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.)
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