Insurers, you may not include pre-existing condition exclusions in your health plans or any other limitation based on an individual or health-related factors.
This I very, very much like. If that were the end of the bill, I could walk away happy. But, we're just at p. 19 and have about 1,000 more to go.
The only reason an insurer can refuse to issue or fail to renew your insurance is if you haven't paid, they've told you you haven't paid and you had a window of time to pay but still didn't. Sounds good to me. That's how my power works, too.
Insurers also cannot discriminate against people with mental health disabilities or substance abuse issues. Odd to me this gets thrown in specifically and is not included with general pre-existing conditions.
Check your pockets:
Premiums can't change except:
a. by age categories set by the Health Care Commissioner (a national health care administrator position created by the bill)
b. by location
c. if the size of your enrolled family changes
Premiums can also change after the Commissioner's office does a study on the insured and not insured, and what their outcomes are in relation to money spent. The Commissioner has 18 months to do the study after Congress enacts the bill. That should definitely be worth watching.
Here after, the Commissioner will be identified as the "Commish" for levity's sake.
Making Premiums Lower (p. 24)
Plans would be required to meet a medical loss ratio set by the Commish every year. If you don't meet it, you have to give the surplus dollars back to your enrollees.
The Commish has to promise to set that ratio with market competition and consumer value in mind.
Can you even imagine? My jaw is nearing the floor with that one. Is this bill trying to force private plans out of the market by making it harder to make money? I agree with a single-payer system and am still perplexed by this.
Subtitle C: You're In!
Now, what's covered?
Some talk of the difference between Health Care Exchange-participating and Health Care Exchange non-participating plans. However, those have not been defined yet. Brilliant structuring. Big Thank You to the House on that one.
The Essential Benefits Package does not impose an annual or lifetime limit.
This, to me is also very big. My insurance caps me out at $1 million over a lifetime, and I'm pretty sure yours might, too. No cap would be great, but I'm questioning the feasibility of this.
Other minimal benefits are: in-patient and out-patient care, physician costs and equipment, PRESCRIPTION DRUGS (high-five, Congress!), rehab, mental health and substance abuse services, preventative services that get an A or B from the Clinical Preventative Services Task Force and CDC recommended vaccines, maternity, well baby and vision and hearing equipment and supplies for kids under 21.
Are some services missing? I can't think of any, but please comment below if you can.
The bill also specifies no cost-sharing (a.k.a. CO-PAYS) for preventative services. This, to me, is suspect, my insurance plan also says that, but when I went to the dietitian, I certainly had to pay. It seems my plan's definition of "preventative" is quite small. Hell, I think they should have bought my bicycle helmet, but whatever. Also, verdict still seems to be out on whether preventative measures work. I'd maybe like us to put that funding towards something we can prove is working... like drugs.
Out of pocket CO-PAYs cap out at $5,000 for an individual and $10,000 for a family. These levels will go up every years based on the Consumer Price Index.
CO-PAYS should touch out at somewhere around 30 percent of a plan's actuarial value. I'm not exactly sure what this means. Check out p. 30 and see if you can explain it to me better. If you buy into an enhanced plan, that number drops to 15 percent. And for all you premium shoppers out there, your plan will cover 90 percent of the value of the benefits (you pay 10 percent). This is all on p. 33.
The Commish is not enough. We need a Committee!
We're going to need a private-public committee, the Health Benefits Advisory Committee, that will recommend what benefits to cover and define plan benefit levels. (So far, we've just touched on essential in this blog.) We've got 60 days to set it up.
The Surgeon General will be the chair along with 9 presidential appointees (Federal employees) and 9 Comptroller General appointees (or non-Fed folk), oh and 8 more Fed guys. Oh, at least one person has to be a practicing physician. You think? We're going to pay per diem for these expert committee members.
No word on if the Commish gets a seat or not.
Lord-A-Mighty! In my limited experience with government (the seven-strong Golden City Council), I've found that you really need less people to get more done. I am very wary of this committee. Staff employees are the people who do the actual work and provide data for analysis. I suspect we're just going to end up with a new government agency.
Next up, policy prophylactics. More protection for consumers.
Wednesday, September 02, 2009
Blogging the Bill #1
Blogging the Bill
Section 1:
Pre-existing condition exclusion ban is first on the Table of Contents. Lookin' good so far!
Important to note: the glossary starts on page 8 and runs to 14. I feel like this might be worth earmarking, so to speak, for future reference.
Reading the glossary, it appears I also need to read the Public Health Service Act of 1946.
Now they're bringing in the Social Security Act. Good thing there's lots of room on my hard drive... and the Employee Retirement Income Security Act of 1974.
Is this a pharmacological study? We've started talking Y1, Y2, Y3... as in years after the bill takes effect, starting in 2013. Perhaps this will help industry insiders understand the legislation.
Finally Title 1-Protections and Standards for Qualified Health Benefits Plan!
Jesus... another glossary. Webster's should get in on this.
Section A: What exactly is a Health Benefit Provider?
1. Grandfathered Health Insurance Coverage (p 16)
Huzzah! Everyone stop freaking out... you can keep your coverage.
Well, if:
a. The company stops new enrollment after the Bill takes effect
b. They don't change any benefits or terms, either
c. And they don't change the percentage by which your premium increases every year without changing it for everyone equally.
(So far, I don't think I'd like to be running an insurance company with these conditions.)
These grandfathered programs would have a 5-year grace period to meet requirements and to get up to speed with the benefit requirements. (Coming in a later section the bill promises.) Collective sigh of relief from the industry?
Now we're getting to the exceptions section which is so convoluted I absolutely have to look up the Public Health Service Act. Thank you Cornell University Law School for your online version of the Act.
Basically, these things remain not included in the definition of "health insurance benefit" if these were already separate from the plan: accident only coverage, workers comp, auto insurance, on-site medical insurance coverage, limited vision and dental, long-term care insurance a.k.a. nursing home insurance.
Nothing too shocking there as these seem to be not included in all insurance plans I've heard of.
Next up, Subtitle B: Standards guaranteeing access to affordable health coverage and such sexy topics as pre-existing conditions and other enrollment requirements.
Section 1:
Pre-existing condition exclusion ban is first on the Table of Contents. Lookin' good so far!
Important to note: the glossary starts on page 8 and runs to 14. I feel like this might be worth earmarking, so to speak, for future reference.
Reading the glossary, it appears I also need to read the Public Health Service Act of 1946.
Now they're bringing in the Social Security Act. Good thing there's lots of room on my hard drive... and the Employee Retirement Income Security Act of 1974.
Is this a pharmacological study? We've started talking Y1, Y2, Y3... as in years after the bill takes effect, starting in 2013. Perhaps this will help industry insiders understand the legislation.
Finally Title 1-Protections and Standards for Qualified Health Benefits Plan!
Jesus... another glossary. Webster's should get in on this.
Section A: What exactly is a Health Benefit Provider?
1. Grandfathered Health Insurance Coverage (p 16)
Huzzah! Everyone stop freaking out... you can keep your coverage.
Well, if:
a. The company stops new enrollment after the Bill takes effect
b. They don't change any benefits or terms, either
c. And they don't change the percentage by which your premium increases every year without changing it for everyone equally.
(So far, I don't think I'd like to be running an insurance company with these conditions.)
These grandfathered programs would have a 5-year grace period to meet requirements and to get up to speed with the benefit requirements. (Coming in a later section the bill promises.) Collective sigh of relief from the industry?
Now we're getting to the exceptions section which is so convoluted I absolutely have to look up the Public Health Service Act. Thank you Cornell University Law School for your online version of the Act.
Basically, these things remain not included in the definition of "health insurance benefit" if these were already separate from the plan: accident only coverage, workers comp, auto insurance, on-site medical insurance coverage, limited vision and dental, long-term care insurance a.k.a. nursing home insurance.
Nothing too shocking there as these seem to be not included in all insurance plans I've heard of.
Next up, Subtitle B: Standards guaranteeing access to affordable health coverage and such sexy topics as pre-existing conditions and other enrollment requirements.
The Hill's Pill
As you may have noticed from Aug. 17's posting, I have very strong opinions on the necessity of health care reform in this country.
That being said, my strongest opinion is that media coverage of the House reform bill, HR 3200, is horrible. Instead of taking the August break for some analysis of the current system and ideas for the future, news people have gone the easier route, covering town hall meetings instead. I understand, crazy people lend themselves to better photos, but think of the info graphic potential, had they gone the other way.
So, in light of the mind-numbing vacuum of information on the topic, I decided to read the damn thing myself.
I hope my notes are helpful and that I can get this done before the Senate releases their own version.
(For reference, I downloaded my draft of the bill from the House Education and Labor Committee here.)
That being said, my strongest opinion is that media coverage of the House reform bill, HR 3200, is horrible. Instead of taking the August break for some analysis of the current system and ideas for the future, news people have gone the easier route, covering town hall meetings instead. I understand, crazy people lend themselves to better photos, but think of the info graphic potential, had they gone the other way.
So, in light of the mind-numbing vacuum of information on the topic, I decided to read the damn thing myself.
I hope my notes are helpful and that I can get this done before the Senate releases their own version.
(For reference, I downloaded my draft of the bill from the House Education and Labor Committee here.)
Monday, August 17, 2009
Healthcare, An Analysis
In the midst of all the name calling, sign snatching and general chaos of ignorance going back and forth during this healthcare reform debate, I have come across a few points that merit bring up.
Here they are:
The Free Choice Fallacy
Currently, you do not have a choice in healthcare as it stands. Probably, it's your employer who picks your plan. Maybe you get to chose between between chocolate and vanilla, but certainly not between hotdogs and ice cream. Your boss might have some choices in the free market, but he’s most likely looking to maximize the tax rebates he gets for paying part of your insurance.
If you are one of the people who can afford and are healthy enough to buy insurance on the free market, huzzah! You do in fact have a choice, unfortunately you’re only 9 percent of insured adults in the market according to the most recent census data from 2007. Enjoy it while it lasts, try not to get sick, whatever that costs you.
(Just for reference, the data also show that 59 percent of the population is insured through their employer, almost 28 percent by the government and 15 percent of the population were uninsured.)
Rationing, It ain't nothing new
It already exists. Your health insurer provides it. For example, my health insurance “rations” the amount of insulin pump supplies I can get by putting a $2,000 per year cap on what they will pay. Incidentally, I was never told that there was a cap when I selected this “chocolate” version of my healthcare plan and just got a notice, buried in fine print this very evening.
Death Squads, Call Vadar
Reference "rationing" above. Why do you think insurance puts those $1 million caps (or rations) on lifetime coverage? Cause they don’t want to pay! Companies make the same decisions as said “death squads” would all the time. After $1million, your life, no matter what you do or how young you are, is not worth it to your insurance company. At least in Britain, the NHS is more than willing to pay up to $49,000 to increase your life by one year National Institute for Health and Clinical Excellence’s June 2008 report.
Show me the (lack of) money
Health care is not only bankrupting the country, it’s bankrupting individual citizens, too. It is the primary reason people in this country declare bankruptcy. It’s out of control. Why spend three times as much per person and end up with a less healthy population? That’s like paying the same price for a Toyota as you would a Porsche. Full disclosure, I LOVE Toyotas.
How will we pay for it? How about taking all the collective insurance premiums, co-pays and deductibles those insured Americans are already spending for a start.
To find that number I found the Agency for Health Care Research and Quality. The precise link to the data, here.
My calculations end up at $359 billion. (I completely low-balled it. Email me for my rudimentary calculations).
Now, let’s take a large part of the money Medicare and your insurance company spend on prescription drugs because they’re not allowed to get wholesale prices even though they are the largest drug buying organization in the world. That’s an easy $2 billion more.
Full disclosure on that number, the best I could come up with was from the Snowe-Wyden amendment to the health care bill. They projected that number on a 5 percent decrease in drug costs. The Medicare Prescription Drug Part D saw an 11 percent decrease (for some Medicare recipients) so that $2 billion is another low ball. The Congressional Budget Office puts this figure at $110 billion.
How about changing our medical care to follow what science shows actually works and change the way doctor’s are reimbursed so they aren’t incentivized to order unnecessary tests and procedures. Turns out it’s hard to pin people down on this number. One study found that $2.76 billion could be saved by streamlining pharmaceutical care using Ace-inhibitors, drugs commonly used to treat high blood pressure.
Using the same format to address heart disease, diabetes, high cholesterol and common types of cancers, I think we can get that number to $200 billion easily. (If you have more data on this, please send it to me! I’d like to really get a handle on this number).
So, our running total now, $359 billion, plus $2 billion plus $200 billion. I’m at $601 billion dollars and I haven’t touched what the government is currently spending.
Now, let’s not be unfair about this. Want more treatment? Want to upgrade to the triple bypass from just the double. Go for it, but I’m not paying. Perhaps you can buy yourself some supplemental insurance, like in France. You don’t need this, let’s be clear, but if you’re prone to hypochondria or know you’re going to incur a lot of medical bills (I might, with the diabetes and all) go for it.
And woah. Lookie there! That’s a publicly-provided basic level of care and an additional privatized market for additional care. Am I dreaming, or is that cake I’m having and eating, too?
No body’s dying here, or are they?
Lastly, I’d like the conversations we as citizens are having with each other and our legislators are having with each other to start being actual discussions on how to fix this problem. Whether you’re a red state or a blue state, your pockets have long been turned inside out because of health care. And if you live in a red state or a blue state, someone on your block is negatively affected by the health care industry now. Negatively affected like stuck in a job because they offer health insurance because of a preexisting condition. Negatively affected like being bankrupted by a catastrophic illness. Negatively affected like choosing between prescriptions and groceries.
Life, Liberty and the Pursuit of prescription drug coverage
What is missing from this debate is whether health care is a right. That conspicuous hole in the discussion indicates to me that Americans believe, at least on some level, in a basic right for health care. So lets start the new discussion there. Let’s start the new discussion with the compassion and analysis such a vital issue deserves.
This arguable a complete oversimplification of a very difficult problem. But I'm impressed with myself for having an idea that seems more comprehensive than any legislator's I've heard at the town meeting coverage. This is one of the most important issues in my life, and will surely be one of the most important issues in my lifetime. Show me the discourse!
Here they are:
The Free Choice Fallacy
Currently, you do not have a choice in healthcare as it stands. Probably, it's your employer who picks your plan. Maybe you get to chose between between chocolate and vanilla, but certainly not between hotdogs and ice cream. Your boss might have some choices in the free market, but he’s most likely looking to maximize the tax rebates he gets for paying part of your insurance.
If you are one of the people who can afford and are healthy enough to buy insurance on the free market, huzzah! You do in fact have a choice, unfortunately you’re only 9 percent of insured adults in the market according to the most recent census data from 2007. Enjoy it while it lasts, try not to get sick, whatever that costs you.
(Just for reference, the data also show that 59 percent of the population is insured through their employer, almost 28 percent by the government and 15 percent of the population were uninsured.)
Rationing, It ain't nothing new
It already exists. Your health insurer provides it. For example, my health insurance “rations” the amount of insulin pump supplies I can get by putting a $2,000 per year cap on what they will pay. Incidentally, I was never told that there was a cap when I selected this “chocolate” version of my healthcare plan and just got a notice, buried in fine print this very evening.
Death Squads, Call Vadar
Reference "rationing" above. Why do you think insurance puts those $1 million caps (or rations) on lifetime coverage? Cause they don’t want to pay! Companies make the same decisions as said “death squads” would all the time. After $1million, your life, no matter what you do or how young you are, is not worth it to your insurance company. At least in Britain, the NHS is more than willing to pay up to $49,000 to increase your life by one year National Institute for Health and Clinical Excellence’s June 2008 report.
Show me the (lack of) money
Health care is not only bankrupting the country, it’s bankrupting individual citizens, too. It is the primary reason people in this country declare bankruptcy. It’s out of control. Why spend three times as much per person and end up with a less healthy population? That’s like paying the same price for a Toyota as you would a Porsche. Full disclosure, I LOVE Toyotas.
How will we pay for it? How about taking all the collective insurance premiums, co-pays and deductibles those insured Americans are already spending for a start.
To find that number I found the Agency for Health Care Research and Quality. The precise link to the data, here.
My calculations end up at $359 billion. (I completely low-balled it. Email me for my rudimentary calculations).
Now, let’s take a large part of the money Medicare and your insurance company spend on prescription drugs because they’re not allowed to get wholesale prices even though they are the largest drug buying organization in the world. That’s an easy $2 billion more.
Full disclosure on that number, the best I could come up with was from the Snowe-Wyden amendment to the health care bill. They projected that number on a 5 percent decrease in drug costs. The Medicare Prescription Drug Part D saw an 11 percent decrease (for some Medicare recipients) so that $2 billion is another low ball. The Congressional Budget Office puts this figure at $110 billion.
How about changing our medical care to follow what science shows actually works and change the way doctor’s are reimbursed so they aren’t incentivized to order unnecessary tests and procedures. Turns out it’s hard to pin people down on this number. One study found that $2.76 billion could be saved by streamlining pharmaceutical care using Ace-inhibitors, drugs commonly used to treat high blood pressure.
Using the same format to address heart disease, diabetes, high cholesterol and common types of cancers, I think we can get that number to $200 billion easily. (If you have more data on this, please send it to me! I’d like to really get a handle on this number).
So, our running total now, $359 billion, plus $2 billion plus $200 billion. I’m at $601 billion dollars and I haven’t touched what the government is currently spending.
Now, let’s not be unfair about this. Want more treatment? Want to upgrade to the triple bypass from just the double. Go for it, but I’m not paying. Perhaps you can buy yourself some supplemental insurance, like in France. You don’t need this, let’s be clear, but if you’re prone to hypochondria or know you’re going to incur a lot of medical bills (I might, with the diabetes and all) go for it.
And woah. Lookie there! That’s a publicly-provided basic level of care and an additional privatized market for additional care. Am I dreaming, or is that cake I’m having and eating, too?
No body’s dying here, or are they?
Lastly, I’d like the conversations we as citizens are having with each other and our legislators are having with each other to start being actual discussions on how to fix this problem. Whether you’re a red state or a blue state, your pockets have long been turned inside out because of health care. And if you live in a red state or a blue state, someone on your block is negatively affected by the health care industry now. Negatively affected like stuck in a job because they offer health insurance because of a preexisting condition. Negatively affected like being bankrupted by a catastrophic illness. Negatively affected like choosing between prescriptions and groceries.
Life, Liberty and the Pursuit of prescription drug coverage
What is missing from this debate is whether health care is a right. That conspicuous hole in the discussion indicates to me that Americans believe, at least on some level, in a basic right for health care. So lets start the new discussion there. Let’s start the new discussion with the compassion and analysis such a vital issue deserves.
This arguable a complete oversimplification of a very difficult problem. But I'm impressed with myself for having an idea that seems more comprehensive than any legislator's I've heard at the town meeting coverage. This is one of the most important issues in my life, and will surely be one of the most important issues in my lifetime. Show me the discourse!
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