Health Bill Benefits for the Impatient

[ProSense]

December 28, 2009

Health Bill Benefits for the Impatient

By DAVID M. HERSZENHORN

<...>

Here are some of the benefits that Democrats say would be available soon after the legislation is adopted:

No annual or lifetime limits Both the Senate and House versions of the legislation ultimately seek to prevent insurers from imposing annual or lifetime limits on coverage in new health policies. In the final package of amendments to the Senate bill, the majority leader, Harry Reid of Nevada, added new language giving the secretary of health and human services the authority to regulate annual limits from six months after the bill is enacted until the broader insurance provisions take effect in 2014. Such limits are a serious concern to people with chronic illnesses like cancer that can require expensive treatments within a relatively short period of time, and the change proposed by Mr. Reid was prompted by inquiries from the American Cancer Society.

Limits on insurance company profits Beginning in 2011, the Senate bill would set tight restrictions to force insurance companies to spend the bulk of their revenues on providing medical care to beneficiaries. The legislation would require insurance companies in the large group market to spend at least 85 percent of their revenues on care and insurers in the individual market to spend at least 80 percent of revenues on care. Critics of the private health insurance, including Senator John D. Rockefeller IV, Democrat of West Virginia, and Senator Sherrod Brown, Democrat of Ohio, said setting such requirements on what insurers call “medical loss ratios” was needed to tamp down on profiteering.

Short-term expansion of state high risk pools To help people who cannot obtain insurance because of pre-existing conditions, both the Senate and House bills would provide $5 billion to increase the availability of coverage through state high-risk insurance pools. This provision would take effect 90 days after enactment of the legislation, but many details remain to be worked out.

New financing for community health centers The House bill provides $12 billion in additional financing for community health centers, which serve needy populations, particularly in rural areas. Senator Bernard Sanders, independent of Vermont, won the inclusion of $10 billion in financing for community health centers in the Senate bill. The final dollar amount will be decided in negotiations between House and Senate leaders, but the money would be available for five years beginning in the current fiscal year.

Closing the Medicare drug “doughnut hole” The legislation would increase the amount of drug costs covered by Medicare by $500 in 2010. And beginning on July 1, 2010, the bill would provide 50 percent discounts on brand-name drugs and biologics that low- and middle-income beneficiaries have to pay for themselves once the coverage gap known as the doughnut hole begins.

Prohibition on rescinding existing coverage Both the House and Senate bills would bar insurance companies from rescinding existing coverage other than “in cases of fraud or intentional misrepresentation of material fact.”

Small business tax credits The Senate bill would offer tax credits to small businesses beginning in 2010 for up to 35 percent of premium costs. The full credit would be available to firms with 10 or fewer employees and average annual wages of $25,000. Reduced credits would be available to firms with up to 25 employees and with average annual wages of up to $50,000.

Patient protections For new health plans, beginning six months after enactment of the legislation, the Senate bill would prohibit insurers from requiring prior authorization before a woman sees an obstetrician or gynecologist. The bill would also require coverage for emergency care.

Discrimination protections for lower-income workers The Senate bill would bar group health plans from setting any eligibility rules for coverage that favor higher-wage employees. This provision would take effect six months after enactment of the legislation.

Cobra extension through 2013 Anyone currently paying for an extension of health benefits as permitted under federal law — for instance, after a loss of employment — would be permitted under the House legislation to continue Cobra coverage until the major insurance coverage provisions of the legislation take effect in 2013.

Reinsurance program for early retirees Both the House and Senate bills would provide federal financing for a new reinsurance program to encourage employers to maintain health benefits for employees and early retirees age 55 to 64.

Consumer assistance provisions Both the House and Senate bills would begin to impose new requirements aimed at making it easier for consumers to interact with insurers, including a requirement that health plans adopt uniform descriptions of plan benefits and appeals procedures and that they begin using identical forms.

[sandnsea]

1. Bless your heart ProSense

I don't know where you find the patience to keep posting informative articles.

[Jane Austin]

2. Thanks, Pro Sense!

I'm trying to picture a small business that has fewer than ten employees, but averages $25,000 a year in wages.

An engineering firm?

Certainly not a retail establishment or a veterinary office.

Thanks for keeping us informed.

[sandnsea]

9. I think that's "up to"

The "up to" is in the $50,000 figure, I think they left it out of the $25,000 remark. That would mean just about every mom n pop would qualify for the credit.

[pnwmom]

3. Thank you! Recommended. n/t

[prolesunited]

4. COBRA extensions are great

if coupled with subsidies. I lose my COBRA coverage at the end of February and have pre-existing conditions, which is why I kept it to begin with. I missed the subsidy deadline by getting laid off two weeks earlier than the effective date. I'm almost relieved that I will lose coverage because the $1,100 a month premiums have drained my savings. Lucky me, I will be broke AND without health care. I guess I'll just crawl in a hole somewhere and die since I'm such a drain on society.

[pnwmom]

8. I'm sorry about your situation. Does your state have a high risk pool

for people with preexisting conditions? These bills will help expand those programs.

You shouldn't have to be going through concerns about your health care in addition to everything else.

[prolesunited]

10. Yeah, but it's limited

You usually have to wait a year or two for people to die.

I'm hoping there is something in there to help me. I'm going to get all checked out and restocked on my meds in the next month.

[levander]

15. There's a not well known law...

If you get cut off COBRA coverage, you have like 60 days you can go to any individual policy and they can't deny you. They have to accept you.

Just wanted to make sure you're aware of this before you go into that situation.

Maybe contact a health insurance broker so you can be clearer on the laws? That's just from memory what I said, but I know I heard something like that.

[frazzled]

25. That is absolutely true (HIPAA laws)

That happened when my brother-in-law's COBRA expired ... and he and his wife were both found to have "pre-existing conditions" (he had slightly elevated blood pressure; she had a slightly bad bone density test result) -- and denied.
I found the law that said the insurance company had to offer them the insurance. It was a matter of finding and filling out the correct form. They had applied separately, even though it was to the same insurance company, rather than applying to switch from COBRA to regular.

But, if the Health Care bill passes, it says above that the state high risk pools are going to be expanded. I'd check into that, too. But they can sometimes be even more expensive. I'm not quite sure.

Here are the HIPAA laws that apply to getting coverage after COBRA ends (and they can't exclude you for pre-existing conditions):

2. If your COBRA ends and you don’t qualify for the disability extension….

A 1996 federal law, called HIPAA, provides that people losing their employer’s coverage after COBRA expires, have a one-time opportunity to move to a broad benefit individual health insurance plan.

The rules on qualifying for individual coverage are not complicated:

1. You must continue your COBRA Continuation as long as possible. You cannot drop COBRA at any time and move to the individual plan.

2. You must have been continuously covered under health insurance for at least 18 months. That’s easy, since COBRA itself lasts 18 months or longer.

3. You must sign up for the individual coverage within 63 days of the end of your COBRA insurance.

The Coverage.

The plans you will have a guaranteed right to buy will change from state to state. Some states require that everyone purchase coverage from one central plan. Other states require every insurance company writing individual health insurance to carry “HIPAA coverage plans” and each person can go with the company of their choice. Either way, the coverage must be broad, and will almost always include prescription drug coverage. Companies offering “HIPAA” plans must offer their two most popular health plans based on premiums written.

http://www.hcvadvocate.org/hepatitis/hepC/cobra-2.html

[levander]

32. And, note that individual insurance is currently much cheaper than group...

prolesunited, I don't know how the HCR bill will affect this, but individual insurance is currently much cheaper than group. Through COBRA, you're paying the same group rates your last company was paying. But, when you get insurance on your own, you'll be paying individual rates.

Also, I believe there currently are some subsidies for COBRA. My neighbor recently found out he could get his last company, Delta, to pay 80% of his premiums. Maybe it that was in the stimulus bill, I don't remember.

But prolesunited, you really should contact a health insurance agent. I'm pretty sure you don't have to pay them. Whoever you end up buying insurance from, they give the agent a kickback.

[grytpype]

5. This is all just a lie from the corporatist meanies and their Manchurian Meanie, Obama

Did I do that right?

[frazzled]

6. No, you forgot to put CORPORATIST in all caps

Plus, you could have used a few exclamation points, and at least one typo.

[grytpype]

7. Sorry, I'll do better next time!

[HopeOverFear]

13. LOL

[Oregone]

11. Can you list the bill drawbacks?

[levander]

17. Drawback: It Raises Cost...

Biggest problem with this bill is that even though Americans pay way too much for health care versus other countries. And, our costs are rising at a higher rate than other countries too. However, since this bill is so concerned about the well being of industry, it contains next to no cost controls. The Center for Medicare Services's analysis of this bill indicated costs will go up even faster with this bill than it would without it...

For all the subsidies and tax credits, if they could just lower the damn costs, that would go a hell of a long way towards making health care more affordable. But, this bill doesn't. It makes the problem worse.

There are plenty of alternative bills that have ways to reduce health care costs, this bill just doesn't borrow from them in any significant way.

[Oregone]

19. Thanks. About time someone answered

Though it wasn't that special person I was hoping for

[levander]

21. Prosense has you on ignore...

She can't deal with the heat...

[Oregone]

24. LOL. That would explain things

Im not the only thing she is ignoring in her quest

[ProSense]

27. Pssst!

I can see you.

[Oregone]

28. You going to take a crack at my original question then?

[levander]

30. You think Prosense cares that their are drawbacks?

Look, if it doesn't fit with her propaganda schedule, as far as she's concerned, it doesn't exist.

Get used to it.

[Oregone]

31. I'm curious if she believes there are any at all, or if the bill is perfect

via the infallible saint Baucus, Conrad, Lieberman, et al

[levander]

33. The fat chicks at the other end of the bar...

are starting not to look so bad?

They're gonna be making last call soon...

[Cha]

34. You have no room to accuse anyone of "propaganda".

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=433x103066#103218

[levander]

35. My, my, my, how bout that? I've gotta fan! n/t

[Cha]

36. No fan of anybody who doesn't

know what the fuck they're talking about.

[ProSense]

26. There you go making up shit again n/t

[Lydia Leftcoast]

12. My comments here

No annual or lifetime limits Good. Could be passed separately.

Limits on insurance company profits ...to spend at least 85 percent of their revenues on care and insurers in the individual market to spend at least 80 percent of revenues on care. Having seen too much of how corporate creeps operate, I'm convinced that if the company's actual expenses are only 10% of premiums, they will still pay out only 80%. In other words, they'll think of it not as "Oh, we're so restricted! We have to pay out 80%!" they'll think of it as "Yay! We get to keep 20%, no questions asked!"

Short-term expansion of state high risk pools Will their be any assurances that this high-risk insurance will be affordable? I know people who would be eligible for Minnesota's existing high-risk pool, but they can't afford it.

New financing for community health centers The only unambiguously good part of the bill. With the money used to subsidize private insurance year after year, how many clinics could they have built and staffed?

Closing the Medicare drug “doughnut hole” That doesn't actually close the doughnut hole. It just softens it somewhat.

Prohibition on rescinding existing coverage With all the lawyers they can now afford with new billions, I'm pretty sure the companies will employ teams of lawyers to look for ways to call 'fraud.' In Germany, insurance cannot be rescinded for any reason except failure to pay premiums.

Small business tax credits Wait a minute. Employee health coverage is already tax deductible as an expense of doing business.

Patient protections For new health plans... Only for new health plans, huh? Pretty weak.

Discrimination protections for lower-income workers I didn't even know that this was a problem, and if it is, double shame on the insurance companies. But will the coverage be affordable?

Cobra extension through 2013 Cobra coverage is expensive. Really expensive. Someone who is long-term unemployed will not be able to afford it that long.

[Clio the Leo]

14. Kickers. NT

[depakid]

16. Yep- people are "impatient" they're "complainers" and "whiners"

but you know what else they are?

Voters- or potential voters.

Better hope they're buying what the Democrats are selling....

[ProSense]

18. "Better hope they're buying what the Democrats are selling...." What does that mean

in relation to the OP?

[ShortnFiery]

20. Yes, If you have money and a good job, making the Health Insurance Companies more RICH

is not going to harm you and yours. However, Lord help you if you're under-employed or have a major illness ... then you're toast or bankrupted.

[depakid]

22. It's downright insulting to call people who've been abused by insurers- or denied care "impatient"

Not exactly the most persuasive way to sell a costly, half assed private insurance mandate.

On the other hand, it's a good way too lose the majority to "the party that didn't do it."

[Name removed]

23. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Phoebe Loosinhouse]

29. There is some disingenous crap in there

1. Harry Reid added the "annual limits" clause BECAUSE of inquiries from the American Cancer Society?! Just the opposite - the American Cancer Society noticed that he snuck in the limits in his Manager's amendment and exposed it!

2. Medical Loss Ratios do nothing to control costs or limit profits. On the contrary, they have a bizarre negative incentive for insurers to make no effort to contain costs since that would lower their profits.

3.The House bill was for a NATIONAL HIGH RISK pool, not state high risk pools. This is just wrong factually.

4. Closing the Medicare doughnut hole was part of the 80 billion "negotiation" of the White House with Pharma - the 80 Billion over 10 years deal. That deal was why the Dorgan drug importation amendment was strangled in it's crib by the White House, even though it would have saved more than the White House Pharma deal and the savings would have been for ALL Americans, not just seniors. There is no reason that they could not have done both.

for background: http://www.slate.com/id/2224621/

5. Right now recissions are done on the basis of the companies claiming fraud. You didn't report that ingrown toenail 6 years ago and then you got cancer. How is the reform any different if they can still go down the fraud/misrepresentation route?

I'm really disappointed in the standards displayed here by the New York Times.