One alarming effect of the Houses Healthcare bill is that it will as a practical matter force many lower and middle income Americans to enroll in their employers sponsored health insurance plan whether they want to or not. The bill does this by excluding people whose employer offers employer sponsored health insurance from being eligible for affordability premium credits (§242(b)(1)). These credits will be of crucial importance to this income segment of Americans to enable them to purchase health insurance especially if one considers that the mandates of this bill will significantly raise the price of health insurance in America. This bill will mandate community underwriting premium pricing essentially, no barring of applicants for pre-existing conditions, no dropping of insurance on enrollees that get sick, no yearly or lifetime benefit limits, free preventive care, modest out-of-pocket limits. Look at some of the states that have only some of these mandates, for example Maine and New Jersey, in these states it has significantly driven up health insurance premiums causing the consequence that in Maine 22 % (twice the national average) are on Medicaid and in New Jersey their uninsured rate is around 15 %. Congress boxing in these Americans like this is absolutely terrible. For some of these Americans their doctor wont be on their employer plans preferred provider list; moreover, there is a lot of good reasons for not going on an employer sponsored plan the better hospitals in ones area may not be on the plans preferred provider list, the coverage of the plan may not be that good, the reputation of the insurance issuer may be poor in terms of paying on claims and determining coverage. It is somewhat surprising small and middle size business advocacy organizations arent calling for the House to scrap this exclusion because this will in all likelihood hurt their ability to hire good people because many of these businesses will only be able to afford bare bone insurance plans and many potential workers who are in the affordability credit program and have a good insurance plan will probably think to themselves why should I take a job with such a business where I will have to give-up the good health insurance coverage I have for me and my family. The House ought to reverse itself here, the tax money of all Americans is being used to pay for this affordability credit program and the distinguishing criteria for eligibility is not defensible. It also doesnt make any sense from the standpoint that employers whose employees pass on joining the employers sponsored plan still have to pay a fee to the exchange for those employees in the same amount as if they didnt have an employer sponsored health plan at all (§311(3)). Since the government is getting this money from employers for their employees who decide to join health plans offered on the exchange one would think the government would try to channel some of that money back to these employees, that would seem only fair to those employees. The House in its bill is being incredibly foolish with its affordability cost sharing credit initiative (that is not the affordability premium credit initiative which is an excellent initiative). This cost sharing initiative will lower co-pays and co-insurance for Americans that have Exchange offered health insurance and who are in the affordable credit program. It is a really bad idea because it is unfair to a large number of Americans who get their health insurance through their employer and because their employer offers health insurance they are not eligible for the cost sharing credits but would otherwise be eligible, the indication the number is large is evident if one considers that over fifty percent of Americans get their health insurance through their employer. So what the nation will see is American families with employer sponsored health insurance struggle to pay their cost sharing health care bills and other American families with the same or better incomes getting significant help on the same type of bills from the government, the effect will be idiotic and unseemly. The American people will consider this program is unfair all Americans are footing the bill for the program why do some lower income people get help and others dont? Moreover, it is a bad idea in light of the alarming budget debts America is facing ($9 trillion over the next ten years) which is moving responsible Americans to call for the U.S. government to be very careful on any significant expansion of government and not to pursue any unneeded spending. This program is unneeded spending at this point let the government first solve the problem of how to provide affordable quality health insurance to all Americans. The House should keep in mind that the bill does mandate on insurance plans out of pocket limits which helps a great deal on this issue. If the Congress wanted to handle this issue right, in light of the terrible financial straights the country is in, it would distinguish the nature of the medical care the government will help cost share on, more specifically limit the help to medical care needed for treatment of serious health problems, since Congress in the bill isnt making such distinctions it should just scrap the whole initiative. The House should scrap the mandate that employers automatically enroll their employees in the employers offered insurance plan unless the individual employee opts-out (§312(4)). This is a violation of these employees rights, health insurance to too vital and too important to ones life, the government shouldnt have a hand in putting people in specific private insurance plans. Obviously the Houses goal here is to get everyone enrolled in a health insurance plan a good goal. The House is on the right track in solving this whole problem by increasing the income tax rate on people who do not carry health insurance §410(a). A further help would be to put in the bill an obligation on the IRS before they issue any refund checks to check the appropriate government data bases to determine if that taxpayer met the requirement of carrying insurance and if that taxpayer didnt make sure that the penalty tax is deducted from the refund check if the taxpayer hasnt already paid the penalty tax. Moreover, the bill should require the Secretary of HHS to create a database of all Americans that arent meeting their legal requirement to carry health insurance and the bill should notify these individuals employers that these employers must increase the withholding tax on these individuals to withhold the penalty tax. Furthermore, the bill should mandate this database be used to stop these individuals from getting any government benefits while their violators including in part, food stamps, LIHEAP, FHA Loans, SBA loans and block them from getting a passport; also, mandate this blocking of services on violators be taken up by the states to compel cooperation on individuals to carry health insurance and ban these violators from being able to get a drivers license to accomplish this withhold parts of transportation and other funding on states to gain their cooperation on this matter. In addition, utilize this database to ban violators from getting employment with the Federal government, states and county subdivisions for three years from the time they stop being violators. In short, the Congress can reach its goal of basically having all Americans carry health insurance by creating a whole array of penalties violators will face. The House is doing a good thing in their bill by eliminating the extra costs on the Medicare system due to Medicare Advantage enrollees over regular Medicare enrollees. But what is a glaring flaw in their bill is not to stop one of the glaring examples of waste and abuse in the Medicare system that experts frequently point out in public discussions on the subject which is the waste brought about by the Medicare systems acquisition of durable medical equipment. One often hears stories about how Medicare rents medical equipment for beneficiaries and the monthly rental fee is so high that if one would take like four months of this rental fee one could go out and actually outright purchase the equipment being rented, it is absurd and ludicrous. The House in their bill should implement the consensus solution to this problem and have Medicare acquire durable medical equipment through competitive bidding. To be fair to the vendors that become the suppliers through this competitive bid system the government should make the contracts for two to three years which would also facilitate the Medicare system putting into place reliable supplier networks so beneficiaries who need such equipment can get it reliably and not have to go through trying experiences. To accomplish this House members would have to stand firm against the special interests lobby who would be opposed to such a change but this is what the American people want this is why they elected the present members they want change from business as usual in Washington, they want the government to work for the American people. The most admirable Americans believe that the availability of affordable quality health care is a human right which the American government should provide to the American people. The U.S. government should and can achieve this goal being wise and responsible which calls on the U.S. government not to create unnecessary bureaucracies and not to pursue enormous unnecessary spending to achieve this goal.