Princess Nancy is about to wet her pants over the House version of Obamacare. For those who are interested, here is a link to the full 1990 pages.
Just looking through the contents, here are a few sections that will be near and dear to the neocon's among us.
Sec. 101. National high-risk pool program.
Sec. 102. Ensuring value and lower premiums.
Sec. 103. Ending health insurance rescission abuse.
Sec. 104. Sunshine on price gouging by health insurance issuers.
That just takes us through the first 31 pages. Section 104 is an interesting take.
The Secretary of Health and Human Services, in conjunction with States, shall establish a process for the annual review of increases in premiums for health insurance coverage. Such process shall require health insurance issuers to submit a justification for any premium increases prior to implementation of the increase.
Seems to me this already exists, except without federal oversight. Apparently the DOI is incapable of handling this task by themselves.
Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions.
Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities.
Of note in the deformity section is this.
EXCEPTION.—Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.
Who judges the self-esteem part?
Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans.
Who wants to bet retiree health benefits will be gone. ERISA all but eliminated traditional pensions, except in the case of government workers who are EXEMPT from ERISA compliance. Retiree health is the next to go south.
Included in the definition of a reduction in benefits is a "substantial" increase in premiums shared by the retiree.
Since this is about 30% longer than the original HR 3200 it has new things as well as these oldies but goodies.
Sec. 221. Coverage of essential benefits package.
Sec. 222. Essential benefits package defined.
Essential benefits start on page 104 and continue through page 108.
Abortion funding, in certain cases, is still in the bill. That will be a deal killer for some.
Re: 1990 Pages Hits the Floor of the HouseGo to Top
I'm reading it now and taking notes - I'm on page 131. There's some interesting stuff so far. For one, carriers can sell plans in or out of the exchanges. "Separate Excepted Coverage" is permitted....more to come.
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The clause I was looking for - page 191
(g) ROLE FOR ENROLLMENT AGENTS AND BROKERS.—Nothing in this division shall be construed to affect the role of enrollment agents and brokers under State law, including with regard to the enrollment of individuals and employers in qualified health benefits plans including the public health insurance option.
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*Temporary Nat'l High Risk Pool starting Jan 1st 2010 ending with health exchanges are implemented
*Cannot have had coverage for 6 months to be eligible
*Employers cannot "dump" employees onto this plan
*2:1 rate ratio max by age
*No more than 125% of "standard individual rate" to be determined by NAIC
*$1,500 deductible for individual, to be determined for families
*No annual of lifetime max
*OOP no more than $5,000 for individuals and $10K for families
*Each state will manage the program
Individual Market Changes as of Jan 1 2010
*Carrier can only rescind plans after a 3rd party review under the guidance of the Secretary
*Rescissions only allowed when "clear evidence of fraud" is determined by 3rd parter reviewer, not by carrier
*"Price Gouging" review - carrier must submit for rate increases under guidance of the Secretary noting reason for rate increases.
Carrier can offer "Separate Excepted Coverage" which can be sold outside of the exchange and allow them to be priced separately (I cannot find out if they still have to be qualified plans.)
Coverage Sold in the Exchange
*No pre-ex exclusions
*2:1 max rating based on age
*Area rating allowed as specified by the Commissioner
*Individual premiums "uniform" with family premiums
*Dependent age to 27
*Carrier's rates must be approved before allowed into the exchange
Carrier may sell outside of the exchange and may offer additional coverage above what the exchange plans mandate (ie: carriers can sell "Cadillac plans."
Essential Benefits
Hospitalization, outpatient, doctors/care providers, supplies and equipment, drugs, rehab, mental/nervous, wellness, maternity, well baby and durable medical equipment (No cost sharing allowed for wellness)
Agents and brokers are allowed to sell plans in the exchange including the public option. More to come.
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PUBLIC OPTION:
*Only sold in exchange
*Abide by all rules private carriers must follow
*Offer Basic, Enhanced and Premium plans
*Geographically adjust premiums in same manner as private plans
*Rates must fully finance costs
*No bailout provision - cannot get additional Federal funding to pay claims
*2 billion to fund private option
*Medicare docs are in network unless they opt out
*No punishment for docs who opt out
*Annual enrollment period where docs can opt in or out
------------------------------------ Health Insurance Agents: Training, Support, Discounts, E&O for $440 www.ihiaa.com
Re: 1990 Pages Hits the Floor of the HouseGo to Top
Well of course it is going to be expensive. PWC and Wellpoint already told us that.
Of course PresBO and Congress disputed that by saying the studies neglected to take into account the taxpayer funded SUBSIDIES that will offset the premium increases. To use the words of the White House, health insurance will be "deficit neutral" since your premiums will rise but you get an offsetting subsidy.
And how about the high risk pool in this bill (page 25).
GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.
(2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments
As are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.
Sounds like rationed health insurance to me, but what do I know?
Re: 1990 Pages Hits the Floor of the HouseGo to Top
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Originally Posted by CHUMPS FROM OXFORD
If maternity is a requirement on all plans...then rates are really going to go through the roof.
Does abortion fall under "preventive health care" or "wellness." Those costs add up too.
And if the Secretary needs to establish wating times to reduce costs, how long could the waiting times for abortion actually be increased and still be effective. Or would we be moving into infanticide as President Obama supported in Illinois.
Change you can believe in.
------------------------------------ Spending Our Way to Prosperity
Last edited by Winter : 10-29-2009 at 05:56 PM.
Reason: Posts merged
Re: 1990 Pages Hits the Floor of the HouseGo to Top
Originally Posted by healthagent
No abortions will be funded under this bill.
We don't know that yet. We only know what the bills voted out on to the floor from the Senate and House look like so far. There are senators and reps who voted the senate bill out on to the floor but have said that they will not support it without a public option, and in the House vice versa. Reps that want abortion have supported the bill without in order to get it out onto the floor to amend it. They have no choice.
If you have ever seen fly tape hanging in the barn, then that is what these bills are once out on to the floor. They are just targets to tack amendments on to. Then the horse trading begins. You want abortion" then support the public option and vice versa.
"The bill" is what the bill will be in final form. We dont know about abortion yet. Most likely it will not fly but there is no getting past the issue without alienating the left. The left will try to placate them by saying they will get it in the next phase which will only cause the right and centrists to resist it as a Trojan Horse.
Blood bath ahead. Not for the faint of heart. Don't worry they will agree upon a set of "guiding principles" by the end of year. The final bill......errrr.......more like the end of next year and if the public option is attached to a trigger which it most likely will or else it will be defeated completely then you dont know where you are until you see where you are against the trigger as we go forward.
Re: 1990 Pages Hits the Floor of the HouseGo to Top
Originally Posted by TXINSURANCE
A few points that concern me... Like this one...
85% loss ration, you think you are going to get 20% commission when the loss ratio is 85%? LOL!!! Try 5% on a good day.
Indeed and that type of concern is fundamental to the whole picture. Some agents, here included, are looking for language that says there can or cannot be commissions and then try to figure out what they would or would not be. The feds will actually establish parameters which squeeze commissions out of the picture without ever talking about commissions. They will dictate the loss ratios then the premiums must still be below the public option premium or the threatened trigger point. But then they will let carriers do whatever they want within that onion skin thick margin to work with. Some agents will be slap happy because commissions are not verboten and congress will be happy that they are allowing free market within the prison cell they allow the carriers to work within.
Having said that, I do believe that in the first couple years there could be some commission and a small micro-gold rush based on volume because carriers are concerned about gaining market share first and working the margins up later as long as they are not taking a loss. After the start-up period the carriers will handle as much as they can through their own enrollers or web sign-up. Might be a dog bone there for an agent but nothing like the old days. Perhaps, I am not objective because the future already exists in my state. We can go round and round a few thousand more times and some agents will talk about how they will take 5% all day long with mandate and guaranteed issue. Ahhh....okay.......that's a lot of "if's" that arent going to happen. If my grandmother had had a beard she might have been my grandfather type of arguments.
Doesnt matter what is and is not in this current version of the bill. That is where it is going over time.
Re: 1990 Pages Hits the Floor of the HouseGo to Top
If you have never looked at a carriers health block, then you can convince yourself that an 85% (or higher) loss ratio is impossible. Fact is, most of the major carriers are paying out 85 - 88% of premiums in claims and they still have room to pay commissions.
It has been that way for years.
DC is in a mindset right now that they can set everyone's pay. That will eventually come to a halt when a bunch of them lose their jobs starting next year and later.
1990 Pages Hits the Floor of the House
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