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.