We need: 1. Public option 2. No pre-existing conditions, 3. cover as many of the 52 million uninsured as possible. 4. Make ALL participate. 5. Breaks for small businesses. 6. Regulate the Insurance COs. 7. Start in next 6-12 months - NOT 2-3 years !! Fsck That !!
The Senate Bill immediately implements several of the same programs as the House legislation :
Insurance Reforms Implemented Immediately
Although most of the financing reforms do not take effect until 2014, several take effect within six months of enactment. The hope is, obviously, that these will be noticed and that Americans will patiently await implementation of the remainder of the bill.
First, the bill bans lifetime coverage limits and unreasonable annual limits. (The bill cross-references Section 223 of the Internal Revenue Code, the HSA provision, to define unreasonable, but 223 does not address coverage limits.) The bill prohibits rescissions except for fraud and misrepresentation and bars cost sharing for specified preventive services. It requires insurers to extend coverage of unmarried dependents up to age 26 (though not to the children of those dependents).
HR 3590 requires HHS to develop within 12 months clear and comprehensive standards for disclosing insurance coverage and requires insurers and self-insured plans to begin using these forms within 24 months. The legislation extends to insured group plans a prohibition against discriminating in favor of highly compensated employees. This prohibition already applies to self-insured and cafeteria plans.
HHS is supposed to develop within 2 years reporting requirements that plans must implement describing their health outcome improvement, patient safety, and wellness programs. Health insurers must report the percentage of their premiums that they spend on administrative costs and rebate to their insureds amounts that they spend on administrative costs in excess of 20% in the group market or 25% in the individual market (subject to qualifications).
Finally, the legislation requires insurers to offer internal and external review of coverage determinations, a provision almost universally available already under state law. Curiously, the bill does not (like the Finance bill) explicitly also recognize the availability of judicial review for these determinations, although it would presumably remain available under existing state or federal law.
New Programs Implemented Immediately
The legislation also creates several new programs, effective in 2010. First, it provides funding for grants to states to establish health insurance ombudsman or consumer assistance programs. Second, it authorizes HHS to require insurers to justify “unreasonable” premium increases and provides grants to the states to review premium increases as well.
Third, the bill establishes a high-risk pool for people who have been uninsured for at least six months and who have a pre-existing condition. Coverage under the program must have an actuarial value of 65%, out-of-pocket limits that do not exceed those applicable to HSA-linked high-deductible policies (currently $5,950 for an individual, $11,900 for a family), and premiums that do not exceed those charged for a standard insurance policy. This program resembles that in the House bill, but would have more limited eligibility. HR 3950 provides $5 billion for this program, which the CBO estimates will be exhausted midway through 2011.
A fourth program provides reinsurance for high-cost claims for retirees with health benefits. A fifth program offers tax credits for small businesses (up to 25 employees) for up to 35% of the employer’s contribution if the employer pays 50% or more of the premium for 2011 through 2013, and then half of the cost of the employer’s premium contribution thereafter for two years. (Non-profit employers get smaller credits). Seventh, the bill has additional provisions to facilitate administrative simplification. A final provision reduces the Medicare Part D doughnut hole by $500 by raising the coverage ceiling for 2010 only.
The immediate regulatory reforms in the bill would by and large remain in effect after 2014 except insofar as they are superseded by the provisions of the new bill. The rebates for excess administrative costs, for example, sunset at the end of 2013. Most of the accessibility and affordability provisions of the bill do not go into effect until 2014, however. I now turn to these. <snip>
Jebus, Dave. You just want it all, dontcha! It's all about ME, ME, ME... Gimme, bringme, buyme.
Seriously, there's one more thing that's never made it into any amendment AFAIK, and that's COBRA reform. I actually wrote to Sen. Sherrod Brown a/b this, and got a lengthy, but sort of non-specific reply from him (or his office). As of now, COBRA falls into the What's wrong with this picture? bucket. Simply put, you lose your income, and get the opportunity to retain your group health policy for double or triple the premium you paid before you got sacked. DOH!
My suggestion to Sen. Brown was that, as part of the reform bill, the Gov't subsidize a portion of one's premium for a limited period of time to prevent most of one's unemployment benefit from going into his/her health insurance premium. For example, the subsidy might cover 75% of what the former employer's contribution was for the first six months of the COBRA period, which is 18 months. Then there's either a phased reduction over the remaining 12 months, or the individual has to assume the full load as of month seven. Or something like that.
And they really really really have to re-introduce that amendment to revoke the industry's anti-trust exemption.
But you know what scares the crap out of me? If, gawd f'bid, this bill is ultimately defeated, or neutered into uselessness, the insurance industry will have been emboldened like never before, and I can imagine them running rampant over all of us.
7. Start in next 6-12 months - NOT 2-3 years !! Fsck That !!
What else ??
Here's an idea to help things move along (sans the obvious Ex-Lax/Metamucil references) SUSPEND ALL HOUSE & SENATE'S HEALTHCARE until it bloody well passes. (sans obvious TP, Flush & Bloody Stool references)
IOW: Put the bassturds in the same boat as the rest of us long enough to cause a few sleepless nights for the old goats with preexisting conditions.
..but even that won't work.. ..since they've already socked away enough cash (salary + lobbyist payouts) to be able to sit it out longer than we can.
It's all about ME, ME, ME... Gimme, bringme, buyme.
Ha ha ,... well I'm covered pretty well, but I realize how lucky I am. and things could change. Amazing how many well off (incl middle income) think its going to be that way forever... look how fast things changed in the downturn.
I agree about COBRA, pretty worthless.
yeah if this fails and many are pulling all the stoppers out to make it fail, we might as well bend-over. .. and NO KY either !!
I think it's gone far enough, they'll get something- the question is WHAT will it look like and do?
The main problem I have not seen addressed is cost limits. - everyone must have insurance (ok). - no exclusion for pre-existing conditions (ok).
But what's to stop an insurance corporation saying - sure you had a heart attack, we'll insure you, your annual premium is.... $25000/year. Thanks for your business!!!
_________________________ I used to think it was terrible that life was unfair. Then I thought what if life were fair and all of the terrible things that happen came because we really deserved them? Now I take comfort in the general unfairness and hostility of the universe.
That's why a serious P.O. is so important. I posted a/b this a month or two ago. If you tell the insurance industry they no longer have the pre-existing condition exclusion, you are forcing them to embrace a bigger high-risk pool. And from a purely business position, you would expect them -- as you would any enterprise -- to hedge their bets with elevated premiums.
My wife's coverage was declined by Aetna because of a pre-existing condition. It will be wonderful to be able to include her in my policy. But without the P.O., I don't even want to think about what it will cost!
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