GI for Children? Not Until 2014

Crabcake Johnny

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Insurers Might Delay Covering Pre-Existing Conditions - NYTimes.com

As I guessed, the law was poorly written if the intent was to force carriers to issue GI coverage to children. It will not happen as the legislation is written.

Submit a child who has a condition or is uninsurable? Uninsurable = decline. A condition will = heavy rate increase. Basically, no change for 4 years.

If Obama wants GI for children he'll have to start with a new draft back at the House.
 
Insurers Might Delay Covering Pre-Existing Conditions - NYTimes.com

As I guessed, the law was poorly written if the intent was to force carriers to issue GI coverage to children. It will not happen as the legislation is written.

Submit a child who has a condition or is uninsurable? Uninsurable = decline. A condition will = heavy rate increase. Basically, no change for 4 years.

If Obama wants GI for children he'll have to start with a new draft back at the House.

I guess this is the consequence of rushing 2000 plus pages through without the time to read the bills....Nancy was right they had to pass before we could find out whats in the bill...
 
I'm sick of the entire mess already. Just have Medicare for all and be done with it.

The article reads like insurance companies are finding loopholes. Nice...what a joke.
 
Politically this is ideal for Obama because his whole gig is to jihad against the carriers now. He will get a lot of mileage out of this.

Just like having Anthem increase rates right while he had suckered the republicans into opening the process up again. He might as well have died and gone to heaven when they did that. Whether his heaven would be with or without virgins, I dont know.

If needed they can also run a standalone amendment back through the house and senate and even if it does not pass they can force republicans on record as being mean to kids to have that for use in the elections. Have to be careful because the dems have demonstrated that they are quite a bit smarter at this than the republicans. As I stated though, I am not saying this is pretty for Obama either. It is a complete mess and the nature of a complete mess is that is a mess. Add immigration in for fun as we go forward.

Yup, I know they have Scott Brown now. Force him to vote on denying coverage to kids and see how that works back in Pinkachusetts. Fun, fun, fun, since daddy took my T-Bird away.
 
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Medicare currently is 34 TRILLION unfunded liability, so adding on to that, with no plan for long term solvency, hardly makes sense!

It will just hasten the total bankruptcy of the country. Can you say "banana republic"?

I know it's in the hole, big-time. You're not telling me something I don't already know.

Fix it. Oh that's right, we'll all have to pay more. Something very few of us are willing to do.
 
I know it's in the hole, big-time. You're not telling me something I don't already know.

Fix it. Oh that's right, we'll all have to pay more. Something very few of us are willing to do.

A Medicare Program for the 21st Century. As the long-term fiscal burden of Medicare becomes more unsustainable, it is clear that – to fulfill the mission of Medicare – small and gradual changes to the program will not suffice. The entire methodology of the program must be converted away from a program that shelters providers and consumers from prices – and is therefore inefficient in restraining rising costs – into one in which beneficiaries choose the most affordable coverage that best suits their needs.

Just as the Medicare Program requires a new methodology, so too does its structure of financing. In this proposal, the Part A and Part B trust funds are combined to create one unified trust fund. The new Medicare Program and the existing program continue to be financed by trust fund revenues, Medicare payroll taxes, and general revenue contributions. The measure of solvency is converted away from one based on the unfunded liability of the Part A trust fund and into one in which the program’s solvency is measured as a percentage of gross domestic product [GDP].

Medicare Payment. For future Medicare beneficiaries who are now under 55 or younger (those who first become eligible on or after 1 January 2021), the proposal creates a standard Medicare payment to be used for the purchase of private health coverage. Currently enrolled Medicare beneficiaries and those becoming eligible in the next 10 years (i.e. turning 65 by 1 January 2021) will see no changes in the current structure of their Medicare benefits. The payment will be made directly to the health plan designated by the beneficiary (similar to the administration of the refundable health care tax credit), with the beneficiary receiving any leftover amount as a payment from the health plan, or assuming financial responsibility for any difference in the payment and the total cost of the premium. This allows the Medicare beneficiary to invest the leftover amount in a Medical Savings Account [MSA] to pay for other medical expenses, or to purchase long-term care insurance.

Each Medicare beneficiary becomes eligible for the payment by enrolling in a health insurance plan. Medicare will publish an annual list of plans that are “Medicare certified.” Medicare enrollees are able to use their payment to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market.

When fully phased in, the average payment is $11,000 per year (the average amount Medicare currently spends per beneficiary), and is indexed for inflation by a blended rate of the CPI and the medical care component of the CPI. For affected beneficiaries, the payment replaces all components of the current Medicare Program (Medicare fee-for-service, Medicare Part B, Medicare Advantage, and Medicare Part D). Payment amounts are income-related and risk-adjusted. They also are partially geographically adjusted, with the geographic adjustment phasing out over time.

Risk Adjustment. When the plan is fully implemented, Medicare beneficiaries will receive on average the standard $11,000, with the flexibility to receive a positive adjustment of that amount based on a risk-assessment from their chosen health plan. Once enrolled, beneficiaries may complete initial health exams through their insurance plans to determine whether they are eligible to receive a higher risk-adjusted payments. Each health plan must submit to the Medicare program any necessary results of the exam for Medicare to determine an adjusted risk-assessment.

Under the current system, Medicare frequently overpays for some services and beneficiaries and underpays for others. By risk-adjusting beneficiaries’ payments based on their health condition, this reform targets support to those who truly need additional help.

Income-Relating. The payment amount is modified based on income, in a manner similar to that for current Medicare Part B premium subsidies. Specifically: beneficiaries with incomes below $80,000 ($160,000 for couples) receive full standard payment amounts; beneficiaries with annual incomes between $80,000 and $200,000 ($160,000 to $400,000 for couples) receive 50 percent of the standard; and beneficiaries with incomes above $200,000 ($400,000 for couples) receive 30 percent.

Enhanced Support for Low-Income Beneficiaries. While any Medicare beneficiary, regardless of income level, is able to set up a tax-free MSA if he or she desires, the new Medicare Program establishes and funds an MSA for low-income beneficiaries. Specifically, for those who are fully “dual eligible” (eligible under current policies for both Medicare and Medicaid), and beneficiaries with incomes below 100 percent of the poverty level, the plan provides an MSA payment equal to the amount of the deductible for the average Medicare high-deductible health plan. Those with incomes between 100 percent and 150 percent of poverty receive 75 percent of the full deposit.

Retention of Medicare for Those 55 and Older. Clearly, the transition to this restructured Medicare Program should protect those at or near retirement – people who have long planned on the existing Medicare Program for their retired years. That is why the transition to the individual purchase of private health insurance applies to those eligible starting on 1 January 2021. For those eligible prior to that date (those 55 and older), the existing Medicare Program remains, and is strengthened with changes, such as income-relating of drug benefit premiums, to ensure its long-term sustainability.

Premiums continue to be based on an all-beneficiary average, so the phasing of the younger population into the new program will not increase premiums for the population continuing in the existing program. The proposal also retains the Medicare payroll tax of 2.9 percent of the Federal Insurance Contributions Act [FICA] and Self-Employed Contributions Act [SECA] payroll tax, as is the case now.
For individuals now younger than 55 only, the proposal adapts Medicare’s eligibility age to reflect Americans’ improving lifespans, raising in gradually, and in modest steps, from the current 65 to 69 years and 6 months.

Fail-Safe Mechanism. The proposal would establish a mechanism that would be activated in the Medicare trustees determined that the percentage of funding from general revenues exceeded 45 percent in the prior fiscal year. If activated, on 1 July or 2 months after the Medicare trustees’ report is released, whichever comes later, the mechanism would apply an automatic 1-percent reduction in payments for services provided in Medicare’s fee-for-service sector.

The plan was developed in consultation with the Congressional Budget Office [CBO] Office of the Chief Actuary of the Centers for Medicaid and Medicare Services, and would assure the solvency of the overall Medicare Program for the long term.


The Roadmap Plan | A Roadmap for America's Future | The Budget Committee Republicans
 
They can pass whatever they want to pass. A team of lawyers will be defining what "is" is for the next 10 years.

Very true.
I brought this up a while back, this bill benefits the legal profession more than anything:

It starts with a team of lawyers in Congress (i think its like 70+ percent who are lawyers).

They present healthcare reform that excludes tort reform (benefiting the legal profession)

They present a plan that will increase the amount of medicaid and low income families in the healthcare system; this in turn will increase the amount of malpractice suits and will raise malpractice insurance premiums, thus raising the cost of healthcare.

The bill itself is a legal mess, being contested in courts even before it was signed into law.

The bill will eventually eliminate group health insurance (i will explain my reasoning for this in another post) and it encourages companies to limit the amount of employees to under 50; this will encourage companies to create multiple subsidiaries which will require lawyers to do.

The legal profession will rake in billions from this healthcare bill!
 

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