


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Klein, Karen E., Business Week: What Obamacare Means for Small Employers in 2013, (October 2012); http://www.businessweek.com/articles/2012-10-04/what-obamacaremeans-for-small-employers-in-2013

Patient Protection and Affordable Health Care Act (House Resolution 3962), http://housedocs.house.gov/rules/health/111_ahcaa.pdf President Harry S. Trumans Proposed Health Program, November 19, 1945; http://www.trumanlibrary.org/anniversaries/healthprogram.htm President Announces Health Care Anti-Fraud Project: Operation Restore Trust, http://archive.hhs.gov/news/press/1995pres/950503.html Roy, Gerald T., Waste, Abuse and Mismanagement in Government Health Care, April 2011; http://www.hhs.gov/asl/testify/2011/04/t20110405a.html

Schoen, Cathy, Doty, Michelle M., Collins, Sara R., and Holmgren, Alyssa L.; Insured But Not Protected: How Many Adults Are Underinsured?, http://content.healthaffairs.org/content/early/2005/06/14/hlthaff.w5.289.short

Billy F. Norris

Research Paper

ENC 1102 01T1

Smith, Ralph, Should Federal Employees Continue to be in the FEHBP? (August 5, 2013), http://www.fedsmith.com/2013/08/05/should-federal-employees-continue-to-be-in-thefehbp/
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Stanton, Melissa, Medicare Turns 48, July 2013; http://www.aarp.org/health/medicareinsurance/info-07-2013/medicare-anniversary-july-30-1965.html

Young, Jeffery Health Insurance Premium Increases Vowed By Companies For 2014 (March 22, 2013); http://www.huffingtonpost.com/2013/03/22/health-insurance-premiumincreases_n_2932704.html