Posted: Wednesday, November 11, 2009 5:47 PM
Wertheimer snags Honest Pursuit for $3.1-million (click title to entry - thank you)
by John P. Sparkman
..."We thought she would be about $2.5-million," said Wertheimer, who races and breeds in partnership with his brother, Gerard. "If you could get that family every day, you wouldn't pay that much."...
November 17th, 2009 1:30 PM
AP POLL: Tax the rich to pay for health bill (click here)
By Erica Werner / Associated Press
The House bill would impose a 5.4 percent income tax surcharge on individuals making more than $500,000 a year and households making more than $1 million.
The poll tested views on an even more punitive taxation scheme that was under consideration earlier, when the tax would have hit people making more than $250,000 a year. Even at that level the poll showed majority support, with 57 percent in favor and 36 percent opposed.
"You know, I mean, why not? If they have that much money, it should be taxed," said Mary Pat Rondthaler, 60, of Menlo Park, Calif. "It isn't the same way that the guy making $21,000 is."
Not everyone agreed.
"They earn their money. And they shouldn't have to pay for somebody else. It doesn't seem fair," said Emerson Wilkins, 62, of Powder Springs, Ga.
Overall, the poll found the public split on Congress' health care plans. In response to some questions, participants said the current system needed to be changed, but they also voiced concerns about the potential impact on their own pocketbooks, preferring to push any new costs onto wealthier Americans....
I think I left off with Page 14 or something like that...
Okay, so I know that The Baucus Bill is not an original bill and I know that it is an amendment to Medicare. I also know the Baucus Bill INAPPROPRIATELY targets aspects of the Medicare LAWS inappropriately and with bias toward cronies such as Medicare Advantage. I also know that simply makes my blood boil.
Now.
The bill goes on to FOCUS the brunt of the responsiblity NOT on the Secretary of Health and Human Services, but, on THE STATES. It is the states that will be ridden into compliance and will carry the EXPENSE of enacting this law. The question is "How much is in this provision that will be paid to the States from the Federal Government to mediate their expenses in ADDING to their expense of being in compliance with this federal legislation?"
The 'title' to the State Plans will be "Qualified Health Benefit Plan. Page 15, lines 1 through 8:
QUALIFIED HEALTH BENEFITS PLAN.—For purposes of this title, a health benefits plan which is offered in the individual or small group market shall be a qualified health benefits plan with respect to a State if—
(1) the plan has in effect a certification (which may include a seal or other indication of approval) issued or recognized by the State that such plan meets the applicable requirements of—
A Seal?
The plan has to display a Seal of some kind to be qualified.
I see.
Well, there is nothing like looking official. Sort of like a birth certificate or something.
Do you know what the placement of a 'simple seal' will cost in 'ceremony' of implementing the bill?
That means there will be a 'CLEARINGHOUSE' of qualified health benefit plans examined by one, possibly two people, in order to QUALIFY for a 'seal' and those folks will probably be making well over $50,000 a year, at least.
And I'll tell how silly this is going to become.
When a 'plan' is submitted and it does not 'get' a seal displayed on it, companies will have the State in court to discern the issue as to why that plan did not qualify AND they will seek redress by having the opportunity to change their plan to meet the requirements for the seal.
If a seal is displayed therefore the public will KNOW all they have to do is find a seal on the document and it is a qualified plan.
It is my opinion, such a ceremonial issue is not necessary and will only lead to corruption.
It will get plenty expensive and will become cost prohibitive to most State budgets. Not only that, but, it will treat the public as if they are dunces that only have to look for a seal, sort of like a 'Seal of Good Housekeeping Seal of Approval.' It is condescending, rude and idiotic.
The rest of the entry of those subparagraphs say basically nothing, but, simply repeat what is already stated in page Page 14 which I already discussed. Page 15, lines 17 through 20:
‘‘(B) complies with such other requirements as the Secretary or the State may establish pursuant to this title for qualified health benefits plans.
That line NULLIFIES the entire Federal government and everything it has stated before this line and after. It is corrupt and double talk.
The bill by Baucus is an empty bill.
It means nothing.
A State can come in and legislate its own version of this bill plugging in and taking out any provision passed by the Federal legislation to send on 'its customized' version for application to State law so long as it 'insures' that Medicare Advantage will insure its Individual and Small Group Market AND any 'Coop' is limited to sharing the cost of perscription medications.
The Baucus Bill is meaningless and is nothing more than a 'gesture' to the people of the USA to say the Senate 'did something' to act as their advocate, but, it completely turns all authority over to each State legislature to do as they please. The Bill says 'Secretary OR the State,' is does not say 'Secretary AND the State.' And WHO is the Secretary to alter any federal legislation at will anyway?
This bill keeps getting weaker and weaker and practically begs the States to participate. Page 16, lines 1 through 12:
‘(A) IN GENERAL.—The term ‘health benefits plan’ means health insurance coverage and a group health plan.
‘‘(B) EXCEPTION FOR SELF-INSURED PLANS AND MEWAS.—Except to the extent specifically provided by this title, the term ‘health benefits plan’ shall not include a group health plan or multiple employer welfare arrangement to the extent the plan is not subject to State insurance regulation under section 514 of the Employee Retirement Income Security Act of 1974.
The Bill pulls in even more EMPTY authority that already exists in the Federal Government. MEWAS is an acronym that stands for "Multiple Employer Welfare Arrangements." It is an aspect of the ERISA laws. ERISA is an acronym that stands for "The Employee Retirement Income Security Act of 1974."
Now to back a bit and I don't believe I have to go through hoops to talk about a bill that is an ORIGINAL bill either. But, to back up a bit, this provision basically says, ALL the previous 'enforcements' of the bill are in place and carry brevity EXCEPT when... Follow? I have a feeling there are more EXCEPT WHENs in this bill than there is law.
Now to realize how silly all this is? One simply has to know that ERISA is not a law that REQUIRES 'squat' compliance from any employer, but, simply provides 'guidelines' to 'help' employers make good decisions. In other words, IF employers are making decisions regarding 'benefits' to employees it is recommended they think about it in a 'certain' way that provides good benefits.
ERISA applies only to Private Employers and does not require employers to provide benefits at all. No insurance. Nothing. So, when the Baucus Bill states the legislation is in effect EXCEPT when ERISA applies by provisions of MEWAS, it is AGAIN nullifying the brevity of the legislation to give permission to provide NO benefits.
Now, MEWAS is a bit like a 'cooperative' for employers to share assets when providing insurance to employees. The problem with MEWAS is that it has been embezzled. Let me see if there is an online reporting of that.
Well, it is discussed here, but, I am going to try to find a case.
MEWA Enforcement (click here) - The Labor Department has devoted significant resources to investigating and litigating issues connected with abusive MEWAs who sell the promise of inexpensive health benefit insurance, but default on their obligations. Particular emphasis has been put on identifying ongoing abusive and fradulent MEWAs and working to shut down such operations.
Here is some fraud, but, it doesn't really constitute embezzlement. It shows clearly what Americans are up against in discerning 'good' health insurance that they thought was affordable form 'bad.'
"Unfortunately, Christine’s experience is not an isolated case. (click here)
I think I found a case in California. The problem is that when I kept going deeper into the site to read the transcripts all kinds of bells and whistles start going off on my computer and I thought I best not continue, so I ran some diagnostics to be sure nothing made its way into this machine. I paid plenty of it, ya know? I am going to try one more time.
This is kind of interesting.
Rodger Burge, an attorney with Parr, Waddoups, Brown, Gee & Loveless in Salt Lake City, said the two opinion (click here) letters reflect a “constant struggle since 1983,” as MEWA providers continue to try to find “creative ways to avoid” state regulation.
Lower Costs, Higher Risks
Prior to the 1983 amendment, MEWA promoters “typically represented to employers and state regulators that the MEWA is an employee benefit plan covered by ERISA and, therefore, exempt from state insurance regulation under ERISA’s broad preemption provisions,” the DOL notes in its guidance, MEWAs Under ERISA: A Guide to Federal and State Regulation.
MEWAs could market insurance coverage at rates lower than regulated insurance companies, which made them more attractive for small businesses that had difficulty obtaining affordable group health care coverage.
“In practice, however, a number of MEWAs have been unable to pay claims as a result of insufficient funding and assets through excessive administrative fees and outright embezzlement,” the DOL said in its guidance....
The problem we face today as a nation is that we have tried as citizens to maintain health insurance to bring care to ourselves and our families and this is the outcome. It is a field day for lawyers.
When NEW law allows the mistakes of the past and the continued problems of the present to 'migrate' into its influence, then it violates the 'public trust.' Because, when people come to their government to help them solve their problems they don't expect it to continue to percipiate the same problems over and over again. The Baucus Bill does exactly that. The bill is basically ignoring the lessons of the past that are grossly well documented and continues to perpetuate the problem.
Embezzlement is when an accountant to a company or even a corrupt Board of Trustees or Board of Directors or an officer to a company takes funds from the company and uses it for personal wealth. It is such a problem that professionals, lawyers, legitimate accountants 'advise' clients or potential clients 'online.' Example here:
Embezzlement: What? Who? Why? How? Detection!! Prevention!! (click here)
A Three-Part Presentation Exclusively For Our Readers (Part 1 ) by Stephen Linker
I have helped clients prevent and/or detect fraud for thirty years. One of my first embezzlement discoveries will serve as the example in this series of articles.
I was a senior accountant working for a small firm in a very quiet community on Long Island. It started off innocently enough. I was working on the year-end closing of the books of a small retail heating oil business. My job was to adjust the books and prepare the client’s financial statements and tax returns for the year end. During that year, the company was in the process of converting their billing and collection system from a manual to a computerized system....
So, to continue to say the Baucus Bill is poorly conceived and even more poorly written is validated by the fact there are 'components' to the bill that repeat the same problems we as a nation are trying to solve. It is not good law. So far my opinion is that it should be abandoned for the other Senate Bill that more strongly resembles the House Bill.
I can't believe after all this I am only upto page 16. Buoy.
Page 17 uses 'new' definitions, the remainder of 16 defines Health Insurance Coverage and Issuer, Group Health Plan and Health Benefits Plan Offeror according to existing definitions in the Tax Code. The new defintions this bill offers is in regard to MARKETS. It first defines 'Group Market" with no delineation to Large or Small, then it defines "Individual Market," and then it defines "Large and Small Group Markets." The verbiage is fairly simple and determines 'large from small' according to the definition in the tax code. There is language that bothers me.
Page 17, lines 10 through 15:
‘‘(1) GROUP MARKET.—The term ‘group market’ means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by an employer.
Here again the legislation removes language to control its focus by dismissing any sincere defintion as to what health insurance coverage is for a group. It states there is a health insurance market that can take any arrangement. It states it as if an after thought and puts it in parenthesis. The probably is that 'any arrangement' actually might legalize fraud and embezzlement when applied to the group health insurance market. That really makes this 'SEAL' thing interesting doesn't it?
What the bill should state is that group health insurance markets are comprised of a 'pool' of qualified insurers that qualify under the laws governing Insurance agencies and companies that provide health insurance to the general public as perscribed by Federal or State Law whichever is more restrictive to the definition of quality and qualification.
What that does is to have the Federal Government define what exactly 'quality qualification' is and also allows more restrictive definitions that a State might have to apply over and above that of the Federal Statues. In realizing any agency or 'insurer' has to have a license to provide such coverage to anyone or to a group in some kind of 'speciality' practice of the licensure, it removes the need for a 'seal' as the 'license' then defines the qualifications of those writing the policies and enforcing the quality.
The licensing of those that write and offer these policies demands MORE than any bogus 'seal' by any State agency that removes such protections from 'individual and small group health insurance policies.'
In other words, my Aunt Betty could become someone that places 'seals' on policies even if she is not licensed. But, if the law states those providing such policies to the public have to be licensed it removes the ability to easily commit crimes. Aunt Betty could act as an independant contractor that is able to understand what it takes to obtain a 'seal' and rubber stamp any policy as she sees fit if that were allowed by State law. The 'idea' that unlicensed agents could be written into a State law to carry out this mess to exonerate the State from the cost of doing same is all too tempting in some states. Oh, yes. Absolutely.
The bill goes on to define the words Preexisting Condition Exclusion and Health Status Related Factors and seem 'okay' for the most part. I'll list them here.
Page 18, lines 16 through 23 and Page 19, lines 1 through 5:
‘‘(b) PREEXISTING CONDITION EXCLUSION.—For purposes of this section, the term ‘preexisting condition exclusion’ means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
‘‘(c) HEALTH STATUS-RELATED FACTORS.—For purposes of this section, the term ‘health status-related factors’ means health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), and disability.
The bill excludes any attempt to qualify as a health benefit plan if there are exclusions as stated above.
I would like to see more than 'acts of domestic violence' included here though.
We already know that issues of 'rape' are considered a pre-existing condition.
So.
To better serve all Americans, it should state, "including conditions arising from acts of crime." After all, prisoners that commit crimes receive state funded medical treatment even after they have been shot by police officers. It is only JUST that every citizen receive the same consideration.
There MIGHT be issue here as well, that exclusions might be justified under this verbiage to place restrictions on 'Acts of God or Nature or War.' The verbiage is not bad but could use some tweeking to include most all issues found to enter into the venue of health care.
And this is not difficult to include.
Hospitals across this country, in all fifty states, provinces, tribal areas and military outposts keep records and 'track' the kind of problems that come into their practices. They have to so 'purchasers' know what to order from medical suppliers to stock the hospital and office selves.
Page 19, lines 6 and 7 and 15 through 22:
‘‘SEC. 2203. GUARANTEED ISSUE AND RENEWAL FOR INSURED PLANS....
...‘‘(B) in the small group market in a State, must accept—
‘‘(i) every small employer in the State that applies for enrollment of its employees under the plan; and
‘‘(ii) every individual who is eligible to enroll in the plan by reason of a relationship to the employer as is determined—
This provision states the plans only qualify if they accept all those that apply to them.
Okay.
However when it comes to the definition of "...small employer...' it leaves out the 'idea' and 'reality' there are 'other small groups' than just that of employers. There can be 'cooperatives' of small groups, namely that of farmers that belong to 'units' that serve their buying needs for supplies. These small groups could affiliate and purchase health insurance for 'individuals' that belong to those groups.
So, I believe there needs to be an inclusion here other than just 'small businesses.' Farmers can be viewed as businesses, but, they aren't necessarily small either. Farmers don't necessarily employ people, some on just seasonal basis and some, 'though few,' are family farms that 'provide a living' to members of that family.
To include the 'opportunity' for all Americans the word 'small business' needs to be broadened to include 'small groups affiliated for a common purpose.'
This bill also defers all these definitions to the authority of the States. Every state knows its populous. So, if the States are to be defining small groups there should be stipulation in the Federal Statue that States include all definitions of small groups within their populous. There needs to be an understanding that as that populous changes so does the definition.
Page 20 and this is where I am going to 'end it for this evening.'
Page 20, lines 12 through 16:
An offeror of a plan shall not be treated as meeting the requirements of this subsection unless the plan also accepts, renews, or continues in force coverage of an individual who is eligible for enrollment in the plan by reason of their relationship to the named insured under the plan.
I like this because it extends COBRA benefits.
In other words, when a child or employee to a group has a change of circumstance they still have the option of keeping their same coverage. So far, there is no restriction to this provision in this bill.
It provides 'continuity' of coverage and will provide the 'insurer' with the insight needed to understand its insured on a continual rather than cost cutting basis. It provides a 'long term' client base that has different demands on health insurance over a lifetime.
In other words, when children are young their health insurance needs are different than when they are adults. The 'average' child needs wellness check ups far more often than they do as adults.
Let's suppose a person is covered by the same health insurance for their entire life. The premium can be bettered 'discerned' as if they are paying for 'life insurance.' The cost of a persons health care needs, assuming FIRST they will remain mostly healthy and vital will be 'limited' to what is required for 'basic health care.' Those costs change from year to year based upon their age. If that cost is spread out over a lifetime the cost to the group and/or individual is known and limited.
That changes where there are 'usual living dynamics' added such as broken bones or diseases. It is interesting to realize health insurance companies have been doing themselves a 'disfavor' by cutting their 'insured' based upon their 'profitability' of the people that have diseases or higher costs to their health care.
It might be that if a disease is sent into remission the increase to their 'bottom line' might actually increase. OR. If a 'brittle diabetic' receives better care from a new physician added to the network, the cost of their care actually would decrease and add to the profitabilty of the company.
So.
To enforce the 'dynamic' that a health insurance company has to keep their insured regardless of the 'individual' profit margin is to realize it increases the probability of profits that can be realized over a lifetime of coverage rather than limiting it to the time when they have no health care needs at all.
Good night for tonight.
