Sec. 102, (c)(2) SEPARATE, EXCEPT COVERAGE PERMITTED: Excepted benefits will be allowed (as per section 2791(c), which I regret I still have not found), but they are not included within health insurance coverage as is defined by this bill. Such benefits have to be offered and priced separately from health insurance coverage (I'm not sure, but I think this is saying that we would have to possess supplemental insurance).
Sec. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS: This section makes it sound as if no pre-existing conditions shall be excluded. I could be wrong, but that's my understanding.
Sec. 112. GUARANTEE ISSUE AND RENEWAL FOR INSURED PLANS: It gives the only reason for possible withdrawal of coverage from a recipient would be for the cause of insurance fraud and it cites sections 2712(b)(2) of the Public Health Service Act.
Sec. 113. INSURANCE RATING RULES: The following exceptions are given as a reason to change the premium rate:
(1) Age: The Commissioner will set the parameters, but variation by age will be permitted. However, as long as the highest premium does not exceed the lowest premium of 2 to 1.
(2) Area: A premium rating area will apply, which will be specified as by the Commissioner in conjunction with State regulators.
(3) Family Enrollment: The ratio for the premium for family coverage shall remain in uniformity with the individual premium, consistent with rules of the Commissioner (So does that mean when one premium goes up, the other must also be raised?).
(b)(1) Study and Reports, STUDY: "The Commissioner...with the Secretary of Health and Human Services and Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:
(A) (paraphrased) Different types of employers and what insurance products they purchase vs. those that self-insure;
(B) Similarities and differences between typical insured and self-
insured health plans;
(C) The financial solvency and capital reserve levels of employers that
self-insure by employer size (Okay, why is this ANY of their business? It would
sound as if they were doing this to set parameters that have to be met and if not, the public option would be forced upon certain employers);
(D) The risk of self-insured employers not being able to pay obligations
or otherwise becoming financial insolvent (Again, see my parenthetical comment above. I call this "micromanagement");
(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid-size employers to self-insure.
(b)(2) REPORTS: "...the Commissioner shall submit to Congress...a report on the study conducted after (1). Such report shall...ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers..."
Sec. 114. NONDISCRIMINATION IN BENEFITS; PARITY IN MENTAL HEALTH AND SUBSTANCE ABUSE DISORDER BENEFITS.
According to subsection (a)(b), there cannot be a withholding of benefits or
benefit structures for qualifying health benefits plans in regard to such persons (my abbreviated understanding of these two subsections).
Sec. 122. ESSENTIAL BENEFITS PACKAGE DEFINED:
(b) Minimum Services to be Covered: hospitalization; outpatient hospital and outpatient clinic services, including ER services; professional services of doctors and other health care professionals; services, equipment and supplies in connection with the doctor's or health care professional's services rendered whether in the hospital, clinic, patients' homes or other settings, as appropriate; prescription drugs; rehab and habitative services; mental health and substance abuse services; preventive services; maternity care; well baby and well child care, oral, vision, and hearing services, equipment and supplies for children under 21 years of age.
(c) Requirements Relating to Cost-Sharing and Minimum Actuarial Value:
(1) NO COST-SHARING FOR PREVENTIVE SERVICES - means exactly
that (I don't fully understand. I still think this means that it's not allowing
your secondary or tertiary coverage to pick up where your primary coverage
leaves off. If you have a greater knowledge of this, please clue me in).
(2) ANNUAL LIMITATION - As you all know, there are usual yearly
limitations with certain health care plans.
(3) APPLICABLE LEVEL - $5,000 for an individual and $10,000 for a
family. "Such levels shall be increased (rounded to the nearest $100) for
each subsequent year by the annual percentage increase in the Consumer
Price Index..."
(4) USE OF COPAYMENTS - "In establishing cost-sharing levels for
basic, enhanced, and premium plans under this subsection, the Secretary
shall, to the maximum extent possible, use only copayments and not
coinsurance.
Sec. 123. HEALTH BENEFITS ADVISORY COMMITTEE: In a nutshell, this committee shall be a "panel of medical and other experts...to recommend covered benefits and essential, enhanced, and premium plans." It shall be chaired by the Surgeon General. The members shall be made up of 9 members who are not Federal employees or officers and will be appointed by the President. Nine members who are not Federal employees...appointed by the Comptroller General appoints members to the Medicare Payment Advisory Committee..." An even number of members (not to exceed 8) who ARE Federal employees and officers, will be appointed by the President.
These members will serve on the Committee in 3-year terms. The members ranks will be comprised of "providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least on practicing physician or other health professional and an expert on children's health." They claim that this broad spectrum of representatives is to ensure that no single sector unduly influences the recommendations of such Committee."
Okay, y'all, NO MAS! I can't handle anymore of this for now. I'll be back after sleep and much caffeine.
Love Ya,
God Bless!
Friday, August 14, 2009
Sunday, August 9, 2009
Universal Health Care Blogging - Part 2
Title I - Protections and Standards for Qualified Health Benefits Plan:
Subtitle A, Sec. 101: Requirements reforming health insurance marketplace:
(b) Requirements for Qualified Health Benefits Plans - On or after the first day of Y1 (Y1, Y2, Y3, etc. represent years beginning 2013 and subsequent years, respectively. Y1 will be 2013), a health benefits plan shall not be a qualified health benefits plan under the division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable health care coverage);
(2) Subtitle C (relating to essential benefits);
(3) Subtitle D (relating to consumer protection).
*Folks, I have no idea how the the aforementioned Subtitles B, C, and D are defined. When you look up the link, it refers you to a Article section and provision which are not conveniently located in the physical bill.
(c) Terminology:
(1) Enrollment in Emloyement-Based Health Plans (You will be
considered "enrolled" with an employer if you are either a participant or a
beneficiary).
(2) Individual and Group Health Insurance Coverage - Individual and
group health care insurance mean health insurance offered in the individual
market as it pertains to Section 2791 of the Public Health Service Act (This is
the type of stuff I cannot trace down and define here at the house on my
own. I need to have access to the law firm's library at work before I can
figure out what this means. The authors of this bill were not kind enough to
put it in her for us, best I can tell).
Sec. 102: Protecting the Choice to Keep Current Coverage:
(a) Grandfathered Health Insurance Coverage - an individual health care coverage that is in force and effect before the first day of Y1 (2013) under these preconditions:
(A) IN GENERAL: One will not be considered enrolled if the first
effective date of coverage is on or after the first day of 2013.
(B) DEPENDENT COVERAGE PERMITTED: A subsequent dependent
of an enrolled person as in (A) is not subject to that subsection. (In my
understanding this would mean a new baby, adopted child, or spouse.
However, I am not certain of that).
(2) Limitation on Changes and Terms or Conditions: ...the issuer
does not change any of its terms or conditions, including benefits and
cost-sharing, from those in effect as of the day before the first day of
Y1 (2013).
(3) Restrictions on Premium Increases: "The issuer cannot vary the
...increase in the premium for a risk group of enrollees in specific
grandfathered health care coverage without changing the premium for
all enrollees in the same risk group at the same rate (if one is affected,
all must be)."
(b)(1) GRACE PERIOD (for Current Employment-Based Health Plans)
(A) IN GENERAL: The Commissioner shall establish a grace period
whereby, for the years beginning at the end of the 5-year period beginning
with Y1, an employment-based health plan in operation as of the day before
the first day of Y1 must meet the same requirements as apply to a qualified
health benefits plan under Section 101, including the essential benefit
package requirement under Section 121.
I'm signing off here, folks. This stuff will cook your brain like an egg after so long.
Subtitle A, Sec. 101: Requirements reforming health insurance marketplace:
(b) Requirements for Qualified Health Benefits Plans - On or after the first day of Y1 (Y1, Y2, Y3, etc. represent years beginning 2013 and subsequent years, respectively. Y1 will be 2013), a health benefits plan shall not be a qualified health benefits plan under the division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable health care coverage);
(2) Subtitle C (relating to essential benefits);
(3) Subtitle D (relating to consumer protection).
*Folks, I have no idea how the the aforementioned Subtitles B, C, and D are defined. When you look up the link, it refers you to a Article section and provision which are not conveniently located in the physical bill.
(c) Terminology:
(1) Enrollment in Emloyement-Based Health Plans (You will be
considered "enrolled" with an employer if you are either a participant or a
beneficiary).
(2) Individual and Group Health Insurance Coverage - Individual and
group health care insurance mean health insurance offered in the individual
market as it pertains to Section 2791 of the Public Health Service Act (This is
the type of stuff I cannot trace down and define here at the house on my
own. I need to have access to the law firm's library at work before I can
figure out what this means. The authors of this bill were not kind enough to
put it in her for us, best I can tell).
Sec. 102: Protecting the Choice to Keep Current Coverage:
(a) Grandfathered Health Insurance Coverage - an individual health care coverage that is in force and effect before the first day of Y1 (2013) under these preconditions:
(A) IN GENERAL: One will not be considered enrolled if the first
effective date of coverage is on or after the first day of 2013.
(B) DEPENDENT COVERAGE PERMITTED: A subsequent dependent
of an enrolled person as in (A) is not subject to that subsection. (In my
understanding this would mean a new baby, adopted child, or spouse.
However, I am not certain of that).
(2) Limitation on Changes and Terms or Conditions: ...the issuer
does not change any of its terms or conditions, including benefits and
cost-sharing, from those in effect as of the day before the first day of
Y1 (2013).
(3) Restrictions on Premium Increases: "The issuer cannot vary the
...increase in the premium for a risk group of enrollees in specific
grandfathered health care coverage without changing the premium for
all enrollees in the same risk group at the same rate (if one is affected,
all must be)."
(b)(1) GRACE PERIOD (for Current Employment-Based Health Plans)
(A) IN GENERAL: The Commissioner shall establish a grace period
whereby, for the years beginning at the end of the 5-year period beginning
with Y1, an employment-based health plan in operation as of the day before
the first day of Y1 must meet the same requirements as apply to a qualified
health benefits plan under Section 101, including the essential benefit
package requirement under Section 121.
I'm signing off here, folks. This stuff will cook your brain like an egg after so long.
Tuesday, August 4, 2009
Universal Health Care Blogging -- Day 1
If you are breathing at all, this health care bill has an effect upon your future regardless of your age or social class. There will be places where I will quote some pertinent parts of the bill verbatim. In other places I will cite section(s) and/or subsection(s), but I will attempt to state them more clearly than they are written. Here we go:
This information is a beginning summary I read which will serve as a preview of what's to come.
The Universal Health Care Bill (H.R. 3200) states that its purpose is "to provide affordable, quality health care for all Americans and reduce the growth of health care spending, and for other purposes (emphasis mine)." I am concerned about what these "other purposes" are, and hopefully we can uncover that somewhere on down the line. I don't like that language because it's purposefully vague in what I think is an attempt to insert other taboo agenda items into the middle of this train wreck.
The total out-of-pocket expenses per person will be $5,000 and $10,000 per family. Employers will be required to offer health benefits to employees unless their payrolls are below $250,000.
An amendment to the Internal Revenue Code will cause taxes to be imposed upon: (1) anyone without coverage under health care benefits; (2) any employer who fails to provide health care coverage requirements for its employees. Also, anyone earning over $350,000 modified adjusted gross income will be charged a surtax.
Amendments to Medicare's title XVIII of the Social Security Act as they pertain to access, coverage, and payments are such: (1) payments to hospitals will be reduced to offset too many readmissions; (2) Medicare Advantage beneficiaries will have limited cost-sharing; (3) Medicare Part D, which is Voluntary Prescription Drug Benefit Program, will reduce gap coverage (I've already witnessed this with my grandmother's meds going up by over $90 per month); (4) there will be increased payments to primary health care providers; and (5) cost-sharing will not be allowed for covered preventive services.
Medicaid's title XIX of the Social Security Act is set to be amended as follows: (1) Medicaid elgibility will be expanded to include low-income individuals and families; (2) coverage of preventive services will be included; and (3) primary health care providers will receive an increase in payments.
The summary says the health care bill aims to provide the following for health care employees:
(1) that it will address (whatever than means) the repayment of loans and training needs for workers; (2) that it plans to establish a "Public Health Workforce Corp" (which sounds scary to me--very socialist and "brownshirt"); (3) will "address health care workforce diversity" (sounds like elimination of equal employment to me); and (4) will "establish the Advisory Committee on Health Workforce Evaluation and Assessment" (sounds like an bureaucratic "ivory tower" position).
Finally, the summary wraps up by saying it plans to: "(1) provide for prevention and wellness activities; (2) establish the Center for Quality Improvement ("ivory tower" again); (3) establish the position of the Assistant Secretary for Health Information (ditto to point (2)); (4) revise the 340B drug discount program (a program limiting the costs of the covered outpatient drugs to certain federal grantees); (5) establish a school-based health care program; and (6) establish a national medical device registry (don't know what this is)."
That's all for now, people. I shall return. I would appreciate hearing from you all as to your understandings on any of these items.
Love Ya,
God Bless!
This information is a beginning summary I read which will serve as a preview of what's to come.
The Universal Health Care Bill (H.R. 3200) states that its purpose is "to provide affordable, quality health care for all Americans and reduce the growth of health care spending, and for other purposes (emphasis mine)." I am concerned about what these "other purposes" are, and hopefully we can uncover that somewhere on down the line. I don't like that language because it's purposefully vague in what I think is an attempt to insert other taboo agenda items into the middle of this train wreck.
The total out-of-pocket expenses per person will be $5,000 and $10,000 per family. Employers will be required to offer health benefits to employees unless their payrolls are below $250,000.
An amendment to the Internal Revenue Code will cause taxes to be imposed upon: (1) anyone without coverage under health care benefits; (2) any employer who fails to provide health care coverage requirements for its employees. Also, anyone earning over $350,000 modified adjusted gross income will be charged a surtax.
Amendments to Medicare's title XVIII of the Social Security Act as they pertain to access, coverage, and payments are such: (1) payments to hospitals will be reduced to offset too many readmissions; (2) Medicare Advantage beneficiaries will have limited cost-sharing; (3) Medicare Part D, which is Voluntary Prescription Drug Benefit Program, will reduce gap coverage (I've already witnessed this with my grandmother's meds going up by over $90 per month); (4) there will be increased payments to primary health care providers; and (5) cost-sharing will not be allowed for covered preventive services.
Medicaid's title XIX of the Social Security Act is set to be amended as follows: (1) Medicaid elgibility will be expanded to include low-income individuals and families; (2) coverage of preventive services will be included; and (3) primary health care providers will receive an increase in payments.
The summary says the health care bill aims to provide the following for health care employees:
(1) that it will address (whatever than means) the repayment of loans and training needs for workers; (2) that it plans to establish a "Public Health Workforce Corp" (which sounds scary to me--very socialist and "brownshirt"); (3) will "address health care workforce diversity" (sounds like elimination of equal employment to me); and (4) will "establish the Advisory Committee on Health Workforce Evaluation and Assessment" (sounds like an bureaucratic "ivory tower" position).
Finally, the summary wraps up by saying it plans to: "(1) provide for prevention and wellness activities; (2) establish the Center for Quality Improvement ("ivory tower" again); (3) establish the position of the Assistant Secretary for Health Information (ditto to point (2)); (4) revise the 340B drug discount program (a program limiting the costs of the covered outpatient drugs to certain federal grantees); (5) establish a school-based health care program; and (6) establish a national medical device registry (don't know what this is)."
That's all for now, people. I shall return. I would appreciate hearing from you all as to your understandings on any of these items.
Love Ya,
God Bless!
Monday, August 3, 2009
Universal Health Care Blogging (H.R. 3200)
With Congress still tangling over stuffing this onerous 1,000 pager of a stinker down our gullets, I decided that my own righteous indignation would be uncalled for if I didn't read the proposed legislation myself. That way, I will be more dangerous to politicians everywhere. Never mind that it's NOT my job to read this pile of slop, but apparently people we have elected to do the job won't read it, so we as constituents NEED TO KNOW what's in the bill. I want to pass on to you what I learn and I will be posting pertinent parts of it here in piecemeal fashion. For that reason, I won't be blogging about faith and/or opinion matters for awhile. I'll be devoting reading and annotation time to reviewing this bill. I saw scary stuff while I was only putting it in the binder. Those are things that need to see the light of day, and I want you to know where all the boogie-men lurk.
My husband says Homeland Security will be sending someone to knee-cap me anyday now. Har-dee-har-har.
My husband says Homeland Security will be sending someone to knee-cap me anyday now. Har-dee-har-har.
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