Deliverable health care changes Democrats should have no problem giving constituents within 6 mos.

[bigtree]

. . . of passage of the health bill; from CNN: http://www.cnn.com/2010/POLITICS/03/16/health.care.immediate/index.html


ALTHOUGH some of the provisions in the reform bill won't be implemented immediately, here's what Democrats say would go into effect in the first year after passage:

*Eliminating caps: If you buy a policy, a health care company will not be able to place a lifetime -- or annual -- cap on how much they will cover. This is will be especially important for those diagnosed with serious illnesses, such as cancer, who face steep medical bills.

*Pre-existing conditions: The Senate bill includes $5 billion in immediate support to provide temporary coverage to uninsured Americans with pre-existing conditions. The money would help you until the new health care exchanges in the Senate bill are put into effect in 2014.

*Children and pre-existing conditions: Another thing that's going to be very important, CNN Senior Political Analyst Gloria Borger said, is that there will be no exclusion of children with pre-existing conditions.

*Dependent children: Your children will be covered until the age of 26.

"Children who are over 21 and may not have a job that pays their health insurance can still be on your policy," Borger said. "That's very important to a lot of families."

*Small business tax credits: Those tax credits are aimed at helping small businesses buy health insurance for their employees. Tax credits of up to 50 percent of premiums will be available to firms that offer coverage, according to the Senate's plan.

*Preventive care: All new insurance plans, Obama said, will be required to offer free preventive care in order to "catch preventable illnesses and diseases on the front end."

*Appeals process: A new independent appeals process will be set up for those who feel that they were unfairly denied a claim by their insurance company.

*Help for seniors: If you fall into the Medicare Part D Drug Benefit coverage gap, dubbed the "donut hole," you will receive $250 to help pay for prescriptions.


read more: http://www.cnn.com/2010/POLITICS/03/16/health.care.immediate/index.html

[Mass]

1. I guess some people cant take the truth. I recommended and the count is now 0.

Yes, these are the reasons why I support this very imperfect bill. It helps people while not doing anything will KILL people.

[Fumesucker]

2. What I've heard very little about in this debate is this:

What are the mechanisms for *enforcement* against the insurance companies to make sure they do what the new law requires?

Is there anything as drastic and inexorable as the IRS enforcement of the individual private mandates?

Rules and regulations are all well and good but without credible and forceful enforcement they aren't worth a bucket of warm spit.

I'm asking this question in light of the fact that California has stopped trying to regulate Anthem Blue Cross because the company just takes every single case to court and ties it up in interminable legal proceedings.

Keep in mind further that torture has always been illegal in the USA and yet there is not even talk of prosecuting those responsible for officially sanctioned torture.

Edited for speling and to add the last sentence.

[bigtree]

16. I think HHS will need some more resources and support

. . . considering the regulating the bill expects to come from that office.

[Fumesucker]

17. And the bill provides the resources and support?

[bigtree]

19. likely not enough for the regulatory task (imo). HHS is mandated to regulate in the bill though

. . . and there will be an increase in money, I'm just not finding money specifically targeted to that task:

The Department of Health and Human Services (HHS) would see almost a 10% increase from the current fiscal year under President Barack Obama's proposed federal budget for fiscal 2011. Included in the budget are numerous areas promoting healthcare reform, including additional funding for health information technology and comparative effectiveness research.

Of the $900 billion proposed for HHS, the lion share is targeted toward Medicare at $489 billion, after recouping an anticipated $722 million through revamped efforts to detect waste, fraud, and abuse. States would receive $290 billion for Medicaid, which includes an additional $25.3 billion to extend by six months those increases included under last year's economic recovery act. Both amounts represent about a 9% increase from 2010.

http://www.healthleadersmedia.com/content/LED-245843/Obamas-Proposed-Budget-More-Money-for-Health-IT-Medicare-Medicaid-NIH


here's PS Robert Gibbs on HHS and regulation: http://www.enewspf.com/index.php?option=com_content&view=article&id=14017:white-house-press-briefing-by-robert-gibbs-february-22-2010&catid=88888983:latest-national-news&Itemid=88889930

Q A few questions on health care, Robert. The detail about a new rate authority to oversee and shoot down premium increases that are deemed to be unjustified, unreasonable -- how is that not big government, the feds getting into the business of regulating and shooting down rate increases?

MR. GIBBS: Well, look, Ben, you understand and you've heard both the President, on numerous occasions, and the Secretary of Health and Human Services discuss unjustifiable rate increases by insurance companies that are experiencing profits and whose rate increases -- proposed rate increases greatly outstrip health care inflation.

I don’t think anybody would consider what a state insurance commissioner would do to be regulating the increases, largely unjustifiable, for health insurance to be an intrusion in their lives, but in fact a help. This is a process that we’ll work through with the Secretary of Health and Human Services in order to ensure that the public has some protection against this, Ben.

[Fumesucker]

20. Ahh. An industry regulatory mandate with no money or insufficient money..

Now *that* is a surprise..


















:sarcasm:

[newfie11]

3. While I do want this to pass

I am wondering about the 250 for medicare prescriptions. Does this mean the donut hole is still there?

[bigtree]

5. from thinkprogress

Completely closes donut hole. Replaces $500 increase threshold increase limit with a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.

Closes donut hole by phasing down the coinsurance so it is the standard 25% by 2020 throughout the coverage gap.

http://wonkroom.thinkprogress.org/2010/02/22/obama-health-plan/

[newfie11]

13. Thanks for clearing that up. n/t

[uberblonde]

4. $100 a day fine for insurance companies...

If they deny you coverage for pre-existing conditions. Does that sound like a real deterrent to you? Sounds like a token slap on the wrist!

[HughMoran]

9. Can always jack the fine up later if they decide to abuse this provision

:)

[zipplewrath]

6. More fluff than substance

*Eliminating caps: If you buy a policy, a health care company will not be able to place a lifetime -- or annual -- cap on how much they will cover. This is will be especially important for those diagnosed with serious illnesses, such as cancer, who face steep medical bills.

The annual cap is interesting, but from what I understand, very few people reach these. I suspect this was more "pre-emptive" than anything else. Prevents the insurance companies from lowering them drastically. The "life time" cap will be more useful, although one should be careful, anyone reaching lifetime caps is probably also near bankruptcy from uncovered expenses. This provision will be most useful to the well off who will now be well protected.

*Pre-existing conditions: The Senate bill includes $5 billion in immediate support to provide temporary coverage to uninsured Americans with pre-existing conditions. The money would help you until the new health care exchanges in the Senate bill are put into effect in 2014.

The manner of that "support" is a tad suspect, in that if it was full support, $5 billion wouldn't really cover it. I suspect this is aimed at some of the hardest cases, and even then it isn't clear that they will be able to afford the uncovered expenses if they are eligible for this support.

*Children and pre-existing conditions: Another thing that's going to be very important, CNN Senior Political Analyst Gloria Borger said, is that there will be no exclusion of children with pre-existing conditions.

Probably the most useful of the features.

*Dependent children: Your children will be covered until the age of 26.

Will help a few for a couple of years, although many plans had this feature already. Note, it will note be FREE. And the amount they can charge isn't clear. Furthermore, our plan has already put folks on notice that thise feature doesn't apply because technically they aren't a health insurance plan. They are "self insured" and so are exempt.

*Small business tax credits: Those tax credits are aimed at helping small businesses buy health insurance for their employees. Tax credits of up to 50 percent of premiums will be available to firms that offer coverage, according to the Senate's plan.

The firms already offer coverage will love this. It will be a form of stimulus similar to a tax cut. Firms that DON'T already offer it will be a mixed bag. And it isn't clear if the "savings" will be passed on to the employee or not.

*Preventive care: All new insurance plans, Obama said, will be required to offer free preventive care in order to "catch preventable illnesses and diseases on the front end."

This, and the CHC will be very nice. It will do little to address any of the systemic problems of our healthcare system, but it will be a nice little political boost to those who aren't sick but will see a doctor anyway. If they actually have a problem, it won't do squat.

*Appeals process: A new independent appeals process will be set up for those who feel that they were unfairly denied a claim by their insurance company.

Pig in a poke. Could be good, could be bad. There are already such systems in place. They aren't wildly popular.

*Help for seniors: If you fall into the Medicare Part D Drug Benefit coverage gap, dubbed the "donut hole," you will receive $250 to help pay for prescriptions.

Another nice feature that will generate votes in the fall. Probably not as much as if they had allowed medicare to negotiate drug prices (ya know, like everyone campaigned upon), but still those in the donut hole will appreciate it I'm sure.


In the end much of this is good new for those already well off. It is "vote buying" to some extent. This entire bill generally ignores the fact that health care costs extend beyond was is covered by most policies. Even those with insurance can and do have excessive health care costs.

[bigtree]

7. good points

well organized and appreciated

[Lydia Leftcoast]

8. Questions (by way of a REALITY CHECK)

Sounds good, BUT...

1. Is the ban on lifetime caps for all current policies as well, or are they grandfathered in and still allowed to impose caps? They're still allowed to impose ANNUAL caps, by the way.

2. What about my OLD insurance plan that still doesn't pay for preventive care? Will it be required to do so, or will I be required to apply all over again to the same company that has all my medical records for the past 16 years to change my policy? That's my current situation: Apply all over again AND pay what would be the first month's premium on top of my current premium.

3. Small businesses can already deduct the premiums they pay for their employees. How is that new?

4. A "subsidy" for the doughnut hole? How 'bout the bold new concept of ELIMINATING the doughnut hole?

Here's where the divide on DU is. The "Rah-Rah Health Care Bill" crowd is NOT LISTENING to those of us out in the real world.

[bigtree]

12. I think the process was taken out of our hands the minute they began 'compromising'

. . . with conservatives and republicans in the Senate for their votes.

here's something about your concerns on the caps from DKos: http://www.dailykos.com/story/2010/3/8/101218/4942?new=true


Here's the National Hemophilia Foundation on the Senate bill: http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=303&contentid=1438

There are also some differences between the two bills on issues of particular importance to the bleeding disorders community. For example, in the Senate bill, lifetime caps are eliminated six months after enactment for new plans, but existing, grandfathered plans can continue to have lifetime caps indefinitely.

In the House bill, lifetime caps are eliminated in all plans immediately. Annual limits are eliminated in 2014 for new plans in the Senate bill; in the House bill, annual caps are prohibited in 2013 for new plans and 2018 for existing plans.

___________________________

There are still lingering concerns about the annual limits exception for existing, grandfathered plans, as you can see in theNew York Times below: http://prescriptions.blogs.nytimes.com/2010/01/26/when-the-insurer-says-no-more/

The Senate bill, on the other hand, would eliminate lifetime limits for new health plans six months after the law’s enactment. Annual limits would be prohibited for new plans starting in 2014 and allowed only on a restricted basis before then. But current plans would get a pass: health plans that people already belong to at the time of enactment would be permanently exempt from the requirement to eliminate lifetime and annual caps.

It’s a sticky issue, and policy analysts agree that the devil will be in the details. For example: What exactly is considered a new plan? Most plans change some details of their coverage every year. "If even minor changes mean a new plan, then the dynamics of the market mean that grandfathered plans will disappear very quickly," said Stephen Finan, senior director of the American Cancer Society Cancer Action Network.

_________________________

from the list of immediate benefits below on this page, the annual limits restriction will be defined by the Secretary of Health and Human Services: http://warner.senate.gov/public/index.cfm?p=senatehealthreformbill

Restricted Annual Limits on Coverage

* The Patient Protection and Affordable Care Act will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned.

A lot of the rule-making and definition of benefits will be set by the Secretary of Health and Human Services and by state insurance commissioners within each state-based exchange. Even if the Senate bill passes with a reconciliation fix, we'll still need to keep our eye on how these benefits will be defined, and how the Secretary of Health and Human Services will define these annual limits until 2014 when the exchanges are operational. A lot of times, the devil is always in the details, which is why we have to remain vigilant.

[Lydia Leftcoast]

23. In other words, "Thanks for nothing, Democrats"

Those of us who already have crappy insurance now have two choices--

1, Keep our crappy insurance and hope they don't raise the premiums too high

2. Enroll in new insurance that costs even more per month than our current crappy insurance but doesn't provide much more coverage

[Nikki Stone1]

10. Unrec: there will be ANNUAL caps.

READ THE DAMNED BILL, WILL YOU?

[bigtree]

14. what's the point in berating folks here?

I AM 'reading the bill', as best I can. If you want to make a point make it. It's not as if this thread is attempting to bar you from offering your opinion on what CNN is reporting. Input is the reason most of us post here (posters jumping down your throat is what keeps folks away).

[eilen]

11. Couldn't health insurance reform be achieved without

mandating the entire population to purchase private health insurance? I mean, there is already regulation for healthcare but this doesn't really offer insurance company customers more than they should already be receiving except for the coverage for dependants. If the economy would improve so there were actual good jobs for our college graduates, we would not need this dependent coverage.

Will people's insurance bills be reduced significantly?

My last insurance coverage had a $3,000 deductible and then paid 80% and did not cover my annual gyn/mammogram (it fell into the deductible well). I had an HSA that I put $100 in per month to cover incidental costs such as preventative care. But I had a coworker who had an autoimmune arthritic condition that required a shot that cost $350/week and could not swing it and support her two boys. So I guess most insurance plans sound fine until you actually need it and then it is hard to keep up with the costs. I had cancer patients who had the best insurance in the state-- the state worker's insurance plan and they were asking for samples for meds as their copay for nongenerics was $30/per med. Which sounds like a good deal for those who pay $60 per med but it adds up and is just as unaffordable to them as for the uninsured and unemployed (who are more likely to qualify for medicaid once their medication costs are added up).

Americans lack of access is mainly due to unaffordability of the care (hospitalization, testing, procedures and drugs).

[bigtree]

15. right. Access is only part of the battle

Deductibles, fees, availability of care . . . I don't think the bill addresses those in any satisfying or significant way.

[inna]

18. Sure, just as it's done in all civilized countries - via (progressive) taxation.

Mandates to the parasitic insurance cartel is corporate welfare, not health care reform.

[Lydia Leftcoast]

21. There are a couple of different means of financing health care

1. Taxation (the UK)

2, Taxation plus modest monthly premiums (Canada)

3. Private insurance with strictly (and I mean controlled FOR REAL) controlled premiums and co-pays (Germany)

4, Income-based premiums and modest co-pays (Japan)

I have been unable to find any system with deductibles, which are the real killers--people who are already paying large amounts per month for their policies and THEN have a four-figure deductible on top of it.

[Fumesucker]

24. Clearly we are about to embark on a hitherto untried course then...

Individual private mandates *with* four-figure deductibles..

[Johonny]

30. No they apparently didn't have the votes for this

I think clearly the next battle is to meld this reform with the previous reform of medicare. As always the reform doesn't end with passing the bill, this is the first step in a long fight. I'll be happy if this passes, I will not be happy if Dems think this is the end of the fight for reform.

[kctim]

22. What prevents

insurance companys from raising premiums in order to offset all these new costs?

[bigtree]

25. the legislation

. . . intends for the Sec. of Health to regulate insurance rates:

Obama’s proposal would give the Health and Human Services secretary, Kathleen Sebelius, new powers to review premium hikes by private insurance companies – and in some cases, block those deemed excessive. Anthem’s rate hikes of up to 39 percent in recent weeks have focused attention on the skyrocketing health insurance costs, the very costs Obama vowed to fight when he undertook comprehensive health care reform last year.

Obama’s plan would create a new board made up health insurance experts, which would determine annually what are reasonable premium hikes in various markets, and the HHS secretary also would work with state officials, the White House said. The proposal was first reported in the New York Times.
http://www.politico.com/news/stories/0210/33258.html

_________________________

At the heart of President Obama’s drive to rein in health costs is a proposal for federal review and regulation of health insurance premiums, with a new agency empowered to block excessive rate increases.

The president’s proposal is modeled on a bill introduced by Senator Dianne Feinstein, Democrat of California, which would give the health secretary the authority to deny or modify premium increases that she found unreasonable.

In a recent report to Congress, the National Association of Insurance Commissioners said, “Most states require insurers in the individual market to obtain prior approval of proposed rate increases before putting them into effect.”

At least 27 states have “prior approval” requirements. In 12 other states, rates must be filed with regulators before their use, and regulators often have the authority to block increases. In other states, insurers must inform state officials of rate increases or file their rates along with standard contract forms.
http://www.nytimes.com/2010/03/09/health/policy/09rates.html?pagewanted=print

[Lydia Leftcoast]

26. The system is too screwed up to reformable

It's like trying to cure gangrene with bandaids.

Next time you meet a doctor in private practice, ask how the insurance companies mess things up.

[kctim]

27. Thanks for the links and info

but it sounds like rates are still going to just keep going up and up.
Same as it always was.

[bigtree]

28. rates will go up

. . . but the expectation is to hinder that expected increase with several constructions and mandates in the bill. With this administration in charge of that effort (Sebelius) I expect some progress, but I'm not certain there is lasting authority within HHS if administrations change. 'Bout what I've come to expect from Congress. I'm not completely discouraged, tho . . .

[kctim]

29. Unrealistic expectations

Our insurance rates will always go up because insurance companys are covering more.

AND

Taxes will go up dramatically in order to make up, and pay for, the tax "credits" and subsidizing prescriptions.

The majority of people are going to be pissed.