What the Pelosi bill really says

iVillage Member
Registered: 02-19-2008
What the Pelosi bill really says
21
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.

iVillage Member
Registered: 02-20-2007
Tue, 11-10-2009 - 1:53pm

You should be commended for putting together such a wealth of information into one post. I'm like another poster though, and I'll

iVillage Member
Registered: 08-30-2002
Tue, 11-10-2009 - 2:54pm

**And CHOICES SCHMOICES, we all don't get to have choices, some people just have more opportunities than others. We don't pick the parents we are born to.


I'm just really tired of the condesending attitudes of some people here.**


ITA. My foster son had a schizophrenic, drug addict father,



iVillage Member
Registered: 02-19-2008
Tue, 11-10-2009 - 9:00pm

"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. "

This will be relevant to this debate when a law is passed mandating home ownership, with failure to comply will result in fines and possible jail time.

"I honestly wish that everybody made tons of money so they all could afford ins for themselves and their family. "

Doesn't take tons of money in many cases.

iVillage Member
Registered: 01-04-2009
Tue, 11-10-2009 - 9:56pm

Ahhh...Betsy McCaughey is at it again.

 

iVillage Member
Registered: 10-22-2009
Tue, 11-10-2009 - 9:57pm

((I'm just really tired of the condesending attitudes of some people here.))

Me too. Lot's of nastiness on this thread.

((. I really don't think you have to worry about healthcare reform, the Senate will not vote for it, the Republicans are the party of NO,))

Just in case you haven't realized yet, the Democrats don't need any Republicans to pass this bill. They are in control and can pass it without any Republicans whatsoever. Are you telling me that the Democrats don't agree with the bill either? Hmmmm.....

(( the Republicans are the party of NO, they don't want to hurt the poor ins companies))

Do you realize that the Democrat's House bill is a $70 billion gift to the insurance companies?

iVillage Member
Registered: 02-19-2008
Tue, 11-10-2009 - 9:57pm

"And CHOICES SCHMOICES, we all don't get to have choices, some people just have more opportunities than others. We don't pick the parents we are born to."

One of the posts on this forum (ER=PCP) tells the story of Gail Johnson, who has not had health insurance since her marriage broke up 10 years ago. She is 56 years old. How long before she is determined to be an adult and have some responsibility for her life?

iVillage Member
Registered: 02-19-2008
Tue, 11-10-2009 - 10:27pm

" Only partly true. Medicare Advantage plans have been receiving, on average, 14% more than traditional Medicare for treating Medicare beneficiaries for several years now. That is your tax money going to what is essentially an "overpayment." The government, which is responsible for these plans, has proposed that these plans "bid" for the right to get your business. The bidding process should help bring costs down and that's where the savings would come from. If MA plans have been overpaid by 14%, they should be able to do just as well with less. Of course the plans are upset about this. I am personally in a MA plan. I like it a lot. In fact, rather than providing me less benefits next year, my MA plan has INCREASED my benefits and lowered my deductible! Let the free market work and let these plans compete with each other for our business. There's no need to scare seniors about it."

The plan is to reduce payments for Medicare Advantage Plans by 14%. That is a cut.

____________________________________________

"• 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.
• May I ask what is wrong with that? God forbid we should educate people about obesity and health at the local level. Is this some kind of not so subtle suggestion that ACORN might be providing these services?"

Attend a Weight Watchers meeting if you wish to learn about obesity and its problems. Ditto AA, NA.

"•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."
• Not true. Medical homes are not HMOs."

What's the difference?

iVillage Member
Registered: 02-19-2008
Tue, 11-10-2009 - 11:00pm

" The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider."

My insurance company is prohibited from doing this under state law. Only MDs are allowed to be gate-keepers. This bill authorizes a lower standard of care than my insurance company is allowed.

" No one will be forced to settle for a nurse practitioner, but I must say that if you have ever worked with one, you would love it!"

No I would not. I don't appreciate having the standards of care lowered.

iVillage Member
Registered: 01-04-2009
Tue, 11-10-2009 - 11:10pm

Not to the Medicare patient. The patient's medical expenses will be covered to the same degree as regular, non-Advantage patients. The 14% bump to support for-profit middlemen will cease to be there. If the patient wants to pay that additional 14% to have a middleman, fine, but the patient doesn't need that middleman and can have the same Medicare medical coverage as the rest of Medicare patients.

http://en.wikipedia.org/wiki/Medical_home

<<

Some suggest that the medical home mimics the managed care “gatekeeper” models historically employed by HMOs; however, there are important distinctions between care coordination in the medical home and the “gatekeeper” model. In the medical home, the patient has open access to see whatever physician they choose. No referral or permission is required. The personal physician of choice, who has comprehensive knowledge of the patient’s medical conditions, facilitates and provides information to subspecialists involved in the care of the patient. The gatekeeper model placed more financial risk on the physicians resulting in rewards for less care. The medical home puts emphasis on medical management rewarding quality patient-centered care.>>>

 

iVillage Member
Registered: 01-04-2009
Tue, 11-10-2009 - 11:12pm
...but no one will be forced to settle for a nurse practitioner.