1990 Pages Hits the Floor of the House

[somarco]

Princess Nancy is about to wet her pants over the House version of Obamacare. For those who are interested, here is a link to the full 1990 pages.

Just looking through the contents, here are a few sections that will be near and dear to the neocon's among us.

Sec. 101. National high-risk pool program.
Sec. 102. Ensuring value and lower premiums.
Sec. 103. Ending health insurance rescission abuse.
Sec. 104. Sunshine on price gouging by health insurance issuers.

That just takes us through the first 31 pages. Section 104 is an interesting take.

The Secretary of Health and Human Services, in conjunction with States, shall establish a process for the annual review of increases in premiums for health insurance coverage. Such process shall require health insurance issuers to submit a justification for any premium increases prior to implementation of the increase.

Seems to me this already exists, except without federal oversight. Apparently the DOI is incapable of handling this task by themselves.

Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions.
Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities.

Of note in the deformity section is this.

EXCEPTION.—Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.

Who judges the self-esteem part?

Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans.

Who wants to bet retiree health benefits will be gone. ERISA all but eliminated traditional pensions, except in the case of government workers who are EXEMPT from ERISA compliance. Retiree health is the next to go south.

Included in the definition of a reduction in benefits is a "substantial" increase in premiums shared by the retiree.

Since this is about 30% longer than the original HR 3200 it has new things as well as these oldies but goodies.

Sec. 221. Coverage of essential benefits package.
Sec. 222. Essential benefits package defined.

Essential benefits start on page 104 and continue through page 108.

Abortion funding, in certain cases, is still in the bill. That will be a deal killer for some.

Enjoy!

 

[Crabcake Johnny]

I'm reading it now and taking notes - I'm on page 131. There's some interesting stuff so far. For one, carriers can sell plans in or out of the exchanges. "Separate Excepted Coverage" is permitted....more to come.
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The clause I was looking for - page 191


(g) ROLE FOR ENROLLMENT AGENTS AND BROKERS.—Nothing in this division shall be construed to affect the role of enrollment agents and brokers under State law, including with regard to the enrollment of individuals and employers in qualified health benefits plans including the public health insurance option.
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*Temporary Nat'l High Risk Pool starting Jan 1st 2010 ending with health exchanges are implemented
*Cannot have had coverage for 6 months to be eligible
*Employers cannot "dump" employees onto this plan
*2:1 rate ratio max by age
*No more than 125% of "standard individual rate" to be determined by NAIC
*$1,500 deductible for individual, to be determined for families
*No annual of lifetime max
*OOP no more than $5,000 for individuals and $10K for families
*Each state will manage the program

Individual Market Changes as of Jan 1 2010
*Carrier can only rescind plans after a 3rd party review under the guidance of the Secretary
*Rescissions only allowed when "clear evidence of fraud" is determined by 3rd parter reviewer, not by carrier
*"Price Gouging" review - carrier must submit for rate increases under guidance of the Secretary noting reason for rate increases.

Carrier can offer "Separate Excepted Coverage" which can be sold outside of the exchange and allow them to be priced separately (I cannot find out if they still have to be qualified plans.)

Coverage Sold in the Exchange
*No pre-ex exclusions
*2:1 max rating based on age
*Area rating allowed as specified by the Commissioner
*Individual premiums "uniform" with family premiums
*Dependent age to 27
*Carrier's rates must be approved before allowed into the exchange

Carrier may sell outside of the exchange and may offer additional coverage above what the exchange plans mandate (ie: carriers can sell "Cadillac plans."

Essential Benefits
Hospitalization, outpatient, doctors/care providers, supplies and equipment, drugs, rehab, mental/nervous, wellness, maternity, well baby and durable medical equipment (No cost sharing allowed for wellness)

Agents and brokers are allowed to sell plans in the exchange including the public option. More to come.
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PUBLIC OPTION:

*Only sold in exchange
*Abide by all rules private carriers must follow
*Offer Basic, Enhanced and Premium plans
*Geographically adjust premiums in same manner as private plans
*Rates must fully finance costs
*No bailout provision - cannot get additional Federal funding to pay claims
*2 billion to fund private option
*Medicare docs are in network unless they opt out
*No punishment for docs who opt out
*Annual enrollment period where docs can opt in or out

 

[djs]

Cool stuff... sign me up!
Oh yeah, one question... how much is my plan???

 

[taterpeeler]

screw that... how much i get paid??

 

[Crabcake Johnny]

Affordability Credits available at 400% FLP - adjusted gross income. Wow.

 

[CHUMPS FROM OXFORD]

If maternity is a requirement on all plans...then rates are really going to go through the roof.

 

[dgoldenz]

Coverage Sold in the Exchange
*2:1 max rating based on age

Uh....wow, that's gonna be expensive. I bet all the 25 year olds will be running out to pay $300/month for coverage.

 

[djs]

If I understand Johns chart correctly, the 25 year old will be paying maybe 10% of that $300/month, meaning $30.

The other $270 will be paid by the working 50 somethings, via higher taxes, so they can pay lower health insurance premiums.

Do I have this wrong????

Dan

 

[somarco]

Well of course it is going to be expensive. PWC and Wellpoint already told us that.

Of course PresBO and Congress disputed that by saying the studies neglected to take into account the taxpayer funded SUBSIDIES that will offset the premium increases. To use the words of the White House, health insurance will be "deficit neutral" since your premiums will rise but you get an offsetting subsidy.

And how about the high risk pool in this bill (page 25).

GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.

(2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments
as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

Sounds like rationed health insurance to me, but what do I know?

 

[Crabcake Johnny]

True but that's just the patch until the exchange is created.