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.
Thursday, July 30, 2009
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!!
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