Doctor tells Obama supporters: Go elsewhere for health care

A Mount Dora doctor posted a sign telling Obama health care supporters to go elsewhere.

Orlando Sentinel – By Stephen Hudak

MOUNT DORA — A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care “elsewhere.”

“I’m not turning anybody away — that would be unethical,” Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. “But if they read the sign and turn the other way, so be it.”

The sign reads: “If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Estella Chatman, 67, of Eustis, whose daughter snapped a photo of the typewritten sign, sent the picture to U.S. Rep. Alan Grayson, the Orlando Democrat who riled Republicans last year when he characterized the GOP’s idea of health care as, “If you get sick, America … Die quickly.”

Chatman said she heard about the sign from a friend referred to Cassell after his physician recently died. She said her friend did not want to speak to a reporter but was dismayed by Cassell’s sign.

“He’s going to find another doctor,” she said.

Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida‘s College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil-rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is “trying to hold onto the nub of his ethical obligation,” Allen said…

Eisner Legislative Alert

President Obama has signed into law additional historic health care reform legislation, H.R. 4872, the Health Care and Education Reconciliation Act; this legislation was passed by the Senate and House on March 25, 2010.

Previously the President signed the Patient Protection and Affordable Care Act, which incorporated H.R. 3590 passed by the Senate on December 24, 2009 and by the House on March 21, 2010 (see Eisner Legislative Alert dated March 25, 2010).

The new legislation reconciles the earlier legislation with most of the health care changes desired by the House and also ends governmental subsidies to banks in connection with federal student loan programs, shifting lending responsibilities to the federal government.

The new legislation does not remove key provisions of the earlier legislation, including provisions to require health care coverage, the creation of exchanges for the purchase of health insurance coverage, tax credits for individuals and businesses to reduce the cost of health insurance premiums, excise taxes on health insurers offering high cost plans and certain health insurance providers, and levies on manufacturers and importers of drugs and certain medical devices. Nor does it change the earlier legislation regarding new limits on contributions to certain health benefit plans, a common definition of qualifying medical expenses, and an increase in the AGI percentage for purposes of individuals deducting medical expenses.  However, the new legislation adds a 3.8% tax on investment income and alters the terms of certain levies in the earlier legislation. Most major tax and fee provisions of both the earlier and new legislation become effective in 2011 or later, with certain provisions such as guaranteed issuance and health care coverage for children effective in 2010.  Please note that:

Attached to this Alert is an updated chart comparing selected provisions of H.R. 3590 which was earlier signed into law on March 23, 2010, and H.R. 4872 as amended by the Senate and House and now also signed by the President…

I. Significant Tax Provisions Senate H.R. 3590 Passed December 24, 2009 Final Reconciliation H.R. 4872 Passed March 25, 2010 Revenue Raised Per CBO Over 10 years Effective Date
Excise Tax on Health Insurers 40% nondeductible excise tax on health insurers offering high cost insurance plans (Cadillac Plans) of more than $8,500 (individuals) or $23,000 (families) $10,200 (individuals) or $27,500 (families); excise tax is attributable to excess benefit $32 billion 2018
Increase in Medicare Tax for Employees and Self-Employed and Investment Income Tax Increased to 2.35% from current 1.45% for earnings over $200,000 (individual) or $250,000 (joint) Same tax rates as Senate, adds 3.8% tax on investment income excludes tax exempt muni bond income/qualified plan distribution $210.2 billion 2013
Increase Medical Expense Deduction AGI Floor Increase deduction floor to 10% of AGI (from current 7.5%) with carve out for persons over age 65 in 2013 to 2016 Same as Senate $15.2 billion 2013
Conform Medical Expense Definition Make similar definitions for FSAs, HSAs, HRAs Archer accounts; exempt over-the­counter medications prescribed by a doctor Same as Senate $5 billion 2011
Limit on FSA Contributions Cap at $2,500, index to CPI after 2011 Same as Senate Indexed for inflation after 2013 $13 billion 2013
Increase Penalties for Nonqualified HSA Distributions Increase to 20% from the current 10% Same as Senate $1.4 billion 2011
End Deduction for Medicare Part D End deduction for subsidy expenses for employers who maintain perscription drug plans for retired employees Same as Senate $4.5 billion 2013
End Medicare Coverage Gap in Prescription Drug Program Provides senior citizens with $250 in 2010, and expands discount on brand and generic drugs to 75% by 2010 Same as Senate Revenue loss 2010
Codify Economic Substance Doctrine With Penalty Imposition Not Included Adds codification $4.5 billion Date of enactment
Limit Executive Compensation Deduction for Executives of Health Care Providers Cap at $500,000 the amount an employer can deduct Same as Senate $600 million 2013
Establish Research Trust Fund Patient-centered outcomes research fund, financed with $2.6 billion in fees on health insurers and self-insured plans Same as Senate Policy plan ending after 9/30/12 and before 9/30/2019
Excise Tax on Tanning Services 10% excise tax on indoor tanning services Same as Senate $2.7 billion 2010
Extend Adoption Credit Increase in the credit to $13,170 in 2010, 2011 with inflation indexing and made refundable Same as Senate $1.2 billion revenue loss 2010
Imposition of Industry Fees Manufacturers and importers of pharmaceuticals and medical devices, and health insurance providers Same as Senate, except replaces fee with 2.3% excise tax on medical device makers; excludes retail medical items such as eyeglasses, contact lenses, hearing aids, other items $107.1 billion 2011 or 2013
Corporate Estimated Payments Not Included Increases tax payments by 15.75% for firms owing at least $1 billion in payments due in July, August, September 2014 $8.1 billion 2014
Corporate Information Reporting Require firms that make payments of more than $600 to any corporation (in exchange for property or services) to file form 1099 with the IRS and provider Same as Senate $17.1 billion 2012
II. Significant Coverage Provisions
Individuals Required to Obtain Health Insurance Coverage or Pay Penalty Excise penalty is a fee of $95 in 2014, $350 in 2015, $750 in 2016 with CPI increases thereafter; tax credits for certain individuals/families; coverage is available through insurance exchanges to be established by 2014 Same as Senate with requirements on employer health plan attributes, and an excise tax that is income-based (if more than the Senate penalty fee amounts) phased in starting in 2014 $17 billion 2014
Employers with 50 or More Employees Assessed Where No Coverage Provided Employer assessment would generally equal $750 for each full time worker; small business tax credit available Follows Senate but employers not offering coverage to employees pay fee of $2,000 per employee (first 30 employees not counted) $52 billion 2014
Group and Self-Insured Plans Coverage Requirements Guaranteed issuance and renewability, rescission prohibited, no denial for pre-existing condition, health status and other factors will not prohibit coverage, no lifetime limits, other requirements Extends health care coverage for dependents, including adult children up to age 26 N/A 2010

Source:  Eisner Accountants and Advisors

Related Links:

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Journal of Accountancy: Tax Provisions in the Health Care Act

Federal Daily: Senators Press for Broader Definition of ‘Inherently Governmental’

WSJ: Would the Founders Love ObamaCare?

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