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...