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.