Friday, August 14, 2009

Digging in to HR 3200

It's been interesting to hear that "there is no bill" but still hear people say what's in and what's not in the bill. Obviously nothing has passed both House and Senate and there are still multiple versions in the works.

It should be noted, however, that the bill most people are discussing is HR 3200. The full text of HR 3200 can be found at

The thing is friggin huge. But that's to be expected. And tbh, huge amounts of reading dont scare me, but I say that by means of a warning.

One of the main charges levied against Obama has been that while people DO get to start out on the plans they want, they will all be funneled into the "public option" eventually - so I decided I wanted to read this for myself.

It's a bit worrisome.

Section 102, "Protecting the Choice to Keep Current Coverage" addresses this very topic. They way I'm reading this section, it makes it sound like almost any change in your insurance policy or life status will REQUIRE you be changed over to the "public option."

Let's look at the text:

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.



(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘grandfathered health insurance coverage’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(b)
(1) LIMITATION ON NEW ENROLLMENT-


(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

ok so far, it's easy to follow. There's a date at which this piece of legislature starts, after which limitations are placed on insurance coverage. There's obviously a bad way to see this and a good way.

The good way is that regulatory restrictions are being placed on the terms, features, and prices of private insurers to protect consumers and citizens. This already happens so it shouldn't be a big shock.

The bad way is that the government is over-controlling what insurance carriers can offer.


(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.


(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, 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.

Ok. This is the stuff that scares me. Basically nothing can change in your policy or your life status or you get funnelled into the "public option?"

That doesn't sound acceptable.


(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
***********************************

So will someone please address this directly? Are we being funnelled into the public option or not?


I don't have a problem with Section 1233, HR 3200 Advance Care Planning Consultation - the Death Panel that people are getting worked up over. If you actually read the darn thing, all it's saying is that we'll have a practicioner and a 1-800 hotline if you want to make a living will or discuss what your benefits and choices are.

What's wrong with that? I'm not seeing it.

Let's keep going... In the same Section 1233
(3) Physician’S QUALITY REPORTING INITIATIVE

(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate.



So who makes up this organization that makes decisions on end-of-life care? That's answered in Section 122

“Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.”

This will be chaired by the Surgeon General and will have “9 members who are not Federal employees or officers and who are appointed by the President”, “9 members who are not Federal employees or officers and who are appointed by the Comptroller General”, and an “even number of members (not to exceed 8 ) who are Federal employees and officers, as the President may appoint.”

A committee with up to 27 members, 18 of whom are picked by the President.

The bill says these people will “reflect 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 one practicing physician or other health professional and an expert on children’s health”.
Don't get me wrong. The Chief Executive appoints people to groups who make life-changing decisions all the time. Agencies that set policy on food, drugs, weapons, natural resources...the list goes on and on. But what kind of checks and balances do we have on this particular group?

I'm not willing to call them a "Death Panel" and I'd much RATHER have a group that is accountable to the citizens of the United States than a for-profit insurance panel.

I am wondering if the end-of-life counseling will be like the "genetic counseling" that pregnant mothers get?

Also, I've read some people posting about the government trying to implement automatic electronic funds withdrawals from citizens' bank accounts. That's not true.

SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

SEC. 163. ADMINISTRATIVE SIMPLIFICATION.
(a) STANDARDIZING ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

These have to do with provider transactions not consumer transactions. Let me explain further.

A system will be set up whereby: both Social Security providers AND add ons to SS and private insurers will promulgate a move to implement a computerized system that can instantly indicate what coverage you have, [with a computer data card, like a credit card] IOW, it will know what your insurance is and what coverage you have. This will assist in billing. It will also streamline the claims process.

This section would change the indicated section in Title 42 so it would automatically apply to Medicare [Title 42 would be amended to reflect this] as well as the applicable providers in the section named in HR 3200. It proposes to eliminate ambiguity due to language constraints and strives to simplify and standardize nomenclature.

It does not set up an open conduit to your bank account.



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