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.