Okay...I'm back. I had an amazing weekend.
I left off part 10 with this section, Pg. 528 SEC. 2703. STATE OPTION TO PROVIDE HEALTH HOME FOR ENROLLEES WITH CHRONIC CONDITIONS...This was a full section about the Secretary and how they are going to handle reports and such. They are going to organize this.
Pg. 538 SEC. 2704. DEMONSTRATION PROJECT TO EVALUATE INTEGRATED CARE AROUND A HOSPITALIZATION. This section is also about the Secretary doing this evaluation, setting up this project, ect.
It's to evaluate the use of bundled payments through Medicade, where there is a hospital stay involved.
They want to increase quality of care while reducing costs. I don't know that it's appropriate for me to laugh but, that is the most naive crap I have ever heard. The only way they could do this is by RATIONING care.
SEC. 2705. MEDICAID GLOBAL PAYMENT SYSTEM DEMONSTRATION PROJECT. Pg. 542
The Secretary is going to pick no more than 5 states to participate in this study. They are going to establish a Medicade global payment system, moving from a fee for payment structure to a global capitated payment model. This study will be between 2010 and 2012, and they have a full year to report their findings.
I am reading this to be such that doctors and nurses will not be paid for their services individually but, a set salary. That is what the direction appears to be moving in.
SEC. 2706. PEDIATRIC ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT. Pg. 544
Pediatric medical providers in a state will be offered incentives. The Secretary will oversee this project.
Pg 547 SEC. 2707. MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT.
Again, the Secretary will establish this project, in which a state will make payments to mental institutes that are not publicly owned.
This appears to be talking about the 3 days a person can be held against their will. The rest of this section goes on to describe how a state can apply for this funding and, again, the Secretary will oversee all of this and make determinations.
Pg. 553 Subtitle J—Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)
...more later...
2010-04-29
2010-04-28
2010-04-22
Health Care Bill - Part Ten
Back to reading the health care bill...
Coming from where I left off in the previous section nine, there is information about rebates for drugs. I think this is talking about the federal government paying money to the states for types of drugs but, it is somewhat unclear.
On pg. 510, Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments
This section is discussing payments that will be made for the uninsured. It says it will be fifty percent but, then goes on to say that this will be lowered if the Secretary determines to do so based on census and, the amount of people in the state that are uninsured.
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries pg. 515
This is discussing those individuals enrolled in Part A or B, and who are also eligible under the State plan. They discuss something about a 5 year period that, I understand as them saying the person will be covered with both. Again, it lists the Secretary as the arbiter as to whether they will extend this for the State an additional 5 years.
Pg. 517 SEC. 2602. PROVIDING FEDERAL COVERAGE AND PAYMENT COORDINATION FOR DUAL ELIGIBLE BENEFICIARIES
No later than Mar 1, 2010, the Secretary shall establish a Federal Coordinated Health Care Office. They list a bunch of reasons for doing this. Apparently, they want someone who will be set up within the Medicare and Medicade system, who is going to establish a way to coordinate communication with these programs and the Federal government. This goes hand in hand with the rest of what has been stated about getting more people on the General government program. I am thinking that eventually, Medicade and Medicare will be no more. I haven't read that specifically but, it seems as though this would be the logical progression.
Subtitle I—Improving the Quality of Medicaid for Patients and Providers pg. 522
This is requiring that the Secretary, define and report what core health quality measures. This must be recommended by the Secretary before Jan 1, 2010.
Pg. 526 SEC. 2702. PAYMENT ADJUSTMENT FOR HEALTH CARE-ACQUIRED CONDITIONS.
Health care-acquired condition’’ means a medical condition for which an individual was diagnosed that could be identified by a secondary diagnostic code described in section 1886 of the Social Security Act.
The Secretary is going to identify current state practices that prohibit payments for health care acquired conditions. The Secretary then, is asked to determine what is appropriate.
Pg. 528 SEC. 2703. STATE OPTION TO PROVIDE HEALTH HOME FOR ENROLLEES WITH CHRONIC CONDITIONS
Once again, the Secretary is going to determine everything. The maximum given to states under this section is $25 million.
Back later!
Coming from where I left off in the previous section nine, there is information about rebates for drugs. I think this is talking about the federal government paying money to the states for types of drugs but, it is somewhat unclear.
On pg. 510, Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments
This section is discussing payments that will be made for the uninsured. It says it will be fifty percent but, then goes on to say that this will be lowered if the Secretary determines to do so based on census and, the amount of people in the state that are uninsured.
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries pg. 515
This is discussing those individuals enrolled in Part A or B, and who are also eligible under the State plan. They discuss something about a 5 year period that, I understand as them saying the person will be covered with both. Again, it lists the Secretary as the arbiter as to whether they will extend this for the State an additional 5 years.
Pg. 517 SEC. 2602. PROVIDING FEDERAL COVERAGE AND PAYMENT COORDINATION FOR DUAL ELIGIBLE BENEFICIARIES
No later than Mar 1, 2010, the Secretary shall establish a Federal Coordinated Health Care Office. They list a bunch of reasons for doing this. Apparently, they want someone who will be set up within the Medicare and Medicade system, who is going to establish a way to coordinate communication with these programs and the Federal government. This goes hand in hand with the rest of what has been stated about getting more people on the General government program. I am thinking that eventually, Medicade and Medicare will be no more. I haven't read that specifically but, it seems as though this would be the logical progression.
Subtitle I—Improving the Quality of Medicaid for Patients and Providers pg. 522
This is requiring that the Secretary, define and report what core health quality measures. This must be recommended by the Secretary before Jan 1, 2010.
Pg. 526 SEC. 2702. PAYMENT ADJUSTMENT FOR HEALTH CARE-ACQUIRED CONDITIONS.
Health care-acquired condition’’ means a medical condition for which an individual was diagnosed that could be identified by a secondary diagnostic code described in section 1886 of the Social Security Act.
The Secretary is going to identify current state practices that prohibit payments for health care acquired conditions. The Secretary then, is asked to determine what is appropriate.
Pg. 528 SEC. 2703. STATE OPTION TO PROVIDE HEALTH HOME FOR ENROLLEES WITH CHRONIC CONDITIONS
Once again, the Secretary is going to determine everything. The maximum given to states under this section is $25 million.
Back later!
2010-04-20
I Took a Vacation/ Health Care Bill
I will be back with my Health Care Bill Series this week! I promise. I took a vacation last week because, I was celebrating my wonderful, perfect, amazing life!
Obama Gets to Pick New Supreme Court Justice?
"Say it isn't so!" Those were my first words.
Justice John Paul Stevens is retiring this summer.
Click title of post for full article.
Justice John Paul Stevens is retiring this summer.
Click title of post for full article.
2010-04-17
The Things Some People Do
I got a message on FB this evening asking me to "explain why" I was a fan of Margret Thatcher and Glenn Beck (you can see the fan pages on my profile because, FB won't allow me to block them).
He sent me a message asking about my Margret Thatcher page:
Life (the title of his message)......ok, you're good, and you knew that, but what's the deal with Maggy
T.I.N.A. Thatcher....affectionately known as "there is no alternative" ?
Not that we have a favorite....
I was confused at first but, he finally explained that he was looking at a list of my "fan pages" and...
..you have this page that says...you know...Maggs...the Baroness.....
she who was ' Roberts' and became 'Thatcher'....I was wondering the
how and why....wence and wither...of said page...not the usual listing.
(Sorry but I'm watching the Bill Moyers rerun with Simon and Co.)
and
...Jenn (may I call you Jenn?)...sorry , but you have a rotating list of..
310 pages..that we all get to see and Ms. Thatcher was 'on deck' for
me....now it's 'Gucci' and the inimitable....'Glenn Beck'
(...gee 'Beck' was kind of cool, but Glenn?) cheers
I responded to him:
My friends call me Tuesday.
A rotating list? Are you talking about pages I belong to on FB? I am so confused.
Yes, I like Margret Thatcher. I'm not sure what you'd like me to explain. :/
~Tuesday
His response:
Ms. Thatcher appears and I flash upon her catch phrase....T.I.N.A.
well known across the planet....the problem was me...not you.....
(but Glenn Beck?...really?...ever hear of Noam Chomsky?)...please
feel free to explain anything to me, I'm here all week.....two shows a night....I think it might be time to ' fire up the color-tinis and watch the pictures as they fly through the air'....'Moyers' is done for now.
cheers
Ever hear of Noam Chomsky? Really? Okay, here's my response to him:
I still have no idea what you'd like me to explain. You and I are obviously at opposite ends of the political spectrum.
I wouldn't expect you to "explain" yourself to me anymore than I should "explain" MYself to anyone. I would never just send someone a message asking them "why they are liberal?" "why they like a certain political figure?" It seems as though you are asking me why I am conservative? Why I like Glenn Beck? Why I like Margret Thatcher?
Because, I do.
I am not sure if you are trying to get into some sort of political battle? Usually, people just accept my views as I accept theirs (if they differ from mine), and we move on. I don't even know you or, what your angle is here. I feel very put-off right now.
I am not interested in getting into a fight with anyone about politics. You don't seem like a mean person at all. Perhaps you are trying to strike up a conversation? Forgive me if that is your only intention. I have to be quite careful on Facebook, as I have already once lost my account due to "friendly conversation" with people who are not on my side of the political spectrum. Many others on here have undergone the same problems.
~Tuesday
Well, this didn't stop him from replying with this:
Sorry again, m'lady and 'my bad'....I've tried to move on from the right
vs. left smokescreen, that keeps this country disstracted and continue the analysis of 'up vs. down' or' top and bottom'....but to
do this you have to look at the old guys....and I started with the
CBS guy Edward R. Murrow....it was a different world 50-60-70
years ago, some of the same problems, some different solutions
but a real conversation used to exist in this country...along with
real news organizations that we no longer have.....
This is my problem, not yours....so not to worry /not a problem.
Someday...when you run out of things to do...look up Ed Murrows
speech from 1957, I believe, delivered to the RTNDA...rather famous as his 'lights and wires in a box' speech and see if you can't
appreciate...a different outlook....a different reality.
Other than that....have a good life....call anytime....I think you'll
do well.
Apologies for the lack of communication/consensus...my error.
sincerely....(He did sign his name and I am not using his name on this!)
Okay, I admit, I'm really bad at wanting to have the "last word." Call it a flaw:
I don't need a different outlook. I started my life on stage and in the theatre. I used to be a liberal. I finally became educated. I studied chemistry and math. I also took some higher level courses in political science.
I have a very well rounded education. I also happen to have a great understanding of politics and the science of politics. I am very well versed on many things. I am not a dimwit just because, I happen to be conservative. For some reason, people on the "left" get this idea that conservatives are somehow small minded, we're stupid, we are not educated, but, that is simply because the media has worked hard to void us out as best they can.
I am glad you apologized. Apology is accepted and, again, I didn't mean to be defensive but, you must understand, your comment, "you've heard of Noam Chomsky?" came off quite condecending. Of course I've heard of Noam Chomsky. Of course I know who Edward Murrow is (too bad for him Joseph McCarthy was indeed RIGHT). It comes off as if you are saying, I must be stupid because, I like Glenn Beck. It sounds very rude and elitist.
Maybe it's YOU that needs a different outlook? I don't know. I wouldn't be as so bold as to tell a stranger this just because, they are a fan of someone I didn't like.
Again, maybe you didn't mean it that way but, I think you would agree that if you go over what you wrote- when you write this to a stranger, who is completely unaware of who you are, and also is only reading your words. without the benefit of other cues like, tone and body language, I think you will understand.
Thank you for clarifying and I hope I have clarified myself as well.
Goodnight-
~Tuesday
I don't know what to think of this. I really don't think this man was trying to be rude to me but, it does demonstrate how some of these folks can be, even without having a bad intention. I'm not sure he realized how pretentious he came across.
Anyway, just thought it was rather odd and wanted to share with you.
He sent me a message asking about my Margret Thatcher page:
Life (the title of his message)......ok, you're good, and you knew that, but what's the deal with Maggy
T.I.N.A. Thatcher....affectionately known as "there is no alternative" ?
Not that we have a favorite....
I was confused at first but, he finally explained that he was looking at a list of my "fan pages" and...
..you have this page that says...you know...Maggs...the Baroness.....
she who was ' Roberts' and became 'Thatcher'....I was wondering the
how and why....wence and wither...of said page...not the usual listing.
(Sorry but I'm watching the Bill Moyers rerun with Simon and Co.)
and
...Jenn (may I call you Jenn?)...sorry , but you have a rotating list of..
310 pages..that we all get to see and Ms. Thatcher was 'on deck' for
me....now it's 'Gucci' and the inimitable....'Glenn Beck'
(...gee 'Beck' was kind of cool, but Glenn?) cheers
I responded to him:
My friends call me Tuesday.
A rotating list? Are you talking about pages I belong to on FB? I am so confused.
Yes, I like Margret Thatcher. I'm not sure what you'd like me to explain. :/
~Tuesday
His response:
Ms. Thatcher appears and I flash upon her catch phrase....T.I.N.A.
well known across the planet....the problem was me...not you.....
(but Glenn Beck?...really?...ever hear of Noam Chomsky?)...please
feel free to explain anything to me, I'm here all week.....two shows a night....I think it might be time to ' fire up the color-tinis and watch the pictures as they fly through the air'....'Moyers' is done for now.
cheers
Ever hear of Noam Chomsky? Really? Okay, here's my response to him:
I still have no idea what you'd like me to explain. You and I are obviously at opposite ends of the political spectrum.
I wouldn't expect you to "explain" yourself to me anymore than I should "explain" MYself to anyone. I would never just send someone a message asking them "why they are liberal?" "why they like a certain political figure?" It seems as though you are asking me why I am conservative? Why I like Glenn Beck? Why I like Margret Thatcher?
Because, I do.
I am not sure if you are trying to get into some sort of political battle? Usually, people just accept my views as I accept theirs (if they differ from mine), and we move on. I don't even know you or, what your angle is here. I feel very put-off right now.
I am not interested in getting into a fight with anyone about politics. You don't seem like a mean person at all. Perhaps you are trying to strike up a conversation? Forgive me if that is your only intention. I have to be quite careful on Facebook, as I have already once lost my account due to "friendly conversation" with people who are not on my side of the political spectrum. Many others on here have undergone the same problems.
~Tuesday
Well, this didn't stop him from replying with this:
Sorry again, m'lady and 'my bad'....I've tried to move on from the right
vs. left smokescreen, that keeps this country disstracted and continue the analysis of 'up vs. down' or' top and bottom'....but to
do this you have to look at the old guys....and I started with the
CBS guy Edward R. Murrow....it was a different world 50-60-70
years ago, some of the same problems, some different solutions
but a real conversation used to exist in this country...along with
real news organizations that we no longer have.....
This is my problem, not yours....so not to worry /not a problem.
Someday...when you run out of things to do...look up Ed Murrows
speech from 1957, I believe, delivered to the RTNDA...rather famous as his 'lights and wires in a box' speech and see if you can't
appreciate...a different outlook....a different reality.
Other than that....have a good life....call anytime....I think you'll
do well.
Apologies for the lack of communication/consensus...my error.
sincerely....(He did sign his name and I am not using his name on this!)
Okay, I admit, I'm really bad at wanting to have the "last word." Call it a flaw:
I don't need a different outlook. I started my life on stage and in the theatre. I used to be a liberal. I finally became educated. I studied chemistry and math. I also took some higher level courses in political science.
I have a very well rounded education. I also happen to have a great understanding of politics and the science of politics. I am very well versed on many things. I am not a dimwit just because, I happen to be conservative. For some reason, people on the "left" get this idea that conservatives are somehow small minded, we're stupid, we are not educated, but, that is simply because the media has worked hard to void us out as best they can.
I am glad you apologized. Apology is accepted and, again, I didn't mean to be defensive but, you must understand, your comment, "you've heard of Noam Chomsky?" came off quite condecending. Of course I've heard of Noam Chomsky. Of course I know who Edward Murrow is (too bad for him Joseph McCarthy was indeed RIGHT). It comes off as if you are saying, I must be stupid because, I like Glenn Beck. It sounds very rude and elitist.
Maybe it's YOU that needs a different outlook? I don't know. I wouldn't be as so bold as to tell a stranger this just because, they are a fan of someone I didn't like.
Again, maybe you didn't mean it that way but, I think you would agree that if you go over what you wrote- when you write this to a stranger, who is completely unaware of who you are, and also is only reading your words. without the benefit of other cues like, tone and body language, I think you will understand.
Thank you for clarifying and I hope I have clarified myself as well.
Goodnight-
~Tuesday
I don't know what to think of this. I really don't think this man was trying to be rude to me but, it does demonstrate how some of these folks can be, even without having a bad intention. I'm not sure he realized how pretentious he came across.
Anyway, just thought it was rather odd and wanted to share with you.
Conservatives Accused of Racial Slurs
Here's an interesting story I came upon today.
It seems the AP reported a story, that indicated racial slurs were yelled at by Tea Party members.
Well, it never happened.
Rep. Heath Shuler is denying a report that he heard racial slurs yelled from a crowd of angry health care protesters outside the U.S. Capitol.
It seems the AP reported a story, that indicated racial slurs were yelled at by Tea Party members.
Well, it never happened.
Rep. Heath Shuler is denying a report that he heard racial slurs yelled from a crowd of angry health care protesters outside the U.S. Capitol.
2010-04-14
Health Care Bill - Part Nine
I am back! I took a long weekend to celebrate. What was I celebrating? Well, my life of course! Every once in awhile, I take some time to do that.
SEC. 2402. REMOVAL OF BARRIERS TO PROVIDING HOME AND COMMUNITY-BASED SERVICES. Pg. 479
This is actually a section that states the Secretary will be providing more oversight of what states do concerning these services. It's just explaining more government, not less, as the title of the section seems to suggest.
SEC. 2404. PROTECTION FOR RECIPIENTS OF HOME AND COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT. This is beginning Jan 1, 2014
The following sections deal with expanding funding for elder care. There is some mention in here that states congress will meet and discuss further things concerning long term care. So, once again, we don't really have any clear understanding here. Just a promise that something will be discussed and possibly passed.
Pg. 492 Subtitle F—Medicaid Prescription Drug Coverage
This section begins to discuss how the government will pay the states for drug care. It's very technical and confusing. It appears as though, they are just expanding what is already set in place with Medicade.
Again, the Secretary is mentioned in here about how they will determine what the states get. It's so frustrating when I read this bill because, it's basically a lot of wasted words. Seems almost like they could have simplified this to one page that says, "The Secretary does everything."
SEC. 2402. REMOVAL OF BARRIERS TO PROVIDING HOME AND COMMUNITY-BASED SERVICES. Pg. 479
This is actually a section that states the Secretary will be providing more oversight of what states do concerning these services. It's just explaining more government, not less, as the title of the section seems to suggest.
SEC. 2404. PROTECTION FOR RECIPIENTS OF HOME AND COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT. This is beginning Jan 1, 2014
The following sections deal with expanding funding for elder care. There is some mention in here that states congress will meet and discuss further things concerning long term care. So, once again, we don't really have any clear understanding here. Just a promise that something will be discussed and possibly passed.
Pg. 492 Subtitle F—Medicaid Prescription Drug Coverage
This section begins to discuss how the government will pay the states for drug care. It's very technical and confusing. It appears as though, they are just expanding what is already set in place with Medicade.
Again, the Secretary is mentioned in here about how they will determine what the states get. It's so frustrating when I read this bill because, it's basically a lot of wasted words. Seems almost like they could have simplified this to one page that says, "The Secretary does everything."
2010-04-08
Health Care Bill - Part Eight
So, yesterday/last night/early morning...I had some issues with my internet connection but, everything is all well and good now! So, let's get back to making some progress with the health care bill.
I left off with page 436.
Subtitle B—Enhanced Support for the Children’s Health Insurance Program SEC. 2101. ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP.
This begins on October 1, 2013, and ends on September 30, 2019. From what I'm reading, the Exchanges are going to seek out and target the low income families with children, in order to ensure they are covered. There's some other jargon in here but, it seems to be repeating stuff that has already been previously stated.
Subtitle C—Medicaid and CHIP Enrollment Simplification SEC. 2201. ENROLLMENT SIMPLIFICATION AND COORDINATION WITH STATE HEALTH INSURANCE EXCHANGES.
Beginning after Jan 1, 2014, States are going to be required to set up a website for allowing people to enroll for seeking assistance. They will then be required to make sure that the family is offered all options they may qualify for.
They will also be required to seek out children who are in poverty, abused, mental problems, AIDS, and even racial minorities. The goal is clearly to get as many children on the government system as possible.
Pg. 451 SEC. 2202. PERMITTING HOSPITALS TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS FOR ALL MEDICAID ELIGIBLE POPULATIONS.
Effective Jan 1, 2014, a hospital that is a participating provider may determine who is eligible for state aid.
Subtitle D—Improvements to Medicaid Services SEC. 2301. COVERAGE FOR FREESTANDING BIRTH CENTER SERVICES. Pg. 453
A free standing birth center is not the residence of the mother, a licensed place that provides birthing services, is not a hospital, and complies with safety laws and such. This section talks about providing more assistance for these centers. It says that this is effective as soon as the bill is signed.
SEC. 2303. STATE ELIGIBILITY OPTION FOR FAMILY PLANNING SERVICES.
This begins on pg. 457. What follows are several pages about eligibility. It says medical assistance will be provided for family planning services. This includes services and supplies described in section 1905(a)(4)(C), which is from the Social Security Act.
Subtitle E—New Options for States to Provide Long-Term Services and Supports - Begins on page 466
This section discusses States having the option to provide medical assistance for home and community-based attendant services. The section goes on to describe what services are covered. This is for nursing facilities, institutions of mental disease, ect. Things like room and board are not included.
I'll be back later...with more.
I left off with page 436.
Subtitle B—Enhanced Support for the Children’s Health Insurance Program SEC. 2101. ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP.
This begins on October 1, 2013, and ends on September 30, 2019. From what I'm reading, the Exchanges are going to seek out and target the low income families with children, in order to ensure they are covered. There's some other jargon in here but, it seems to be repeating stuff that has already been previously stated.
Subtitle C—Medicaid and CHIP Enrollment Simplification SEC. 2201. ENROLLMENT SIMPLIFICATION AND COORDINATION WITH STATE HEALTH INSURANCE EXCHANGES.
Beginning after Jan 1, 2014, States are going to be required to set up a website for allowing people to enroll for seeking assistance. They will then be required to make sure that the family is offered all options they may qualify for.
They will also be required to seek out children who are in poverty, abused, mental problems, AIDS, and even racial minorities. The goal is clearly to get as many children on the government system as possible.
Pg. 451 SEC. 2202. PERMITTING HOSPITALS TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS FOR ALL MEDICAID ELIGIBLE POPULATIONS.
Effective Jan 1, 2014, a hospital that is a participating provider may determine who is eligible for state aid.
Subtitle D—Improvements to Medicaid Services SEC. 2301. COVERAGE FOR FREESTANDING BIRTH CENTER SERVICES. Pg. 453
A free standing birth center is not the residence of the mother, a licensed place that provides birthing services, is not a hospital, and complies with safety laws and such. This section talks about providing more assistance for these centers. It says that this is effective as soon as the bill is signed.
SEC. 2303. STATE ELIGIBILITY OPTION FOR FAMILY PLANNING SERVICES.
This begins on pg. 457. What follows are several pages about eligibility. It says medical assistance will be provided for family planning services. This includes services and supplies described in section 1905(a)(4)(C), which is from the Social Security Act.
Subtitle E—New Options for States to Provide Long-Term Services and Supports - Begins on page 466
This section discusses States having the option to provide medical assistance for home and community-based attendant services. The section goes on to describe what services are covered. This is for nursing facilities, institutions of mental disease, ect. Things like room and board are not included.
I'll be back later...with more.
2010-04-06
For My Mother and My Mother-in-Law
Sorry, not quite in the mood to do anything tonight. I have tried to get into reading and writing today but, I'm just sort of sulking. In 2001, on this day, I lost my mother to cancer and, just last year, my mother-in-law passed away for the same reason.
It's odd and, beautiful and, sad at the same time. I don't know how I feel. I'm quite a happy person and, I'm not trying to feel sorry for myself or anything. I just needed to take everything in.
Thank you for your patience.
It's odd and, beautiful and, sad at the same time. I don't know how I feel. I'm quite a happy person and, I'm not trying to feel sorry for myself or anything. I just needed to take everything in.
Thank you for your patience.
Chicago is Closely Watched With Cameras
Chicago, it turns out, has one of the most complete camera coverage, compared to any other city.
With the help of it's cameras, authorities were recently able to determine that Michael Scott, Chicago's school board president, had committed suicide. He was not murdered, as some had speculated. They found that he had drove around but, made no stops and was not following anyone or, being followed.
Click here for full article.
This can be a good thing but, it is also a sign that big brother is always looking over our shoulder.
With the help of it's cameras, authorities were recently able to determine that Michael Scott, Chicago's school board president, had committed suicide. He was not murdered, as some had speculated. They found that he had drove around but, made no stops and was not following anyone or, being followed.
Click here for full article.
This can be a good thing but, it is also a sign that big brother is always looking over our shoulder.
Taliban - 27 Less
27 Taliban members have been reported as being killed. This is after major airstrikes and ground fighting in Badghis, by NATO forces and Afghan forces.
Health Care Bill - Part Seven
I took Sunday off, as a break from the health care bill but, I'm back and reading it, once again. Thank you for joining me...
Beginning on pg. 427 - SEC. 2003. REQUIREMENT TO OFFER PREMIUM ASSISANCE FOR EMPLOYER-SPONSORED INSURANCE.
This is self explanatory and, I think this is just stating as it did before, that an employer must offer at least one silver level and one gold level. There's some "striking and adding" concerning children but, I'm not exactly sure what they are saying. I think they are saying that you must cover your child but, it looks like the state can determine if you are required to do so until the age of 19.
The bill overall does require that insurance companies at least offer coverage for people who have children all the way until they are 26.
SEC. 2004. MEDICAID COVERAGE FOR FORMER FOSTER CARE CHILDREN.
If the child was in the care of the government for more than six months of the year. It doesn't matter if it's consecutive or not but, they must also be under 25.
SEC. 2005. PAYMENTS TO TERRITORIES
This section discusses increase in payments to territories of the US: Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
Pg. 432 SEC. 2006. SPECIAL ADJUSTMENT TO FMAP DETERMINATION FOR CERTAIN STATES RECOVERING FROM A MAJOR DISASTER.
FMAP = Federal medical assistance percentage...in case you were wondering. I, myself, didn't know what that was.
This section just states that if the president declares a disaster, the state will receive increased funds for medical assistance.
Pg. 436 Subtitle B—Enhanced Support for the Children’s Health Insurance Program
SEC. 2101. ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP
At this point, I'm having issues accessing the bill. It keeps giving me an error message and, I think this has to do with my current, wireless connection. As soon as I figure out how to solve this issue, I will come back and finish. Thank you for your patience.
Beginning on pg. 427 - SEC. 2003. REQUIREMENT TO OFFER PREMIUM ASSISANCE FOR EMPLOYER-SPONSORED INSURANCE.
This is self explanatory and, I think this is just stating as it did before, that an employer must offer at least one silver level and one gold level. There's some "striking and adding" concerning children but, I'm not exactly sure what they are saying. I think they are saying that you must cover your child but, it looks like the state can determine if you are required to do so until the age of 19.
The bill overall does require that insurance companies at least offer coverage for people who have children all the way until they are 26.
SEC. 2004. MEDICAID COVERAGE FOR FORMER FOSTER CARE CHILDREN.
If the child was in the care of the government for more than six months of the year. It doesn't matter if it's consecutive or not but, they must also be under 25.
SEC. 2005. PAYMENTS TO TERRITORIES
This section discusses increase in payments to territories of the US: Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
Pg. 432 SEC. 2006. SPECIAL ADJUSTMENT TO FMAP DETERMINATION FOR CERTAIN STATES RECOVERING FROM A MAJOR DISASTER.
FMAP = Federal medical assistance percentage...in case you were wondering. I, myself, didn't know what that was.
This section just states that if the president declares a disaster, the state will receive increased funds for medical assistance.
Pg. 436 Subtitle B—Enhanced Support for the Children’s Health Insurance Program
SEC. 2101. ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP
At this point, I'm having issues accessing the bill. It keeps giving me an error message and, I think this has to do with my current, wireless connection. As soon as I figure out how to solve this issue, I will come back and finish. Thank you for your patience.
2010-04-05
W VA Mine Blast kills 12
After an explosion in a coal mine, 10 are trapped or missing, and 12 have been killed.
Click on title of post for full story.
Click on title of post for full story.
2010-04-04
Health Care Bill - Part Six
Thank you so much for joining me in reading the health care bill. I just wanted to clarify for those of you that are reading this - I want to do this for the purposes of all of us having a basic, general understanding of what is in this bill and, what we can expect will happen because this bill was passed. I find that there are a lot of folks out there saying things and, I want to be armed with the truth.
Today, I began on page 324...
CHAPTER 48—MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE
So, this is the section that talks about penalties if you don't carry essential, minimum coverage. Beginning 2013, you and all your dependents MUST carry minimum, ESSENTIAL coverage. If you fail to do this for more than a month in a calendar year, than you are required to pay a fine. This fine is worked into your taxes. The fine will be...
The penalty determined under this subsection for any month with respect to any individual is an amount equal to 1⁄12 of the applicable dollar amount for the calendar year.
The limitation shall not exceed an amount equal to 300 percent the applicable dollar amount, which is 750 dollars. They actually phase this in. The year of 2014 shall be 95 dollars and, for 2015, it will be 350 dollars. Then, beginning 2016, it will go to the 750 dollars, however, they put some sort of a clause in here that basically states that this could be increased based on cost of living and will be rounded up to the nearest multiple of 50 dollars.
Through page 329, they discuss some other effects of this fine, like family size and household income. Again, this is more tax stuff so, I will let you read it directly but, I think the main thing to know here is that they are going to enforce this penalty through the IRS.
Beginning on page 330, there is an exemption for religious conscience. Here is the exact wording:
RELIGIOUS CONSCIENCE EXEMPTION.—Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
So, this will take some cross referencing. Another exemption listed here are individuals that belong to a health care sharing ministry. This would be an organization that falls under the tax exempt 501c3, and they share medical expenses. (Bottom of pg. 330 and 331).
If you are an illegal alien, you don't pay this fine. I guess that's because, they are here illegally and won't be filling taxes.
Incarcerated individuals are not responsible for the months they are incarcerated.
Individuals who cannot afford coverage are also exempt from the penalty. The description of this is on pg. 332 and, it says that if the required contribution is more than 8 percent of the total household income, then you are deemed not to be able to afford coverage.
Through page 340, there is some more information concerning taxes and some other exemptions. I just covered the more important ones at the beginning. Since, those will be the ones that apply to MOST people.
Page 340 - SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE
I am reading this section as, whoever is providing the insurance, will then have to report to the Secretary who they have insured and, include that the individual and, their dependents are covered with essential coverage.
No later than June 30th of each year, a notification will be sent to individuals not covered. In the notification, it will include information about where a person can receive essential coverage and, what is available to them through the Exchange.
SEC. 1511. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS. Pg. 346.
Large employers are those that have more than 200 full time employees and they offer one or more health care plans. All new employees will be automatically enrolled but, they are required to give the employee a notice that will allow them to opt-out, if they so chose.
Page 347 SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOYEES OF COVERAGE OPTIONS
Pretty self explanatory.
SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH COVERAGE. Pg. 348
If a large employer does not offer essential insurance for it's full time employees (an employee that works on average 30 hours per week), they will have to pay an amount equal to the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month.
If they offer coverage but, there is a waiting period of more than 30 days, then a fine is paid for that as well. For further details of this, see pg. 350.
The next several pages deal with tax information for large employers.
SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE COVERAGE Pg. 357
Large employers are required to report employees that are covered. What follows is an outline of reporting procedures for the employer.
Pg. 364 - SEC. 1552. TRANSPARENCY IN GOVERNMENT.
Within 30 days of this act being passed, the Secretary of health and human services is required to post on their website a list of all the authorities that are provided to them through this act.
SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE
This is oddly placed and oddly worded. It basically says if the federal, state, or local government is receiving financial assistance under this act, it cannot discriminate a health care entity (defined as a physician, a hospital, health care professional, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan), that does NOT provide assisted suicide services.
Pg. 366 SEC. 1554. ACCESS TO THERAPIES
This is just a list of things that basically states that the Secretary shall not do anything unreasonable that would stand in the way of a patient having access to medical care.
SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS
This part says that you are not required to participate in any health insurance program that is created under this act. If you do not participate, you will not be fined.
Okay but, you still need to get essential care from somewhere...so, it won't be long till the government plan is all you have for an option.
The next several pages are what I consider common knowledge stuff. You can't be discriminated against for age, education, ect. Civil rights stuff.
SEC. 1560. RULES OF CONSTRUCTION- no effect on anti-trust laws. Details for all this are on pg. 371.
Subtitle C—Other Provisions SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS. Pg. 373
This section is basically for the Secretary. They will have to initiate a program that will allow for electronic enrollment. This section discusses the standards and outlines them.
The next several pages are very confusing and I have to admit, I am completely lost. Here is an example of what I mean:
(i) in paragraph (1)—
2 (I) in the matter preceding sub
paragraph (A), by striking ‘‘small employer’’ and inserting ‘‘employer, or
5 individual, as applicable,’’;
6 (II) in subparagraph (A), by adding ‘‘and’’ at the end;
8 (III) by striking subparagraphs
9 (B) and (C); and
10 (IV) in subparagraph (D)—
11 (aa) by inserting ‘‘, or individual, as applicable,’’ after ‘‘employer’’; and
14 (bb) by redesignating such
15 subparagraph as subparagraph
16 (B);
17 (ii) in paragraph (2)—
18 (I) by striking ‘‘small employers’’
19 each place that such term appears
20 and inserting ‘‘employers, or individuals, as applicable,’’; and
22 (II) by striking ‘‘small employer’’
23 and inserting ‘‘employer, or individual, as applicable,’’; and
It's pages of "striking" and "inserting."
TITLE II—ROLE OF PUBLIC PROGRAMS Subtitle A—Improved Access to Medicaid
SEC. 2001. MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS Pg. 396
This gives information as to who qualifies for medicaid. This mostly applies to those that are 100 percent of the poverty line (I take this to me above or below), and childless, not considered a dependent, ect.
The bill then goes on to deal with even past the year 2019. Then, the will make increases. Of course!
Beginning Jan 1, 2011, parents that receive health care plan assistance are required to have their children enrolled under the program.
The next few pages deal with how the states will work with the Federal government concerning funding for assistance.
Page 411, discusses that the Medicade must be considered essential coverage - just like what the private insurance companies must offer, what the exchanges, and co-ops must offer as well. This is effective Jan 1, 2014.
SEC. 2002. INCOME ELIGIBILITY FOR NONELDERLY DETERMINED USING MODIFIED GROSS INCOME Pg. 418
This is a section that discusses how they are going to arrive at someone's eligibility for received medical assistance. A modified gross income is what will be used to determine this. It further goes on to explain what will not be used to determine eligibility, like assets. This determination is left up to the Secretary and the state. They will figure out what test shall be applied. Modified gross income is defined in Internal Revenue Code of 1986. I do not have that bill handy.
The next few pages deal more with tax stuff and, dealings between the Secretary and the state; you are more than welcome to read that yourself.
Tomorrow, I will start with p. 427. That's all for today.
Today, I began on page 324...
CHAPTER 48—MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE
So, this is the section that talks about penalties if you don't carry essential, minimum coverage. Beginning 2013, you and all your dependents MUST carry minimum, ESSENTIAL coverage. If you fail to do this for more than a month in a calendar year, than you are required to pay a fine. This fine is worked into your taxes. The fine will be...
The penalty determined under this subsection for any month with respect to any individual is an amount equal to 1⁄12 of the applicable dollar amount for the calendar year.
The limitation shall not exceed an amount equal to 300 percent the applicable dollar amount, which is 750 dollars. They actually phase this in. The year of 2014 shall be 95 dollars and, for 2015, it will be 350 dollars. Then, beginning 2016, it will go to the 750 dollars, however, they put some sort of a clause in here that basically states that this could be increased based on cost of living and will be rounded up to the nearest multiple of 50 dollars.
Through page 329, they discuss some other effects of this fine, like family size and household income. Again, this is more tax stuff so, I will let you read it directly but, I think the main thing to know here is that they are going to enforce this penalty through the IRS.
Beginning on page 330, there is an exemption for religious conscience. Here is the exact wording:
RELIGIOUS CONSCIENCE EXEMPTION.—Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
So, this will take some cross referencing. Another exemption listed here are individuals that belong to a health care sharing ministry. This would be an organization that falls under the tax exempt 501c3, and they share medical expenses. (Bottom of pg. 330 and 331).
If you are an illegal alien, you don't pay this fine. I guess that's because, they are here illegally and won't be filling taxes.
Incarcerated individuals are not responsible for the months they are incarcerated.
Individuals who cannot afford coverage are also exempt from the penalty. The description of this is on pg. 332 and, it says that if the required contribution is more than 8 percent of the total household income, then you are deemed not to be able to afford coverage.
Through page 340, there is some more information concerning taxes and some other exemptions. I just covered the more important ones at the beginning. Since, those will be the ones that apply to MOST people.
Page 340 - SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE
I am reading this section as, whoever is providing the insurance, will then have to report to the Secretary who they have insured and, include that the individual and, their dependents are covered with essential coverage.
No later than June 30th of each year, a notification will be sent to individuals not covered. In the notification, it will include information about where a person can receive essential coverage and, what is available to them through the Exchange.
SEC. 1511. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS. Pg. 346.
Large employers are those that have more than 200 full time employees and they offer one or more health care plans. All new employees will be automatically enrolled but, they are required to give the employee a notice that will allow them to opt-out, if they so chose.
Page 347 SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOYEES OF COVERAGE OPTIONS
Pretty self explanatory.
SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH COVERAGE. Pg. 348
If a large employer does not offer essential insurance for it's full time employees (an employee that works on average 30 hours per week), they will have to pay an amount equal to the product of the applicable payment amount and the number of individuals employed by the employer as full-time employees during such month.
If they offer coverage but, there is a waiting period of more than 30 days, then a fine is paid for that as well. For further details of this, see pg. 350.
The next several pages deal with tax information for large employers.
SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE COVERAGE Pg. 357
Large employers are required to report employees that are covered. What follows is an outline of reporting procedures for the employer.
Pg. 364 - SEC. 1552. TRANSPARENCY IN GOVERNMENT.
Within 30 days of this act being passed, the Secretary of health and human services is required to post on their website a list of all the authorities that are provided to them through this act.
SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE
This is oddly placed and oddly worded. It basically says if the federal, state, or local government is receiving financial assistance under this act, it cannot discriminate a health care entity (defined as a physician, a hospital, health care professional, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan), that does NOT provide assisted suicide services.
Pg. 366 SEC. 1554. ACCESS TO THERAPIES
This is just a list of things that basically states that the Secretary shall not do anything unreasonable that would stand in the way of a patient having access to medical care.
SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS
This part says that you are not required to participate in any health insurance program that is created under this act. If you do not participate, you will not be fined.
Okay but, you still need to get essential care from somewhere...so, it won't be long till the government plan is all you have for an option.
The next several pages are what I consider common knowledge stuff. You can't be discriminated against for age, education, ect. Civil rights stuff.
SEC. 1560. RULES OF CONSTRUCTION- no effect on anti-trust laws. Details for all this are on pg. 371.
Subtitle C—Other Provisions SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS. Pg. 373
This section is basically for the Secretary. They will have to initiate a program that will allow for electronic enrollment. This section discusses the standards and outlines them.
The next several pages are very confusing and I have to admit, I am completely lost. Here is an example of what I mean:
(i) in paragraph (1)—
2 (I) in the matter preceding sub
paragraph (A), by striking ‘‘small employer’’ and inserting ‘‘employer, or
5 individual, as applicable,’’;
6 (II) in subparagraph (A), by adding ‘‘and’’ at the end;
8 (III) by striking subparagraphs
9 (B) and (C); and
10 (IV) in subparagraph (D)—
11 (aa) by inserting ‘‘, or individual, as applicable,’’ after ‘‘employer’’; and
14 (bb) by redesignating such
15 subparagraph as subparagraph
16 (B);
17 (ii) in paragraph (2)—
18 (I) by striking ‘‘small employers’’
19 each place that such term appears
20 and inserting ‘‘employers, or individuals, as applicable,’’; and
22 (II) by striking ‘‘small employer’’
23 and inserting ‘‘employer, or individual, as applicable,’’; and
It's pages of "striking" and "inserting."
TITLE II—ROLE OF PUBLIC PROGRAMS Subtitle A—Improved Access to Medicaid
SEC. 2001. MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS Pg. 396
This gives information as to who qualifies for medicaid. This mostly applies to those that are 100 percent of the poverty line (I take this to me above or below), and childless, not considered a dependent, ect.
The bill then goes on to deal with even past the year 2019. Then, the will make increases. Of course!
Beginning Jan 1, 2011, parents that receive health care plan assistance are required to have their children enrolled under the program.
The next few pages deal with how the states will work with the Federal government concerning funding for assistance.
Page 411, discusses that the Medicade must be considered essential coverage - just like what the private insurance companies must offer, what the exchanges, and co-ops must offer as well. This is effective Jan 1, 2014.
SEC. 2002. INCOME ELIGIBILITY FOR NONELDERLY DETERMINED USING MODIFIED GROSS INCOME Pg. 418
This is a section that discusses how they are going to arrive at someone's eligibility for received medical assistance. A modified gross income is what will be used to determine this. It further goes on to explain what will not be used to determine eligibility, like assets. This determination is left up to the Secretary and the state. They will figure out what test shall be applied. Modified gross income is defined in Internal Revenue Code of 1986. I do not have that bill handy.
The next few pages deal more with tax stuff and, dealings between the Secretary and the state; you are more than welcome to read that yourself.
Tomorrow, I will start with p. 427. That's all for today.
2010-04-03
Health Care Bill - Part Five
From my reading of the health care bill today, I learned...
Yesterday ended with the bill discussing a plan to eventually offer a nationwide qualified health plan. On page 225, it discusses some formalities that the states must do like, filling forms. This is mostly formal office protocol.
REINSURANCE AND RISK ADJUSTMENT SEC. 1341. TRANSITIONAL REINSURANCE PROGRAM FOR INDIVIDUAL AND SMALL GROUP MARKETS IN EACH STATE.
Again, the Secretary and the National Association of Insurance Commissioners (the ‘‘NAIC’’), shall include provisions for the states.
The purpose of this program is to stabilize premium coverage for the individual and small group markets in a state, during the first three years in an operation of an Exchange.
Huh? Again, why are we needing all this bureaucracy? This entire section is confusing me.
SEC. 1342. ESTABLISHMENT OF RISK CORRIDORS FOR PLANS IN INDIVIDUAL AND SMALL GROUP MARKETS.
The information in this section is more information about the Secretary establishing a program of risk corridors. This is mostly information for the Secretary. This continues on into the section about risk adjustment. So, basically what they are trying to do is make reasonable adjustments for plans based on what risk you carry. This is pretty basic with any insurance company. However, in this bill, the process of doing this is uncomfortably worded and, again, it's all about the Secretary making decisions.
SEC. 1401. REFUNDABLE TAX CREDIT PROVIDING PREMIUM ASSISTANCE FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
If you have received coverage of at least the silver level through an exchange and the premium is over 1/12 of your household income, you can receive the tax credit. There's more details in this section but, that's the basic reading I'm getting.
They go into some further details about who can qualify for what but, I'm not a tax person. If you are someone that needs this section explained, I would consult a person that specializes in taxes.
SEC. 1402. REDUCED COST-SHARING FOR INDIVIDUALS ENROLLING IN QUALIFIED HEALTH PLANS.
If you an individual who is enrolled through an Exchange and you have a qualified health plan (which is a bit redundant because, I thought the Exchanges could only offer you a qualified health plan), and your household exceeds 100 percent of the poverty line but, less than 400 percent of the poverty line, you qualify for reduced cost-sharing.
There are some other reductions explained in here. Again, some general outlines given and, any reductions that are given by the issuer under this subsection shall be reported to the Secretary.
If you're an Indian, and your income is below 300 percent of the poverty line, you will have no cost sharing under the plan, which should be a qualified plan, in the individual market, through an Exchange. Isn't this condescending racism? When are we going to stop with the reparations to Indians? It's our land, we won it, get over it already.
The bill goes on to talk about cost sharing and once again, the Secretary will be making determinations and guidelines based on family size and, household income to determine eligibility for credit allowable.
SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND REDUCED COST-SHARING, AND INDIVIDUAL RESPONSIBILITY EXEMPTIONS.
This section is self explanatory. You can read this section if you are interested but, here we go again with the Secretary, who will be forming a program. Again, this will apply to people who purchase their plans through an Exchange.This will be a program that you are applying for reduced cost sharing. You will have to provide information and then then, they determine what your share will be or, tax credit.
It does say in there that you have to be a citizen or, an alien that is lawfully here. They will also check with Homeland Security, if you apply for this reduction. What follows is more of the inter workings between the Secretary and other departments like the Exchanges and the Commissioner of Social Security.
Then, there are pages that are dedicated to explaining an appeals process, if someone is turned down for eligibility for exemption or cost reduction.
If there is found any fraud or, fraudulent information you have given, you can be assessed a fine of no more than $25,000. If they can prove you knowingly and willfully provided false information, you can be charged up to $250,000 and other fees.
Pg. 290 - SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS. This will be another program established by the Secretary and Secretary of Treasure which will provide Exchanges with advances determinations of tax credits and cost sharing. This is basically saying what has been said before, it's just assuring things are done timely and in advance.
It states again in here that, nothing in this subsection allows for Federal payments, credits, or cost-sharing reductions for individuals who are not lawfully present in the United States.
SEC. 1413. STREAMLINING OF PROCEDURES FOR ENROLLMENT THROUGH AN EXCHANGE AND STATE MEDICAID, CHIP, AND HEALTH SUBSIDY PROGRAMS.
This section is stating that Secretary will establish a system of some sorts for a person who applies through an Exchange. They will be able to fill out one form and, the state will work to determine the best offer for this person. Maybe they qualify for another state program that they are unaware of, if so, the state will notify that person. This could be a CHIP program or, Medicaid, ect.
So, if they can get you on the government programs, they will work hard in doing so.
SEC. 1414. DISCLOSURES TO CARRY OUT ELIGIBILITY REQUIREMENTS FOR CERTAIN PROGRAMS.
Basically, this says that if you are applying, they need to disclose information to other departments: your social security number, tax payer return information, ect. (pg. 303)
SEC. 1415. PREMIUM TAX CREDIT AND COST-SHARING REDUCTION PAYMENTS DISREGARDED FOR FEDERAL AND FEDERALLY-ASSISTED PROGRAMS.
Pretty explanatory. Very short section, pg. 306.
PART II—SMALL BUSINESS TAX CREDIT SEC. 1421. CREDIT FOR EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL BUSINESSES.
SEC. 45R. EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL EMPLOYERS. A small business owner is considered having no more than 25 full time employees. Other various definitions of terms and phrases are described in this section.
Again, this is another section dealing with taxes. If you are a small business owner, it may behoove you to seek some professional assistance in dealing with this section, if you are unfamiliar with tax language.
Subtitle F—Shared Responsibility for Health Care PART I—INDIVIDUAL RESPONSIBILITY SEC. 1501. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.
This section starts off rather odd. It just goes into certain things that "Congress finds..." One of these findings is stating that, National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. This begins on pg. 320.
This section is worth a read. Quite amazing our Congress is to have found all these "facts." It finally ends with what is their justification for passing this bill: SUPREME COURT RULING.—In United States v. South-Eastern Underwriters Association (322 U.S. 533 (1944)), the Supreme Court of the United States ruled that insurance is interstate commerce subject to Federal regulation.
I will be back tomorrow....starting with page 324. Please, join me if you like. Make comments. It's important that we all understand what is in this bill. Educating ourselves will make our arguments stronger, as well as empower us as citizens.
Yesterday ended with the bill discussing a plan to eventually offer a nationwide qualified health plan. On page 225, it discusses some formalities that the states must do like, filling forms. This is mostly formal office protocol.
REINSURANCE AND RISK ADJUSTMENT SEC. 1341. TRANSITIONAL REINSURANCE PROGRAM FOR INDIVIDUAL AND SMALL GROUP MARKETS IN EACH STATE.
Again, the Secretary and the National Association of Insurance Commissioners (the ‘‘NAIC’’), shall include provisions for the states.
The purpose of this program is to stabilize premium coverage for the individual and small group markets in a state, during the first three years in an operation of an Exchange.
Huh? Again, why are we needing all this bureaucracy? This entire section is confusing me.
SEC. 1342. ESTABLISHMENT OF RISK CORRIDORS FOR PLANS IN INDIVIDUAL AND SMALL GROUP MARKETS.
The information in this section is more information about the Secretary establishing a program of risk corridors. This is mostly information for the Secretary. This continues on into the section about risk adjustment. So, basically what they are trying to do is make reasonable adjustments for plans based on what risk you carry. This is pretty basic with any insurance company. However, in this bill, the process of doing this is uncomfortably worded and, again, it's all about the Secretary making decisions.
SEC. 1401. REFUNDABLE TAX CREDIT PROVIDING PREMIUM ASSISTANCE FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
If you have received coverage of at least the silver level through an exchange and the premium is over 1/12 of your household income, you can receive the tax credit. There's more details in this section but, that's the basic reading I'm getting.
They go into some further details about who can qualify for what but, I'm not a tax person. If you are someone that needs this section explained, I would consult a person that specializes in taxes.
SEC. 1402. REDUCED COST-SHARING FOR INDIVIDUALS ENROLLING IN QUALIFIED HEALTH PLANS.
If you an individual who is enrolled through an Exchange and you have a qualified health plan (which is a bit redundant because, I thought the Exchanges could only offer you a qualified health plan), and your household exceeds 100 percent of the poverty line but, less than 400 percent of the poverty line, you qualify for reduced cost-sharing.
There are some other reductions explained in here. Again, some general outlines given and, any reductions that are given by the issuer under this subsection shall be reported to the Secretary.
If you're an Indian, and your income is below 300 percent of the poverty line, you will have no cost sharing under the plan, which should be a qualified plan, in the individual market, through an Exchange. Isn't this condescending racism? When are we going to stop with the reparations to Indians? It's our land, we won it, get over it already.
The bill goes on to talk about cost sharing and once again, the Secretary will be making determinations and guidelines based on family size and, household income to determine eligibility for credit allowable.
SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND REDUCED COST-SHARING, AND INDIVIDUAL RESPONSIBILITY EXEMPTIONS.
This section is self explanatory. You can read this section if you are interested but, here we go again with the Secretary, who will be forming a program. Again, this will apply to people who purchase their plans through an Exchange.This will be a program that you are applying for reduced cost sharing. You will have to provide information and then then, they determine what your share will be or, tax credit.
It does say in there that you have to be a citizen or, an alien that is lawfully here. They will also check with Homeland Security, if you apply for this reduction. What follows is more of the inter workings between the Secretary and other departments like the Exchanges and the Commissioner of Social Security.
Then, there are pages that are dedicated to explaining an appeals process, if someone is turned down for eligibility for exemption or cost reduction.
If there is found any fraud or, fraudulent information you have given, you can be assessed a fine of no more than $25,000. If they can prove you knowingly and willfully provided false information, you can be charged up to $250,000 and other fees.
Pg. 290 - SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS. This will be another program established by the Secretary and Secretary of Treasure which will provide Exchanges with advances determinations of tax credits and cost sharing. This is basically saying what has been said before, it's just assuring things are done timely and in advance.
It states again in here that, nothing in this subsection allows for Federal payments, credits, or cost-sharing reductions for individuals who are not lawfully present in the United States.
SEC. 1413. STREAMLINING OF PROCEDURES FOR ENROLLMENT THROUGH AN EXCHANGE AND STATE MEDICAID, CHIP, AND HEALTH SUBSIDY PROGRAMS.
This section is stating that Secretary will establish a system of some sorts for a person who applies through an Exchange. They will be able to fill out one form and, the state will work to determine the best offer for this person. Maybe they qualify for another state program that they are unaware of, if so, the state will notify that person. This could be a CHIP program or, Medicaid, ect.
So, if they can get you on the government programs, they will work hard in doing so.
SEC. 1414. DISCLOSURES TO CARRY OUT ELIGIBILITY REQUIREMENTS FOR CERTAIN PROGRAMS.
Basically, this says that if you are applying, they need to disclose information to other departments: your social security number, tax payer return information, ect. (pg. 303)
SEC. 1415. PREMIUM TAX CREDIT AND COST-SHARING REDUCTION PAYMENTS DISREGARDED FOR FEDERAL AND FEDERALLY-ASSISTED PROGRAMS.
Pretty explanatory. Very short section, pg. 306.
PART II—SMALL BUSINESS TAX CREDIT SEC. 1421. CREDIT FOR EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL BUSINESSES.
SEC. 45R. EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL EMPLOYERS. A small business owner is considered having no more than 25 full time employees. Other various definitions of terms and phrases are described in this section.
Again, this is another section dealing with taxes. If you are a small business owner, it may behoove you to seek some professional assistance in dealing with this section, if you are unfamiliar with tax language.
Subtitle F—Shared Responsibility for Health Care PART I—INDIVIDUAL RESPONSIBILITY SEC. 1501. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.
This section starts off rather odd. It just goes into certain things that "Congress finds..." One of these findings is stating that, National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. This begins on pg. 320.
This section is worth a read. Quite amazing our Congress is to have found all these "facts." It finally ends with what is their justification for passing this bill: SUPREME COURT RULING.—In United States v. South-Eastern Underwriters Association (322 U.S. 533 (1944)), the Supreme Court of the United States ruled that insurance is interstate commerce subject to Federal regulation.
I will be back tomorrow....starting with page 324. Please, join me if you like. Make comments. It's important that we all understand what is in this bill. Educating ourselves will make our arguments stronger, as well as empower us as citizens.
2010-04-02
Doctor Has a Message for Obama Supporters
In Mount Dora, a doctor has put an interesting sign outside his door:
Sign at the office door of Dr. Jack Cassell, a Mount Dora urologist. (Photo by Deirdre Lewis / April 1, 2010)
Obama's Approval Rating in the Toilet
Obama's approval rating has dropped to 44 percent and, his disapproval rating has increased to 41 percent.
When it comes to health care, the President's approval rating is even lower -- and is also a new all-time low. Only 34 percent approved, while 55 percent said they disapproved.
Click title of post for full article.
Only 34 percent approve of the health care bill and, these demoncraps are trying to say that the American people wanted this? I suppose they think if they tell a lie long enough, folks will believe and, why not? That's how they have always done everything in the past.
When it comes to health care, the President's approval rating is even lower -- and is also a new all-time low. Only 34 percent approved, while 55 percent said they disapproved.
Click title of post for full article.
Only 34 percent approve of the health care bill and, these demoncraps are trying to say that the American people wanted this? I suppose they think if they tell a lie long enough, folks will believe and, why not? That's how they have always done everything in the past.
Obama Says to "Tone Down Rhetoric"
In Obama's brief interview with "The Early Show," he explains that there is no substance in claims that he's a socialist.
Excerpt from article:
"I do think that everybody has a responsibility, Democrats or Republicans, to tone down some of this rhetoric. And the truth is some of these comments when you actually ask, well, this is based on what? This notion that 'Obama's a Socialist,' for example. Nobody can really (he chuckled) give you a good answer -- much less when they, you know, make…"
"They would say mandating that people have to buy (health) insurance or something like that," Smith pointed out.
"Yeah," Mr. Obama said, "the -- the sort of plan proposed by current -- Republican nominee Mitt Romney, yeah. So it - it -- it doesn't make too much sense.
Click title of post for full article.
Excerpt from article:
"I do think that everybody has a responsibility, Democrats or Republicans, to tone down some of this rhetoric. And the truth is some of these comments when you actually ask, well, this is based on what? This notion that 'Obama's a Socialist,' for example. Nobody can really (he chuckled) give you a good answer -- much less when they, you know, make…"
"They would say mandating that people have to buy (health) insurance or something like that," Smith pointed out.
"Yeah," Mr. Obama said, "the -- the sort of plan proposed by current -- Republican nominee Mitt Romney, yeah. So it - it -- it doesn't make too much sense.
Click title of post for full article.
Health Care Bill - Part Four
Today, in my reading of the health care bill...
Each state must establish an American Health Benefit Exchange. There are grants available for states doing this but, again, the Secretary will determine who gets the grants and for how much. These will be facilities that are for purchasing qualified health plans and provide help for small businesses.
The next several pages are just a description of the Secretary's duties.
On pg. 137, I am reading about how the state's can make more requirements, aside from just the essential requirements that have yet to be determined by the Secretary. If the state makes any further requirements for coverage, than the state will assume all costs for that coverage.
As I continue to read on, I am finding that the Secretary is going to keep track of many things and transfer this information to the Secretary of Treasure. This information will include what plans were offered by employers and if the costs were reasonable. The idea, I am understanding, is to make sure that employers are all adhering to the bill and, offering affordable coverage.
Beginning January 1, 2015, it is required that all of these Exchanges will be run by the states and not funded by the federal government at all. They will charge fees and such for their services. The next several pages discuss the various things that the Exchange must do (office stuff).
On page 176, it says that members of congress have available to them health plans that created under this act or, ones that are offered through an exchange. However, ironically it doesn't say anything about them having to get coverage from an Exchange that is in their state. Is it possible that Exchanges from any state will offer them coverage?
Well, it looks like the next page sort of answers my question...
(ii) resides in the State that established the Exchange (except with respect to territorial agreements under section 1312(f)).
When I cross reference, it isn't very clear. It basically says that the Exchange can make the determination themselves. So, it looks like it's possible that members of congress will likely have a choice of any Exchange from any state. What Exchange is going to turn down a member of congress?
Section 1313 is basically a section that talks about the financial integrity that is to be upheld by the Exchanges.
Section 1321 describes the flexibility the states have concerning Exchanges.
It says something in here about the Secretary determining if the Exchanges have insured a certain percentage of the population. It appears as though they will determine if the Exchanges are working based upon the percentage of the population that is being insured through them but, there are no figures given and everything is at the discretion of the Secretary.
SEC. 1322. FEDERAL PROGRAM TO ASSIST ESTABLISHMENT AND OPERATION OF NONPROFIT, MEMBER RUN HEALTH INSURANCE ISSUERS.
Non profit? How is this going to work? Well, so far, what I am reading in this section is almost identical wording to the operations of the Exchanges. These shall be referred to as Consumer Operated and Oriented Plan (CO-OP) program.
The purpose of these are listed as: It is the purpose of the CO-OP program to foster the creation of qualified nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets in the States in which the issuers are licensed to offer such plans.
Again, we find that the Secretary can provide grants for anyone that applies to run a CO-OP. They can get money for start-up costs. The next few pages talk about the requirements associated for obtaining these grants.
SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION. Based on the information in here, the Secretary can offer this option through Exchanges provided the state wants to offer this option.
What do they define this community health insurance option as?
(A) except as specifically provided for in this section, complies with the requirements for being a qualified health plan;
(B) provides high value for the premium charged;
(C) reduces administrative costs and promotes administrative simplification for beneficiaries;
(D) promotes high quality clinical care;
(E) provides high quality customer service to beneficiaries;
(F) offers a sufficient choice of providers; and
(G) complies with State laws (if any), except as otherwise provided for in this title, relating to the laws described in section 1324(b).
This option will only offer the essential health care benefits. If the state requires any more benefits, the state will eat those costs. There will be start-up funds that will be given out to provide the community option.
There is so much money being appropriated in all sorts of directions. Why can't the Exchanges just take care of this? I am not seeing a reason for this bureaucracy.
On page 200, SEC. 1324. LEVEL PLAYING FIELD They have some very odd wording here but, I am under the impression that this means that the private insurer must offer plans that are in accordance with the same that will be offered under the public options, which they are calling Consumer Operated and Oriented Plan program under section 1322, a community health insurance option under section 1323, or a nationwide qualified health plan under section 1333. These laws are the ones that discuss such things as the guaranteed renewal, and pre-existing conditions that have already been explained previously.
The next section talks about how the individual states will have some flexibility when it comes to what plans they offer. So, again, we really do not know anything that is in this bill. It's all approved by the Secretary, the state, and various committees- depending on what issue they are dealing with. Sure, there are some ideas and some outlines here but, ultimately there is nothing sent in stone.
This same section has to do with low income individuals that do not qualify for medicade. If you are in this category, you are a resident of the state and do not qualify for medicare, your income exceeds 133 percent but, not more than 200 percent of the poverty line, you are eligible for employer coverage but, it is not affordable for you -OR-you are not eligible for employer coverage, and you are not yet 65 years of age. You are not eligible to use the Exchange. From what I am reading, the state will use contractors that will handle these individuals. Then, there is a bunch of information on qualifying contractors and use of funds.
Beginning on page 219, it talks about how states can get together and offer more options by combining forces. Of course, all this has to be approved by the Secretary. Of course this leads up to conjoining the states in what will ultimately be a nationwide qualified health plan.
Okay, I'm done for tonight. I'll be back tomorrow for part 5.
Each state must establish an American Health Benefit Exchange. There are grants available for states doing this but, again, the Secretary will determine who gets the grants and for how much. These will be facilities that are for purchasing qualified health plans and provide help for small businesses.
The next several pages are just a description of the Secretary's duties.
On pg. 137, I am reading about how the state's can make more requirements, aside from just the essential requirements that have yet to be determined by the Secretary. If the state makes any further requirements for coverage, than the state will assume all costs for that coverage.
As I continue to read on, I am finding that the Secretary is going to keep track of many things and transfer this information to the Secretary of Treasure. This information will include what plans were offered by employers and if the costs were reasonable. The idea, I am understanding, is to make sure that employers are all adhering to the bill and, offering affordable coverage.
Beginning January 1, 2015, it is required that all of these Exchanges will be run by the states and not funded by the federal government at all. They will charge fees and such for their services. The next several pages discuss the various things that the Exchange must do (office stuff).
On page 176, it says that members of congress have available to them health plans that created under this act or, ones that are offered through an exchange. However, ironically it doesn't say anything about them having to get coverage from an Exchange that is in their state. Is it possible that Exchanges from any state will offer them coverage?
Well, it looks like the next page sort of answers my question...
(ii) resides in the State that established the Exchange (except with respect to territorial agreements under section 1312(f)).
When I cross reference, it isn't very clear. It basically says that the Exchange can make the determination themselves. So, it looks like it's possible that members of congress will likely have a choice of any Exchange from any state. What Exchange is going to turn down a member of congress?
Section 1313 is basically a section that talks about the financial integrity that is to be upheld by the Exchanges.
Section 1321 describes the flexibility the states have concerning Exchanges.
It says something in here about the Secretary determining if the Exchanges have insured a certain percentage of the population. It appears as though they will determine if the Exchanges are working based upon the percentage of the population that is being insured through them but, there are no figures given and everything is at the discretion of the Secretary.
SEC. 1322. FEDERAL PROGRAM TO ASSIST ESTABLISHMENT AND OPERATION OF NONPROFIT, MEMBER RUN HEALTH INSURANCE ISSUERS.
Non profit? How is this going to work? Well, so far, what I am reading in this section is almost identical wording to the operations of the Exchanges. These shall be referred to as Consumer Operated and Oriented Plan (CO-OP) program.
The purpose of these are listed as: It is the purpose of the CO-OP program to foster the creation of qualified nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets in the States in which the issuers are licensed to offer such plans.
Again, we find that the Secretary can provide grants for anyone that applies to run a CO-OP. They can get money for start-up costs. The next few pages talk about the requirements associated for obtaining these grants.
SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION. Based on the information in here, the Secretary can offer this option through Exchanges provided the state wants to offer this option.
What do they define this community health insurance option as?
(A) except as specifically provided for in this section, complies with the requirements for being a qualified health plan;
(B) provides high value for the premium charged;
(C) reduces administrative costs and promotes administrative simplification for beneficiaries;
(D) promotes high quality clinical care;
(E) provides high quality customer service to beneficiaries;
(F) offers a sufficient choice of providers; and
(G) complies with State laws (if any), except as otherwise provided for in this title, relating to the laws described in section 1324(b).
This option will only offer the essential health care benefits. If the state requires any more benefits, the state will eat those costs. There will be start-up funds that will be given out to provide the community option.
There is so much money being appropriated in all sorts of directions. Why can't the Exchanges just take care of this? I am not seeing a reason for this bureaucracy.
On page 200, SEC. 1324. LEVEL PLAYING FIELD They have some very odd wording here but, I am under the impression that this means that the private insurer must offer plans that are in accordance with the same that will be offered under the public options, which they are calling Consumer Operated and Oriented Plan program under section 1322, a community health insurance option under section 1323, or a nationwide qualified health plan under section 1333. These laws are the ones that discuss such things as the guaranteed renewal, and pre-existing conditions that have already been explained previously.
The next section talks about how the individual states will have some flexibility when it comes to what plans they offer. So, again, we really do not know anything that is in this bill. It's all approved by the Secretary, the state, and various committees- depending on what issue they are dealing with. Sure, there are some ideas and some outlines here but, ultimately there is nothing sent in stone.
This same section has to do with low income individuals that do not qualify for medicade. If you are in this category, you are a resident of the state and do not qualify for medicare, your income exceeds 133 percent but, not more than 200 percent of the poverty line, you are eligible for employer coverage but, it is not affordable for you -OR-you are not eligible for employer coverage, and you are not yet 65 years of age. You are not eligible to use the Exchange. From what I am reading, the state will use contractors that will handle these individuals. Then, there is a bunch of information on qualifying contractors and use of funds.
Beginning on page 219, it talks about how states can get together and offer more options by combining forces. Of course, all this has to be approved by the Secretary. Of course this leads up to conjoining the states in what will ultimately be a nationwide qualified health plan.
Okay, I'm done for tonight. I'll be back tomorrow for part 5.
2010-04-01
Arctic Sea Ice Will Hit Normal Line
For the first time since 2001, the Arctic Sea ice will hit the "normal" line statistic.
Now, for the environmentalists, is this bad news?
Click title of post for article and video, that was created by Marian Wilkinson, who insisted in 2008 that we would have an ice free Arctic within a few years, due to our harm to the environment.
Now, for the environmentalists, is this bad news?
Click title of post for article and video, that was created by Marian Wilkinson, who insisted in 2008 that we would have an ice free Arctic within a few years, due to our harm to the environment.
Militia Man Says He's Innocent
One of the militia men that was arrested in Detroit, Michael David Meeks, 40, is claiming his innocence. His attorney is planning on showing evidence of this in court.
According to the article, it was an FBI agent that infiltrated the group and, a plan of the militia was to make fake 911 calls, kill the police officers that respond to the calls, and finally set off a bomb at the funeral.
Click title of post for full article.
According to the article, it was an FBI agent that infiltrated the group and, a plan of the militia was to make fake 911 calls, kill the police officers that respond to the calls, and finally set off a bomb at the funeral.
Click title of post for full article.
5 Pirates Captured By US Navy
After an incident that occurred, where the US Navy had exchanged fire, and finally took out a mother ship, the US Navy has captured 5 pirates near Seychelles.
As of now, the US Africa Command has indicated that they still have the pirates in custody and it will remain that way, for now.
Click title of post for article on AP.
As of now, the US Africa Command has indicated that they still have the pirates in custody and it will remain that way, for now.
Click title of post for article on AP.
Health Care Bill - Part Three
Today in our health care bill, I am reading...
... more about penalties that will be assessed by the Secretary and a report will be created, that will document who received penalties. This report will then be given to the Secretary of Treasury.
Any fees that are not paid, will be increased and be considered a legally enforceable debt. Then, continuing in this section that I'm reading is mostly office protocol. How they are going to handle electronic funds and such...pretty boring stuff here. I'm skimming quite a bit of this.
On page 78, it says that no plan offered by group or individual plan may impose any pre-existing condition exclusion.
Now, it goes into rates. It doesn't give a price or anything, just that it tells the insurance company that they can charge different rates for age, tobacco use, or if the plan covers individual vs. family.
On, page 82 -SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE. So, the insurer must accept everyone that applies. They may restrict this to an open enrollment period. You have guaranteed renewability.
The bill then says that there is a prohibition against any types of discrimination for coverage. These include:
(1) Health status.
(2) Medical condition (including both physical and mental illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
(8) Disability.
(9) Any other health status-related factor determined appropriate by the...wait for it...
Secretary. Shocker right? I cannot believe this bill!
An employer is required to offer a wellness program. This is geared to education to promote health and prevent disease.
The next several pages go on about some types of wellness programs and what incentives can be offered. If you own a company, you might find this section to be valuable. However, I'm not sure it is because, as with everything, so far in this bill, you'll have to wait till the Secretary determines what is acceptable.
After all this, beginning on page 94, we read about another report that will be coordinated with the Secretary, the Secretary of Labor, and the Secretary of Treasure, that will be then given to the appropriate committee in the Senate as a review of the effectiveness of the wellness programs, and various elements like rewards that were offered for taking the wellness programs.
If you apply for coverage with an insurer, you will not wait more than 90 days to obtain coverage.
This next one is for unions that have collective bargaining agreements...If you have a contract that was ratified BEFORE the date this bill was enacted, than either the contract will just continue on the same or, changes can be made that fit to the bill and will not be considered illegally terminating the contract.
SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.
Very general terms: must have a seal of approval, must offer essential coverage, must be offered by insurer who has a legal and up-to-date license, offers at least one plan under silver level and one under gold level, must charge the same premium -whether directly to individual or, through an agent, and complies with other regulations yet to be set by the Secretary.
SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS
So, what are these "requirements" that we are going to be guaranteed in our coverage?
Well, they have to be established by the Secretary, of course but, they did attempt to outline some things for us in the bill.
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
The next section of pages go on to deal with how the Secretary will ensure that all of these areas are equal and great, and then, after some time, they will review and modify or, update standards...very, very boring stuff.
For employer sponsored plans, they have set some limits on deductibles. $2000 for individual plans and $4000 for any other plan.
When the bill starts talking about limitation and such, it goes into heavy cross referencing. For our purposes, on my blog, I will skip that.
Beginning on page 112, we finally see them talking about the levels of coverage. They have designated the terms: bronze, silver, gold, and platinum. As we read previously, at minimum, an insurer must offer at least one plan that falls under silver and, one that falls under the gold level.
The bronze is a 60/40 plan; silver is 70/30; gold is 80/20; platinum is 90/10. So, for bronze, 60/40 means the insurance pays 60 percent, while you pay 40 percent, ect.
What follows is some information concerning the employer and the IRS. The Secretary, of course, will be setting the standards. Again, a section that could be useful, if we knew what the Secretary was going to do.
Beginning on p. 116 we see the special rules that pertain to abortion. Pertaining to coverage through an insurer, the coverage is optional. The insurer must offer one plan that covers abortion and, one plan that does not offer abortion. Wow. They must offer a plan that provides it? It does say that it's not part of the essential coverage that was previously, but loosely defined.
There is a few paragraphs here that indicate that there are abortions that are eligible for federal funding and, there are abortions that are not eligible for funding. I am still trying to figure out how they are differentiating between the two. This is on p. 117. I thought there would be some language about rape or incest but, I'm not seeing anything. I'm reading this as the states will determine if abortions can be funded by government or not. It looks like what they did was say, "it's okay, as long as the State says it is."
So, the next question I have is, how are the states going to determine this? Are we going to vote or, are the state legislatures going to determine?
They do include this paragraph, p. 123...
PROVIDER CONSCIENCE PROTECTIONS.—No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.
I'll be back tomorrow.
... more about penalties that will be assessed by the Secretary and a report will be created, that will document who received penalties. This report will then be given to the Secretary of Treasury.
Any fees that are not paid, will be increased and be considered a legally enforceable debt. Then, continuing in this section that I'm reading is mostly office protocol. How they are going to handle electronic funds and such...pretty boring stuff here. I'm skimming quite a bit of this.
On page 78, it says that no plan offered by group or individual plan may impose any pre-existing condition exclusion.
Now, it goes into rates. It doesn't give a price or anything, just that it tells the insurance company that they can charge different rates for age, tobacco use, or if the plan covers individual vs. family.
On, page 82 -SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE. So, the insurer must accept everyone that applies. They may restrict this to an open enrollment period. You have guaranteed renewability.
The bill then says that there is a prohibition against any types of discrimination for coverage. These include:
(1) Health status.
(2) Medical condition (including both physical and mental illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
(8) Disability.
(9) Any other health status-related factor determined appropriate by the...wait for it...
Secretary. Shocker right? I cannot believe this bill!
An employer is required to offer a wellness program. This is geared to education to promote health and prevent disease.
The next several pages go on about some types of wellness programs and what incentives can be offered. If you own a company, you might find this section to be valuable. However, I'm not sure it is because, as with everything, so far in this bill, you'll have to wait till the Secretary determines what is acceptable.
After all this, beginning on page 94, we read about another report that will be coordinated with the Secretary, the Secretary of Labor, and the Secretary of Treasure, that will be then given to the appropriate committee in the Senate as a review of the effectiveness of the wellness programs, and various elements like rewards that were offered for taking the wellness programs.
If you apply for coverage with an insurer, you will not wait more than 90 days to obtain coverage.
This next one is for unions that have collective bargaining agreements...If you have a contract that was ratified BEFORE the date this bill was enacted, than either the contract will just continue on the same or, changes can be made that fit to the bill and will not be considered illegally terminating the contract.
SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.
Very general terms: must have a seal of approval, must offer essential coverage, must be offered by insurer who has a legal and up-to-date license, offers at least one plan under silver level and one under gold level, must charge the same premium -whether directly to individual or, through an agent, and complies with other regulations yet to be set by the Secretary.
SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS
So, what are these "requirements" that we are going to be guaranteed in our coverage?
Well, they have to be established by the Secretary, of course but, they did attempt to outline some things for us in the bill.
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
The next section of pages go on to deal with how the Secretary will ensure that all of these areas are equal and great, and then, after some time, they will review and modify or, update standards...very, very boring stuff.
For employer sponsored plans, they have set some limits on deductibles. $2000 for individual plans and $4000 for any other plan.
When the bill starts talking about limitation and such, it goes into heavy cross referencing. For our purposes, on my blog, I will skip that.
Beginning on page 112, we finally see them talking about the levels of coverage. They have designated the terms: bronze, silver, gold, and platinum. As we read previously, at minimum, an insurer must offer at least one plan that falls under silver and, one that falls under the gold level.
The bronze is a 60/40 plan; silver is 70/30; gold is 80/20; platinum is 90/10. So, for bronze, 60/40 means the insurance pays 60 percent, while you pay 40 percent, ect.
What follows is some information concerning the employer and the IRS. The Secretary, of course, will be setting the standards. Again, a section that could be useful, if we knew what the Secretary was going to do.
Beginning on p. 116 we see the special rules that pertain to abortion. Pertaining to coverage through an insurer, the coverage is optional. The insurer must offer one plan that covers abortion and, one plan that does not offer abortion. Wow. They must offer a plan that provides it? It does say that it's not part of the essential coverage that was previously, but loosely defined.
There is a few paragraphs here that indicate that there are abortions that are eligible for federal funding and, there are abortions that are not eligible for funding. I am still trying to figure out how they are differentiating between the two. This is on p. 117. I thought there would be some language about rape or incest but, I'm not seeing anything. I'm reading this as the states will determine if abortions can be funded by government or not. It looks like what they did was say, "it's okay, as long as the State says it is."
So, the next question I have is, how are the states going to determine this? Are we going to vote or, are the state legislatures going to determine?
They do include this paragraph, p. 123...
PROVIDER CONSCIENCE PROTECTIONS.—No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.
I'll be back tomorrow.
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