What the Pelosi bill really says
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| Mon, 11-09-2009 - 10:08am |
Every year, for as long as I've had insurance. My state (Connecticut) has added a new mandate to help women without fail. This annual ritual is done by our state legislature to prove just how much they love and care for women. My state loves women a whole lot.
The result has been premiums for women are about twice as high as premiums for men. Our state it turns out doesn't love men quite as much. However, if it's anything to do with women, in particular woman's breasts, then there is no limit to the love and mandates our state will impose.
Now comes the interesting part. For a while now, people have asked me how the new federal insurance plan will affect me. Of course the first answer is open enrollment will result in self selection and a radical increase in premiums. If history is to be a guide, premiums should go up between 300-400% of what they are now once the sick can self select their insurance. Many who are healthy will be priced out of their insurance. The result could be fewer with insurance than without it as a result of this legislation.
However, today, I have a link to a news story about the actual bill our House passed. In it, I learn that we are grandfathered into our old plan, UNTIL a change is made. As my state likes to mandate change every year for women ... within the first year, my daughter will be forced out of her insurance coverage and into federally approved coverage. Even though the coverage she has now may be much better. As someone who privately contracts for my insurance from a company that only works with clients who are in state, I have to wonder what authority the federal government has to steal my daughters current health insurance from her?
Now I have two answers for people who wonder why I oppose federal health care. 300-400% premium increases will be tough to handle, and having my daughter kicked off her current plan without our having done anything isn't fair to her or us.
I also have to wonder why the IRS will investigate our health insurance and determine if it is sufficient. How does health insurance integrate with taxes? Why should health insurance be a tax issue?
The story is here - http://online.wsj.com/article/SB10001424052748704795604574519671055918380.html
What the Pelosi Health-Care Bill Really Says
Here are some important passages in the 2,000 page legislation.
The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.
What the government will require you to do:
• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.
• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.
On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.
• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.
• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.
• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.
Eviscerating Medicare:
In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.
• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."
A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.
• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.
• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."
Questionable Priorities:
While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.
• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.
• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.
• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."
• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

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If these truly are the rules and regulations there are going to be tons of people uninsured and many of them in jail because many Americans can't or won't be able to afford such costs (myself included). Such regulation would go over like a lead balloon and I think you'd see rioting in the streets before you'd see working class Americans accept something so outlandish and costly.
I have more of a wait and see attitude. I don't want to shoot a new plan in the head just yet because the old plan sure isn't working either.
***and having my daughter kicked off her current plan without our having done anything isn't fair to her***
Aaaaaw, you mean your dd is going to be on a level playing field with millions of other people who have also "done nothing" wrong and can't get/afford insurance? Welcome to the
If you get a chance, re-read the first post in this thread. My daughter is grandfathered into her current plan until any change in benefit occurs. Once a benefit changes, she must enroll in a conforming (federally approved) plan. Which will mean she'll be dropped by her current insurance provider and forced into the connector or gateway or whatever term they wind up with for open enrollment.
From the first post, I repeat the following - "Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit."
We buy our own insurance, will get no grace period, and will have to enroll in a federally approved plan if the co-pay, deductible or benefit changes. Per the above. I deliberately purchased very good plans for my kids. My understanding is the federal plans aren't likely to be as good.
Why should my child be forced out of her policy if my state imposes a new mandate? Something I don't think my state has failed to do for women at least annually over the past 20 years.
You have to look at the bright side. My DH thinks our legislature will stop adding mandates for private policies. This may protect us.
Even if my daughter is forced into the federal program, the House version prohibits any funding for abortion in private plans (or public plans for that matter). Not even morning after pills.
My state has mandated all this for years.
Imagine a country with no insurance funding by any means for abortion. Maybe Democrats are secretly pro-life?
Your child is no more important than mine; why should everything bend in YOUR favor?"
The reason things should bend my child's way is because she had parents with foresight to purchase her an individual health insurance policy and who paid the premiums every month on time without fail.
I read many stories about parents who wait until their child has a problem before they seek any sort of coverage.
Insurance is a shared risk against an unknown. It costs less than coverage. Coverage is protection from a certainty and is very expensive.
When your house burns down, you need coverage. If you were wise and purchased insurance prior to the fire, you will receive the coverage. If you apply for coverage to protect your burned down home from fire, you may be denied. Such is the situation many are confronted with when they seek insurance with pre-conditions.
"If you can afford policies for yourself and your entire family then you have nothing to worry about."
Go back and read the first post. It is very apparent this bill is about a great deal more than providing insurance for all.
"Why should he be denied insurance because for 6 months 4 years ago he was on a psychiatric medication prescribed by a doctor?"
The answer to your question (above) is to be obtained from the insurance underwriter who denies coverage. In my state, if coverage is denied, you are allowed to speak directly with the underwriter (I know I have personally done this).
The underwriter can explain the rules the insurance company is using for the policy your child has applied for.
It is entirely possible that there are other pools, that will have higher premiums, which your child may qualify for. You can ask an insurance agent, or speak with an underwriter about possible alternative risk pools.
Note, you may not care for the premiums in high risk pools. Many states create a statewide high risk pool to help cover people with pre-existing conditions.
The current Obama plan seems to be to force the healthy to pay for the coverage of the ill under threat of prison. I guess that is a workable plan, but it seems draconian to me, and will deprive many of both liberty and property. How much is our collective liberty and property worth? What is the value of freedom?
Generally insurance plans, and risk pools are established by insurance companies and submitted for approval to state insurance commissions on an annual basis. These plans must be viable and solvent. Covering those with severe pre-existing conditions dramatically raises premium costs. The solution generally is to segregate unknown risk (those without pre-conditions) from high risk (those with pre-conditions). This is a way to be fair to all, and to be able to offer true insurance to those whose risk is unknown at as reasonable a cost as possible.
UM, inless you bought your home outright, you HAVE to carry a Homeowners policy! As long as the BANK owns it as in you have a mortgage you have to have ins on it, at least in PA. I honestly wish that everybody made tons of money so they all could afford ins for themselves and their family.
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