Here are a few recent articles (and video) on healthcare reform.
health care reform: veering off track
Government intervention in health insurance is nothing new
Sunday, August 2, 2009
Saturday, August 1, 2009
Division B - Medicare and Medicaid
This section on the changes to Medicare and Medicaid eat up pages 215 to page 855. The giant section is divided up as follows:
Title I - Improving Health Care Value
Subtitle A - Provisions related to Medicare Part A
Part 1 - Market Basket Updates
Part 2 - Other Medicare Part A provisions
Subtitle B - Provisions related to Part B
Part 1 - Physician's Services
Part 2 - Market Basket Updates
Part 3 - Other provisions
Subtitle C - Provisions related to Medicare Parts A and B
Subtitle D - Medicare Advantage reforms
Part 1 - Payment and Administration
Part 2 - Beneficiary Protections and Anti-Fraud
Part 3 - Treatment of Special Needs Plans
Subtitle E - Improvments to Medicare Part D
Subtitle F - Medicare Rural Access Protections
Title II - Medicare Beneificiary Improvements
Subtitle A - Improving and Simplifying Financial Assistance for Low Income Medicare beneficiaries
Subtitle B - Reducing Health Disparities
Subtitle C - Miscellaneous Improvements
Title III - Promoting primary care, mental health services and coordinated care
Title IV - Quality
Subtitle A - Comparative Effectiveness Research
Subtitle B - Nursing Home Transparency
Part 1 - Improving transparency of information on skilled nursing facilities and nursing facilities
Part 2 - Targeting enforcement
Part 3 - Improving staff training
Subtitle C - Quality measurements
Subtitle D - Physician payments sunshine provision
Subtitle E - Public reporting on health care-associated infections
Title V - Medicare Graduate Medical Education
Title VI - Program Integrity
Subtitle A - Increased funding to fight waste, fraud, and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Subtitle C - Enhanced program and provider protections
Subtitle D - Access to information needed to prevent fraud, waste, and abuse
Title VII - Medicaid and CHIP
Subtitle A - Medicaid and health reform
Subtitle B - Prevention
Subtitle C - Access
Subtitle D - Coverage
Subtitle E - Financing
Subtitle F - Waste, Fraud, and Abuse
Subtitle G - Puerto Rico and the territories
Subtitle H - Miscellaneous
Title VIII - Revenue-related provisions
Title IX - Miscellaneous Provisions
It's going to be painful but I'm going to slog through it. The key is really understanding the current code, which of course I don't.
Title I - Improving Health Care Value
Subtitle A - Provisions related to Medicare Part A
Part 1 - Market Basket Updates
Part 2 - Other Medicare Part A provisions
Subtitle B - Provisions related to Part B
Part 1 - Physician's Services
Part 2 - Market Basket Updates
Part 3 - Other provisions
Subtitle C - Provisions related to Medicare Parts A and B
Subtitle D - Medicare Advantage reforms
Part 1 - Payment and Administration
Part 2 - Beneficiary Protections and Anti-Fraud
Part 3 - Treatment of Special Needs Plans
Subtitle E - Improvments to Medicare Part D
Subtitle F - Medicare Rural Access Protections
Title II - Medicare Beneificiary Improvements
Subtitle A - Improving and Simplifying Financial Assistance for Low Income Medicare beneficiaries
Subtitle B - Reducing Health Disparities
Subtitle C - Miscellaneous Improvements
Title III - Promoting primary care, mental health services and coordinated care
Title IV - Quality
Subtitle A - Comparative Effectiveness Research
Subtitle B - Nursing Home Transparency
Part 1 - Improving transparency of information on skilled nursing facilities and nursing facilities
Part 2 - Targeting enforcement
Part 3 - Improving staff training
Subtitle C - Quality measurements
Subtitle D - Physician payments sunshine provision
Subtitle E - Public reporting on health care-associated infections
Title V - Medicare Graduate Medical Education
Title VI - Program Integrity
Subtitle A - Increased funding to fight waste, fraud, and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Subtitle C - Enhanced program and provider protections
Subtitle D - Access to information needed to prevent fraud, waste, and abuse
Title VII - Medicaid and CHIP
Subtitle A - Medicaid and health reform
Subtitle B - Prevention
Subtitle C - Access
Subtitle D - Coverage
Subtitle E - Financing
Subtitle F - Waste, Fraud, and Abuse
Subtitle G - Puerto Rico and the territories
Subtitle H - Miscellaneous
Title VIII - Revenue-related provisions
Title IX - Miscellaneous Provisions
It's going to be painful but I'm going to slog through it. The key is really understanding the current code, which of course I don't.
Title 4 - changes to tax code (sections 401-453)
OUCH.
If an individual does not belong to a qualifying plan (including VA, medicare, etc.), they get a 2.5% wallop on their modified adjusted gross income. The tax, however, can't exceed the average cost (premium) of a self-only basic plan offered by an Exchange plan.
There is a religious exemption for health coverage - interesting!
If an employer decides not follow along (good luck with that!) - an 8% tax on payroll wages.
For small businesses, the IRS code gets modified... —Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986. Wow, it is hard to read!
- the tax credit for SMB is based on 50% of their health coverage expenses
- the credit slides down as the expenses go over 20K
- no credit allowed for employees who get paid over 80K
- SMB means <=25 employees, where an employee makes at least 5K
Section 441 - more taxes!
1% for income between 350K-500K (after 2012, goes to 2%)
1.5% for 500K-1M (after 2012, goes to 3%)
5.4% over 1M (OUCH)
then we get... there will be a study done in 2012 for the years 2009-2019 to determine the reduction in federal expenditures based on Division B (medicare and medicaid changes) of this Act. If this report shows between 150B and 175B in savings over and above the 525B savings expected, the 1% tax above will no apply. If it's > 175B, then the 1.5% tax above does not apply either.
Section 452 appears to be unrelated to the healthcare code and is just a straight tax code change. It is listed as 'codification of economic substance doctrine'. This would seem VERY important, but I have no idea what it means. Any comments?
If an individual does not belong to a qualifying plan (including VA, medicare, etc.), they get a 2.5% wallop on their modified adjusted gross income. The tax, however, can't exceed the average cost (premium) of a self-only basic plan offered by an Exchange plan.
There is a religious exemption for health coverage - interesting!
If an employer decides not follow along (good luck with that!) - an 8% tax on payroll wages.
For small businesses, the IRS code gets modified... —Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986. Wow, it is hard to read!
- the tax credit for SMB is based on 50% of their health coverage expenses
- the credit slides down as the expenses go over 20K
- no credit allowed for employees who get paid over 80K
- SMB means <=25 employees, where an employee makes at least 5K
Section 441 - more taxes!
1% for income between 350K-500K (after 2012, goes to 2%)
1.5% for 500K-1M (after 2012, goes to 3%)
5.4% over 1M (OUCH)
then we get... there will be a study done in 2012 for the years 2009-2019 to determine the reduction in federal expenditures based on Division B (medicare and medicaid changes) of this Act. If this report shows between 150B and 175B in savings over and above the 525B savings expected, the 1% tax above will no apply. If it's > 175B, then the 1.5% tax above does not apply either.
Section 452 appears to be unrelated to the healthcare code and is just a straight tax code change. It is listed as 'codification of economic substance doctrine'. This would seem VERY important, but I have no idea what it means. Any comments?
Friday, July 31, 2009
Title 3 - shared responsibility (sections 301-324)
This area is a tough read as it lists the impositions on the employer. ugh.
full time employees:
- for an individual, the employer MUST pay 72.5% of the premium of the lowest cost plan offered by the employer.
- for a family, it's 65%
non-full time employees:
TBD
An employee must specifically opt-out of any employer-offered coverage otherwise they automatically get the lowest cost coverage. For employees that opt out, the employer must pay a fee to the HCA. It's not entirely clear to me what the % means, but it's either 8% of all employee wages, or 8% of the premium which would have been paid. There is a sliding scale for employers with payrolls up to 400K.
Section 321 amends Subtitle B of title I of the Employee Retirement Income Security Act of 1974. It doesn't appear to be anything too drastic, just updating definitions and such to reflect this new healthcare act. Section 323 does the same for Part C of title XXVII of the Public Health Service Act.
full time employees:
- for an individual, the employer MUST pay 72.5% of the premium of the lowest cost plan offered by the employer.
- for a family, it's 65%
non-full time employees:
TBD
An employee must specifically opt-out of any employer-offered coverage otherwise they automatically get the lowest cost coverage. For employees that opt out, the employer must pay a fee to the HCA. It's not entirely clear to me what the % means, but it's either 8% of all employee wages, or 8% of the premium which would have been paid. There is a sliding scale for employers with payrolls up to 400K.
Section 321 amends Subtitle B of title I of the Employee Retirement Income Security Act of 1974. It doesn't appear to be anything too drastic, just updating definitions and such to reflect this new healthcare act. Section 323 does the same for Part C of title XXVII of the Public Health Service Act.
Thursday, July 30, 2009
Subtitle C - individual affordability credits (sections 241-246)
what a nice little term 'affordability credits' - sounds so pleasant doesn't it? Another fun one 'credit eligible individuals' - doesn't this sound like someone who has done a good job with their finances and can secure a loan? No, it's almost the exact opposite, it's someone who needs help paying their insurance premiums.
The commissioner (HCA) will have a form that people can fill out to apply for credits (a reduction to their premium). There will of course be a process to determine whether the individual is eligible; the HCA can use the state's Medicaid determination in the process, and in so doing, the HCA will be nice enough to reimburse the state's Medicaid for their time and effort.
In years 1 and 2, credits will only apply to people on a 'basic' plan. In year 3 and after, there will be an option to apply a credit to an 'enhanced' or 'premium' plan.
The credit is specifically not a cash rebate.
So, who would be able to apply for a credit?
- an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).
in the last section (246), it specifically states that no credits shall be available to persons not lawfully present in the US.
- someone not on an employer-sponsored insurance plan
- family income below 400% of the Federal poverty level for their size of family
- not Medicaid eligible
- after year 2, a family on an employer-sponsored plan but the cost of the plan is > 11% of the family's income
When defining income, we're talking about 'modified adjusted gross income'.
Credits will not be treated like a benefit from the employer (for tax purposes).
The premium credit is applied on a sliding scale based on family income. Essentially, if you are the poorest of the poor, you need to pay about 3% of the premium (if I'm understanding it correctly).
There is also the concept of credits for cost-sharing affordability. If I'm reading this correctly, it applies to HCA paying the insurance companies their % of the premiums.
The commissioner (HCA) will have a form that people can fill out to apply for credits (a reduction to their premium). There will of course be a process to determine whether the individual is eligible; the HCA can use the state's Medicaid determination in the process, and in so doing, the HCA will be nice enough to reimburse the state's Medicaid for their time and effort.
In years 1 and 2, credits will only apply to people on a 'basic' plan. In year 3 and after, there will be an option to apply a credit to an 'enhanced' or 'premium' plan.
The credit is specifically not a cash rebate.
So, who would be able to apply for a credit?
- an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).
in the last section (246), it specifically states that no credits shall be available to persons not lawfully present in the US.
- someone not on an employer-sponsored insurance plan
- family income below 400% of the Federal poverty level for their size of family
- not Medicaid eligible
- after year 2, a family on an employer-sponsored plan but the cost of the plan is > 11% of the family's income
When defining income, we're talking about 'modified adjusted gross income'.
Credits will not be treated like a benefit from the employer (for tax purposes).
The premium credit is applied on a sliding scale based on family income. Essentially, if you are the poorest of the poor, you need to pay about 3% of the premium (if I'm understanding it correctly).
There is also the concept of credits for cost-sharing affordability. If I'm reading this correctly, it applies to HCA paying the insurance companies their % of the premiums.
Subtitle B (sections 221-226) - Public Health Insurance Option
ah, now we get to the meat and potatoes...
The Secretary of Health and Human Services would run this new health insurance option. It has to follow all of the same rules as any other insurance option under the new Exchange; by definition it also has to only be offered under the exchange. We also get another new deparment - office of the ombudsman of the health insurance option.
The option gets $2B (2,000,000,000) in startup money to cover initial claims before the payment of premiums. The bill literally states that any premiums are to cover the cost of the healthcare and any administrative costs. The $2B is to be repaid to the treasury over a period of 10 years.
In a nutshell, the rates to providers, hospitals, doctors, etc will be the same as done for medicare. For the first 3 years, this will include a 5% uplift, but after year 3 all bets are off. Any service which provides medicare options today will automatically be included as an in-network provider unless they opt out. Anybody else see a serious problem here? Who are the doctors and providers who offer their services for less?
The Secretary of Health and Human Services would run this new health insurance option. It has to follow all of the same rules as any other insurance option under the new Exchange; by definition it also has to only be offered under the exchange. We also get another new deparment - office of the ombudsman of the health insurance option.
The option gets $2B (2,000,000,000) in startup money to cover initial claims before the payment of premiums. The bill literally states that any premiums are to cover the cost of the healthcare and any administrative costs. The $2B is to be repaid to the treasury over a period of 10 years.
In a nutshell, the rates to providers, hospitals, doctors, etc will be the same as done for medicare. For the first 3 years, this will include a 5% uplift, but after year 3 all bets are off. Any service which provides medicare options today will automatically be included as an in-network provider unless they opt out. Anybody else see a serious problem here? Who are the doctors and providers who offer their services for less?
Section 208 - state-based exchanges
Very interesting... the concept would appear to be a good one, or at least a good-will offering. If a state wishes to run its own healthcare exchange, it can do so and it would run in place of the federal exchange. Of course... the state exchange has to follow all of the same rules as the federal exchange, is still under the Commissioner's authority, etc.
The feds would also do a matching grant to assist the state with funding the exchange.
So why... I could see a state like Texas running one to at least make it appear that they are keeping some of their states rights. Or a state like Massachusetts which is already running a 'healthcare for all' option...
The feds would also do a matching grant to assist the state with funding the exchange.
So why... I could see a state like Texas running one to at least make it appear that they are keeping some of their states rights. Or a state like Massachusetts which is already running a 'healthcare for all' option...
Section 207 - the trust fund
There was an earlier mention of this trust fund, but this section describes "who's gonna pay for this thing?"
- taxes on individuals refusing coverage. It states this is already covered by section 59B of the IRS code of 1986
- taxes on employers not providing acceptable coverage - section 3111C of the same code.
Whatever comes up short, the Treasury has to make it up. Well, why didn't you say it was so easy!?
While very short, this is a very interesting and complicated section. This would appear to be at least one of the sections that describes the opposition's "they're gonna tax your health care benefits" slogans. The argument appears to be very disingenuous, although, to be fair, this bill is also changing the definition of what it means to be covered. So it could be that someone who would not be taxed today would be taxed after this is passed, but the great majority of people's status wouldn't change.
- taxes on individuals refusing coverage. It states this is already covered by section 59B of the IRS code of 1986
- taxes on employers not providing acceptable coverage - section 3111C of the same code.
Whatever comes up short, the Treasury has to make it up. Well, why didn't you say it was so easy!?
While very short, this is a very interesting and complicated section. This would appear to be at least one of the sections that describes the opposition's "they're gonna tax your health care benefits" slogans. The argument appears to be very disingenuous, although, to be fair, this bill is also changing the definition of what it means to be covered. So it could be that someone who would not be taxed today would be taxed after this is passed, but the great majority of people's status wouldn't change.
Section 206 - "other"
The "other" sections are the real killers... here we get the reminder that the Commissioner is responsible for coordinating the distribution of cost-sharing credits to the providers and coordination of risk-pooling. Both concepts are still unclear to me.
Here in the "other" section, we also get a brand-new federal deparment - the Office of the Inspector General for the Health Insurance Exchange. The IG is appointed by the president. The entire office gets terminated 5 years after this Act is enacted. Right... but anyway, the office is basically there to audit the exchange and make sure they don't screw up. There is also an interesting provision:
The provisions of subsections (b) (other than paragraphs (1) and (3)), (d) (other than paragraph (1)), and (e) of section 121 of division A of the Emergency Economic Stabilization Act of 2009 (Public Law 110–343) shall apply
Here in the "other" section, we also get a brand-new federal deparment - the Office of the Inspector General for the Health Insurance Exchange. The IG is appointed by the president. The entire office gets terminated 5 years after this Act is enacted. Right... but anyway, the office is basically there to audit the exchange and make sure they don't screw up. There is also an interesting provision:
The provisions of subsections (b) (other than paragraphs (1) and (3)), (d) (other than paragraph (1)), and (e) of section 121 of division A of the Emergency Economic Stabilization Act of 2009 (Public Law 110–343) shall apply
Wednesday, July 29, 2009
Section 205 - outreach and enrollment policies
The commission is able to get the word out about the healthcare exchange - was there any doubt about that?
Open enrollment is September - November. What is the deal with open enrollment anyway? Why not get rid of the entire stupid concept? What other insurance only opens its doors to you for 30 days a year? Wouldn't this be a great chance to get rid of this anti-consumer feature?
There's an interesting section about children born in the US w/ no healthcare coverage. In that case, they become a non-traditional Medicaid eligible individual. While this notation seems to be out of place in this section, it does include a note about auto-enrolling such kids in the Medicaid program. This is essentially "all kids are covered". This section also says that if a person is Medicaid eligible, they can choose Medicaid as an option instead of paying for one of the insurance options.
Open enrollment is September - November. What is the deal with open enrollment anyway? Why not get rid of the entire stupid concept? What other insurance only opens its doors to you for 30 days a year? Wouldn't this be a great chance to get rid of this anti-consumer feature?
There's an interesting section about children born in the US w/ no healthcare coverage. In that case, they become a non-traditional Medicaid eligible individual. While this notation seems to be out of place in this section, it does include a note about auto-enrolling such kids in the Medicaid program. This is essentially "all kids are covered". This section also says that if a person is Medicaid eligible, they can choose Medicaid as an option instead of paying for one of the insurance options.
Saturday, July 25, 2009
Section 203 - Plan options
Certainly interesting stuff here - any plan in the Exchange has to offer the same tiered services: basic, enhanced, and premium. You can't offer enhanced w/o basic, premium w/o enhanced, etc. There is also a premium plus program which includes dental and vision.
The idea of cost-sharing is still muddled (for me). In some places, it seems like a copay. In others it seems like a % of the insurance cost that the feds pick up.
The insurance companies which operate in the Exchange can only do so after contracting with the HCA. They must follow the guidelines set forth, most are mildly intrusive except for the following which are overly intrusive -
- The entity shall provide for implementation of the affordability credits provided for enrollees under subtitle C, including the reduction in cost-sharing under section 244(c) - whatever that means...
- must provide enrollment for everybody
The idea of cost-sharing is still muddled (for me). In some places, it seems like a copay. In others it seems like a % of the insurance cost that the feds pick up.
The insurance companies which operate in the Exchange can only do so after contracting with the HCA. They must follow the guidelines set forth, most are mildly intrusive except for the following which are overly intrusive -
- The entity shall provide for implementation of the affordability credits provided for enrollees under subtitle C, including the reduction in cost-sharing under section 244(c) - whatever that means...
- must provide enrollment for everybody
Friday, July 24, 2009
section 201 - Health Insurance Exchange
Wow - this is going to take a long time! I'm not even 10% of the way through this beast. Fortunately, it sounds like the House is not going to rush this to a vote before their summer break so maybe I'll be able to get through most of this before they do.
Here are some new terms:
Health Insurance Exchange - facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
Acceptable coverage - you're insured under a plan that meets the fed's requirements, or insured under a plan that doesn't but it's in the grace period.
The rollout of the new exchange is phased:
year 1: people who are not insured, those who have medicaid but meet some really specific circumstances, employers with less than 10 employees
year 2: same people as above, employers with less than 20 employees
year 3: all people, all employers.
Note that none of the above lists any restriction about citizenship, legal status, etc. We are freakin' nuts.
Here are some new terms:
Health Insurance Exchange - facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
Acceptable coverage - you're insured under a plan that meets the fed's requirements, or insured under a plan that doesn't but it's in the grace period.
The rollout of the new exchange is phased:
year 1: people who are not insured, those who have medicaid but meet some really specific circumstances, employers with less than 10 employees
year 2: same people as above, employers with less than 20 employees
year 3: all people, all employers.
Note that none of the above lists any restriction about citizenship, legal status, etc. We are freakin' nuts.
Wednesday, July 22, 2009
the 100's...
sections 101 and 102 start to detail how existing health plans will work in this new plan.
existing employment-based health plans will have a 5 yr grace period (the plan starts in 2013) to match the new minimum requirements for "acceptable healthcare". There are some limited-type plans (102.b.1.b) which will not get a grace period.
Individual health insurance changes on day 1 of the plan.
sections 121, 122, and 124 list the minimum requirements for an acceptable plan.
Here are some of the interesting ones:
- no annual or lifetime limits on benefits
- must cover:
- hospitalization
- outpatient/emergency services
- access to doctors / health professionals
- prescription drugs
- rehabilitation services
- preventative services, including vaccines
- maternity care
- well-baby/child care (under 21) including oral/vision/hearing
- no pre-existing condition requirements
- can't cancel or not renew unless because of non-payment of insurance fees
The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services. Hmm - huh? This term is everywhere in the bill so it's meaning is crucial to understanding what's going on here. Right now, I think it involves the idea of having both your employment insurance and the govt insurance pay your bills, much like you would have today if both you and your spouse have insurance. Of course, I'm probably wrong...
After the start of the plan, the 'commissioner' and his team will investigate which companies go with insurance and which self-insure. After 18 months, they'll produce a report with recommendations to make sure small-mid sized business don't all self-insure and cause risk pools for the large employer insursers or large employer self-insurers. This would seem to be a protection for the existing large plans.
For insurance plans that use provider networks (don't they all?), the commissioner gets to decide whether a particular network is valid and whether the cost diff between in/out of network is valid. Not good...
Section 116 introduces the idea of medical loss ratio - plans that don't meet the ratio have to offer refunds. I'm thinking this means that insurance companies can not operate as a for-profit company, but we'll see...
The health benefits advisory committee is chaired by the surgeon general and:
- 9 members appointed by the president
- 9 members appointed by Comptroller General (?)
- up to 8 federal employees appointed by president
- 3 yr term
- supposed to representative of various jobs/experts (haha)
- no pay except for travel expenses.
There is a new agency in the Executive Administration - the Health Choices Administration
questions - what is an 'exchange-participating health benefits plan'?
- commissioner of HCA is appointed by pres and approved by senate
can you imagine how big this agency is going to be? Let's take a look at the payroll of the biggest insurer and times it by...5... 10... ?
Why wouldn't this fall under the existing Health and Human Services agency?
The law will allow for 'reinsurance' of employer-plans which cover retirees. This seems to be an option for the plan, but if they choose to do so, they can be reimburse by the feds for 80% of the cost. The reinsurance plan allocates 10B (yes, that's billion) in a treasury trust fund to handle this. That's some cost savings...
existing employment-based health plans will have a 5 yr grace period (the plan starts in 2013) to match the new minimum requirements for "acceptable healthcare". There are some limited-type plans (102.b.1.b) which will not get a grace period.
Individual health insurance changes on day 1 of the plan.
sections 121, 122, and 124 list the minimum requirements for an acceptable plan.
Here are some of the interesting ones:
- no annual or lifetime limits on benefits
- must cover:
- hospitalization
- outpatient/emergency services
- access to doctors / health professionals
- prescription drugs
- rehabilitation services
- preventative services, including vaccines
- maternity care
- well-baby/child care (under 21) including oral/vision/hearing
- no pre-existing condition requirements
- can't cancel or not renew unless because of non-payment of insurance fees
The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services. Hmm - huh? This term is everywhere in the bill so it's meaning is crucial to understanding what's going on here. Right now, I think it involves the idea of having both your employment insurance and the govt insurance pay your bills, much like you would have today if both you and your spouse have insurance. Of course, I'm probably wrong...
After the start of the plan, the 'commissioner' and his team will investigate which companies go with insurance and which self-insure. After 18 months, they'll produce a report with recommendations to make sure small-mid sized business don't all self-insure and cause risk pools for the large employer insursers or large employer self-insurers. This would seem to be a protection for the existing large plans.
For insurance plans that use provider networks (don't they all?), the commissioner gets to decide whether a particular network is valid and whether the cost diff between in/out of network is valid. Not good...
Section 116 introduces the idea of medical loss ratio - plans that don't meet the ratio have to offer refunds. I'm thinking this means that insurance companies can not operate as a for-profit company, but we'll see...
The health benefits advisory committee is chaired by the surgeon general and:
- 9 members appointed by the president
- 9 members appointed by Comptroller General (?)
- up to 8 federal employees appointed by president
- 3 yr term
- supposed to representative of various jobs/experts (haha)
- no pay except for travel expenses.
There is a new agency in the Executive Administration - the Health Choices Administration
questions - what is an 'exchange-participating health benefits plan'?
- commissioner of HCA is appointed by pres and approved by senate
can you imagine how big this agency is going to be? Let's take a look at the payroll of the biggest insurer and times it by...5... 10... ?
Why wouldn't this fall under the existing Health and Human Services agency?
The law will allow for 'reinsurance' of employer-plans which cover retirees. This seems to be an option for the plan, but if they choose to do so, they can be reimburse by the feds for 80% of the cost. The reinsurance plan allocates 10B (yes, that's billion) in a treasury trust fund to handle this. That's some cost savings...
where did this mess start?
I need to go back and read the Employee Retirement Income Security Act of 1974. I'm pretty sure this contains much of the start of our current mess. It's referenced quite a bit in the beginning of the bill; I'm thinking it involves the requirements of businesses to provide healthcare to their employees. We'll see... but even if that's not the right law, it certainly is the start of the mess. What does employment have to do with healthcare? Nothing. Absolutely nothing. Why should employers be on the hook for providing healthcare for their employees? They shouldn't!!
Gotta read it
HR 3200 - ‘‘America’s Affordable Health Choices Act of 2009’’ - sounds good doesn't it? NO WAY! I'm a strict constitutionalist and I believe the federal government has absolutely no business getting into the healthcare insurance biz. Everything I hear about it scares me to death.
But.
This is such a politically-charged debate that I can't believe either side. The fact that there are only 2 sides should be the first (and only) clue, but we do need a real debate. There's no doubt that our healthcare biz needs serious reform, but let's do it the right way!
Since I can't believe anybody, I'm starting to read the bill, the whole thing. Here's a link if you want to follow along.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf
I'll be making notes, stuff to follow up on, good stuff, bad stuff, and everything in between. I wonder how long this is going to take?
But.
This is such a politically-charged debate that I can't believe either side. The fact that there are only 2 sides should be the first (and only) clue, but we do need a real debate. There's no doubt that our healthcare biz needs serious reform, but let's do it the right way!
Since I can't believe anybody, I'm starting to read the bill, the whole thing. Here's a link if you want to follow along.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf
I'll be making notes, stuff to follow up on, good stuff, bad stuff, and everything in between. I wonder how long this is going to take?
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