A PORTION OF H.R. 3200

Below is a randomly chosen sample of the verbiage in the House of Representatives healthcare bill chosen at random by a Lawyer and some of his comments.

Page 780 of the House Bill is part of Section 1721, setting forth amendments to the Social Security Act (42 U.S.C. 14 1396b(a)(13), by adding a new paragraph "(C)" as follows:

(C) payment for primary care services (as defined in section 1848(j)(5)(A), but applied without regard to clause (ii) thereof) furnished by physicians (or for services furnished by other health care professionals that would be primary care services under such section if furnished by a physician) at a rate not less than 80 percent of the payment rate applicable to such services and physicians or professionals (as the case may be) under part B of title XVIII for services furnished in 2010, 90 percent of such rate for services and physicians (or professionals) furnished in 2011, and 100 percent of such payment rate for services and physicians (or professionals) furnished in 2012 or a subsequent year;

Try reading this language out loud. Plain English is nowhere to be found. Other equally obscure provisions in this section include a subsection on the "adequacy of payment for Primary Care Services and reimbursement rates."

The Democrats propose to increase payments using "100% FMAP" (Federal Medical Assistance Percentages) under this new section "(C)":

(3)(A) The portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(C) furnished on or after January 1, 2010, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of June 16, 2009.

(B) Subparagraphs (A) shall not be construed as preventing the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified under such subparagraphs.

VERDICT: Close to incomprehensible. I think this section means that there will be an increase in reimbursements to states for payments to primary care physicians under Medicaid. I could be wrong. There are so many cross-references, that it would take several hours to figure out all the implications and the conditions on which such payments are made, much less the source of revenue for the payments.

What this section does show is the density of the House Bill. Understanding just this single provision is a daunting task. Call it the banality of bureaucracy. Someone, be it a lobbyist or staffer or both, spent an enormous amount of time writing this dense text to accomplish something which is not explained in a form almost anyone could understand or comprehend.

William A. Jacobson is Associate Clinical Professor of Law at Cornell Law School in Ithaca, NY, and author of the Legal Insurrection Blog.

So, do you really want this voted into law??