Thursday, August 20, 2009

It's that time again. Time to read more of the House Bill for Health Insurance Reform. What amazing wonders will I find this time?



Ya gotta love Barney Frank. He was beautiful. "So what planet do you spend most of your time?" Loved it ! Go get 'em Barney ! How can anyone believe a person that demands to be recognized as someone that refers to the President of the USA as a Nazi? She can't be taken serious. She lost her legitimacy as she turned her statements into hate mongering. It can't be tolerated.


...Under this scenario (click title to entry - thank you), one bill would include the new regulations on insurance companies, such as requiring them not to reject people with preexisting conditions. As conservative opposition to reform has grown at so-called town hall protests this month, President Obama and others have been pushing these regulations as the key lynchpins to reform that would help those with and those without insurance. It is thought these measures could get the more than 60 votes in the Senate needed to survive through any filibuster threat....



Under the House Health Insurance Reform Bill there will enrollments procedures (starting on page 97). They basically look like any other enrollment procedure one would find with an employer. There are special considerations, no different than the private sector, for special circumstances including birth of a child, adoption, marriage with some extra provisions by the bill such as a move outside the service area for a provider, significant change of income and the like. It goes on to say there will be automatic enrollment in one plan or another for people ineligible for Medicaid with 'affordibility' credits upon application for them and acceptance into a program. The bill also states, all plans will be paid directly to the provider and not through the government.

All these provisions are regarding Exchange Eligible people. There is a lot of willingness to have contact with people in need and there will be a website set up to help them in their choices and enrollment, a toll free number, etc. Basically, the bill is making every effort to enroll Americans in a health insurance option that will be appropriate for their eligibility.

I had wondered how this bill would impact SCHIP. There are children in the country with coverage as members of low income families, with parents that cannot afford health insurance. There is a section on page 100 that begins to discuss the provisions of SCHIP. This section also makes it completely clear the health insurance plans are for those born IN the USA.

Page 100, lines 20 through 25 and Page 101, lines 1 through 13.

SPECIAL DUTIES RELATED TO MEDICAID AND CHIP.—
COVERAGE FOR CERTAIN NEWBORNS.—
IN GENERAL.—In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed— (i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and (ii) to have elected to enroll in Medicaid through the application of paragraph 13 (3).


Basically, the health insurance reform bill sides with coverage first and placement of future benefits later. If the parents already have insurance then this section would not apply, but, for those parents (I am thinking primarily new parents.) that do not have health insurance in place when the child is born, then the child will be covered until the time the family can address a plan for coverage.

In regard to SCHIP, it is my estimation that once 'families' are covered there will be children coming off SCHIP to be covered under their family's plan. In receiving coverage as a family, that will relieve the States of some of their programs that cover children as well and assist State budgets to balance without additional burden's of health care for children. That is my understanding to some of this.

There is also a provision within this bill for children currently enrolled through Social Security. A child with such benefits will become automatically 'Exchange eligible' unless the child is already eligible for Medicaid, there would be no further need to qualify. See, there is going to be some shifting of government liability depending on the enrollment status of those served on other government programs.

The bill goes on to say, that the enrollment in Medicaid or in a health insurance on The Exchange remains fluid should eligibility change over time. In other words, if a child is receiving benefits under Medicaid, but, becomes eligible for the Exchange as their parents now have that option, the child can move into a family plan unless the income of the parents dictate the child to be enrolled in Medicaid. Should circumstances change and let's say the parent(s) become unemployed or disabled, the child will always be covered by one method or another. I think what we will see with The Exchange is that parents working in lower paying jobs will qualify for insurance of one kind or another and will be able to include their children on their own insurance plans. Today, the care of children falls to the States or SCHIP without the benefit of parent(s) being covered. I believe that will change.

There will be a Special Inspector General as defined on Page 107, starting with line 18:

DUTIES.—The Special Inspector General shall — conduct, supervise, and coordinate au21
dits, evaluations and investigations of the Health Insurance Exchange to protect the integrity of the Health Insurance Exchange, as well as the health and welfare of participants in the Exchange;


The really interesting aspect to this bill, which can't be appreciated unless one is reading the entire bill personally, are the number of 'past' legislations (existing law) that comes into play in one method of another in this bill. It is as though we, as a nation, have been inching up to this for some time now and this consolidates all the aspects of health care to date in a clear venue of inclusiveness. I sincerely believe this bill consolidates all the past legislative efforts into one clear concise venue. In doing that, there will be a lot of 'duplicity' that will stop with the passage of the bill. This bill isn't nearly as expensive as it seems right now. This bill appears to be very careful to include all citizens at all levels of need or interest without exception, but, I believe in time will trim spending in other areas and absorb much of the other laws it cites. The House was very thorough in their inclusion of all relevant, existing laws.

Page 109, lines 4 through 6: TERMINATION.—The Office of the Special Inspector General shall terminate five years after the date of the enactment of this Act.

Excellant and exactly what I thought this provision was about. See, this bill is so 'careful' in the inclusion of every American citizen it provides a Special Inspector General of oversee the 'start up' of the program. Imagine being a legislator in DC and writing a historical bill such as this is and then find out because of some stupid loophole or lack of wording someone dies when they should have been included under the new law. Imagine how that weighs on the people of the House that wrote these provisions? By providing 'extra help' for the start up of this new law, there will be no losses or misunderstandings. Concise deployment of the law and accounting for the cost and use allowed under the law will be handled by an exclusive office that has oversight while providing oversight. The new law is really intended to streamline health insurance and its cost at every turn. I like it.

Page 109, lines 16 through 21.

PAYMENTS FROM TRUST FUND.—The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange, including payments under subtitle C (relating to affordability credits).

The new law provides for a separate trust fund to be used for expenses exclusive to The Exchange and the operations of the administration of the new law. This trust fund will receive all the taxes and fines from those people that do not abide by the law by subscribing to a health insurance company. Those taxes and fines will be for individuals and companies that are not in complicance with the law. The law doesn't seem to rely on any punitive measures such as prison to reach compliance. If individuals or companies choose to pay the excise tax rather than being in compliance that is their option. There are specific sections of the IRS Tax Code stated in relation to the Trust Fund where monies would be applied and enforced.

Like I said, they were very thorough in their writing of this bill.

There are provisions for States to set up their own health insurance exchanges if State legislators care to engage the issue. The States can even regionalize their exchange if they feel they can provide better than the federal government. However, the State Exchanges have to pass an approval process to be sure they are offering equivalent options at comparable costs or less.



continued below...

continued from above...

If I am reading this correctly, when it comes to the State Exchange, it would have to allow for portability of insurance over State boundaries IF the State Exchange was indeed regionalized and operating under one authority. The law does limit 'One Exchange" per State and it cannot add expenses to the federal government in operation or creation of any State Health Insurance Exchange. There cannot be any degradation of services under a State or Regional Exchange. If the Exchange were found to provide less benefits or fail its citizens in any manner; all or part of the Exchange could be stopped and returned to the Federal Authority.

Here again, the bill serves the people of the country and not any fiscal entity that would benefit from the new law it creates. At the forefront of any of this legislation is the citizen and their needs in health insurance reform. The House should be proud of their dedication to the 'best outcome' for Americans outlined in this bill. It is carefully stated to keep 'the people/person' the focus of the law. The Federal Government gives up no authority to retain any of the provisions for its authority regardless of a State or Regional Exchange. That is how it will maintain its oversight to such programs until they are found to be sound and citizens are protected with viability. It's a good thing.

Page 116, Lines 1 through 17, sets up The Public Option for health insurance. This is the beginning paragraph:

Subtitle B—Public Health Insurance Option
SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.
ESTABLISHMENT.—For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the ‘‘public health insurance option’’) that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary’s primary responsibility is to create a low-cost plan without comprimising quality or access to care.


It provides for all the same options within any other insurance offered at The Exchange. This option is to be marketed at The Exchange. It provides for data collection to set rates and prices. This is the paragraph on Page 118, lines 4 through 9:

DATA COLLECTION.—The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care.

This data will become an information bank for all health insurance companies. If insurance companies want to sincerely compete in the market place they will have to take into consideration the statistics that will come out of the public option in health insurance. If the companies are to compete for the business of the people taking the public option they will have to come to understand who and why they fall under this provision of the law. Once they understand the 'populous' that subscribes to the public option they can begin to taylor more of their own products to meet the needs of those accepting the public option.

This provision is especially interesting. It provides for access to federal courts to assure Medicare participants they will not lose rights under this new law. Page 118, lines 14 through 22:

ACCESS TO FEDERAL COURTS.—The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.

I see this provision as a means for 'interest groups' such as AARP to litigate any complaints their members might have. Of course, individuals can always bring suit if necessary, but, more than likely if there is something about the law that impinges on the rights of Medicare recipients it will happen in larger numbers than an individual. So this provision would be of particular interest to 'interest groups' as a method to protect their members.

The section regarding The Public Option goes on for quite a few pages. It discusses the particulars of how the option will provide for people. Of most concern so far is the establishment of a provider network that will accept payments under this option. It is based in the rates Medicare pays, however, the Secretary has the authority to increase said payments to providers if there are too few providers for any geographic area. The idea is to have established by Y 4 payments that will support a provider network for this option. That is upto page 124.

There are going to be two levels of physicians. There is to be no compromise in the quality of care or the quality of physicans. But, the two levels are delineation in relation to payment. Page 127, lines 1 through 16. These are levels of physicans for the Public Option.

PHYSICIANS.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes:
PREFERRED PHYSICIANS.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.
PARTICIPATING, NON-PREFERRED PHYSICIANS.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.


The cost for the Public Option will be based on "Affordability Credit." The Affordability Credit will be applied for by persons unable to pay for the entire premium they fall under or their family falls under. The funds to make up the difference will come from the Trust Fund. The Trust Fund must maintain a 90 day balance of funds in the Exchange for anticipated expenditures. Those funds can be appropriated from the General Treasury initially, but, constituted from payments from individuals or companies. That brings us to page 130 of the bill.

During Y1 and Y2 the Affordibility Credit can only be used on the Basic Option. After Y3 the credits can be expanded to other levels of care, however, the difference between the credit and the price of the policy has to be paid by the insured. At no point in time will an Affordibility Credit be transacted into a rebate or refund for cash. They are strickly for the use of purchasing health insurance. The Affordibility Credit is applied to families with incomes 400 percent of the Federal poverty level (or if my math is correct approximately $68,000). The term family may exclude divorced or separated couples depending on their income while raising the family alone. And the term 'income' is to Adjusted Gross Income. There is a formula to apply for calculating the amount a family would pay over a one year plan. Those payments will be broken down into 1/12th of the total to be paid monthly. Not all plans may survive the implementation of the law. If there is limited enrollment of any of the plans, those plans may be dropped from the funding.

Page 137, lines 1 through 3 provides for the scale of premiums for people receiveing Affordibility Credits. The table is on Page 137, to transfer the table here doesn't turn out well enough to make sense of it. The bill goes on to enforce integrity of the provisions, what constitutes income and how it is reported and what constitutes a change in income, etc.

Page 143, line 16 begins to speak to Employer Responsibility in offering health insurance. It goes on to explain the relationship between emloyee and employer, family coverage, percentage of benefit paid, the timeliness of the payment of the benefit, the percentage a company has to pay for its employees. Generally, the employer contribution is 72.5% for individual and 65% for a family. It provides the definition of full time employee, autoenrollment of employees. It addresses the cost of 'Exchange Coverage.' The law allows the Commissioner to set percentages an employer needs to pay for less than full time employees. It also states, a percentage discount on a policy for employees does not constitute payment of the premium. There is also the election by an employee to 'Opt-Out' of any insurance coverage. That action by the employee has to occur in 30 days of the first option for automatic enrollment.

On page 150 the bill starts to explain the law in relation to small businesses and it is here I will stop for this evening.

Death Threats Against President Up 400 Percent, Week of August 13 - 19, 2009. Click title to entry for article - Thank you


The politics of waging war in Afghanistan. Is it killing our soldiers?


International forces under the banner of the North Atlantic Treaty Organization are continuing to fight Taliban insurgents in Afghanistan. But NATO field commanders are hindered by certain restrictions placed on troops by European governments.
NATO has more than 60,000 troops in Afghanistan as part of a United Nations mandated contingent known as the "International Security Assistance Force" - or ISAF.
ISAF troops are located in most parts of the country. One of their most difficult missions is to fight insurgents in southern Afghanistan - home of the Taliban, ousted from power by a U.S.-led coalition in 2001.

"Caveats"

Analysts say NATO is hindered in its fight against the Taliban by so-called "caveats" - restrictions placed by various NATO countries on what their forces can or cannot do.
Tomas Valasek, at the London-based Center for European Reform, describes some of those restrictions.
"What's happening is that whenever a call for troops comes in for a particular operation, the different contingents come back, or get back to the NATO commanders saying, well we'd love to take part but under the national 'caveat' we are not allowed to operate in this particular area, or we're not allowed to operate this far away from the base, or we are not allowed to operate at night," he said.
Valasek says NATO commanders in the field are finding it difficult to put together a workable strategy....

40 Candidates including two women. Voting for a President in Afghanistan.


An Afghan woman's ink-dipped finger after showing her identity card to vote in Herat, western Afghanistan. Photograph: Rahed Homavandi/Reuters

Afghan poll hailed as a 'success' (click here for video and article)

Afghan President Hamid Karzai and his Western allies have pronounced the country's election a success, after voting passed off largely peacefully.
Mr Karzai hailed Afghans for braving Taliban "bombs and intimidations". His praise was echoed by the US and Nato.
There were some attacks by insurgents, but the UN says the vast majority of polling stations were able to function.
President Karzai is facing challenges from about 30 rivals. Official results are not expected for two weeks.
"The Afghan people dared rockets, bombs and intimidations," he told reporters as polls closed following a one-hour extension.
Mr Karzai praised the citizens who turned out to vote
"We'll see what the turnout was. But they came out to vote. That's great."
In Washington, White House spokesman Robert Gibbs said: "Lots of people have defied threats of violence and terror to express their thoughts about the next government for the people of Afghanistan."...

US military deaths in Iraq war at 4,332


...The figure includes nine military civilians killed in action. At least 3,465 military personnel died as a result of hostile action, according to the military's numbers....

Iraqi PM orders security review (click here for video at article)
Page last updated at 21:50 GMT, Wednesday, 19 August 2009 22:50 UK
...He said Iraqi security forces were "very capable of confronting terrorists", but acknowledged that a security review was necessary.
"The criminal operations that happened today no doubt call for a re-evaluation of our plans and our security methods to face the terrorist challenges," he said in a statement.
The prime minister also said insurgents had taken advantage of government efforts to restore normalcy by removing concrete blast walls from main roads in Baghdad.
"These attacks represent a reaction to the opening of streets and bridges and the lifting of barriers inside the residential areas," he said.
An Iraqi army spokesman said two al-Qaeda members had been arrested in Baghdad in connection with the attacks.
There have so far been no claims of responsibility for the bombings....

Beach poison hit dogs two months ago (New Zealand)


...The Herald understands a council officer and a public health officer checked the beach where the dogs became ill but found nothing.
They cleared seaweed from the beach as a precaution, but, when they did not receive any further reports, concluded that the danger had passed - perhaps after a deliberate poisoning.
Dogs were purposely poisoned last year when sausages laced with a blue substance were left in Auckland parks.
But authorities believe a natural toxin is more likely to be behind the latest illnesses.
Stomach contents of a beagle that died after walking on Narrow Neck beach in early July were sent to MAF for testing. But it was not until a second dog died three weeks later on Monday after walking on the same beach that a public warning was issued.
Dog owners were angry they were not warned sooner, with reports of dogs becoming ill at Waiheke Island, Browns Bay and Karaka Beach in the Eastern suburbs....

The weather in Antarctica (Crystal Ice Chime) is cold:

The Antarctica Challenge: (click title to entry - thank you) A Global Warning to screen in Copenhagen during the United Nations Climate Change Conference
Toronto, 18 August 2009 - The United Nations Environment Programme (UNEP) is partnering with Canada's Polar Cap Production's, Inc. to present Mark Terry's new climate change documentary The Antarctica Challenge: A Global Warning in Copenhagen during this year's United Nations Climate Change Conference, December 7 to 18, 2009....


The winds are moderate with exceptions at the north end and south east end of Antarctica. What is unusual about this 12 Noon image is the directions are opposite of the other images in the 24 hour loop. It could be a change in wind direction due to reappearance of sunlight to the continent. Spring will beginning soon.

August 20, 2009
12 PM UTC
Antarctica Wind Satellite Image (click here for 24 hour loop - 12 AM, 6AM, 12PM, 6PM)

The heat transfer systems off the Equator are noted here and in the image at the bottom of entry. There has definately been a return of frigid air over the continent this winter.

August 20, 2009
1800 GMT
Antarctica Jet Stream/Vortex (click here for 54 hour loop)



August 20, 2009
12 PM UTC
Antarctica temperature image (click here for 24 hour loop - 4 times reporting 12A, 6A, 12P, 6P)


August 21, 2009
0720 AM
Antarctica, Ross Island, Scott Base




August 20, 2009
1327 gmt

Antarctica Satellite


Flights to Antarctica resume (click here)
7:20AM
Thursday Aug 20, 2009
The first flight to Antarctica for six months will depart from Christchurch today.
Following three months of darkness and half a year in isolation, the arrival of spring means the flights can resume to the icy continent.
A US Air Force C-17 Globemaster is being used for the mission.
Scott Base Winter Leader Nathan Cross says the plane will deliver fresh fruit and vegetables, mail and new staff to the New Zealand and US Antarctic stations.
Twenty-six New Zealanders have been stationed at Scott Base for the winter to research the formation of sea ice.
- NEWSTALK ZB


The Warmest Reporting Station

Base Esperanza, Antarctica

8:14 PM GMT

Lat/Lon :: 63.4 South and 57 West

Temperature :: 33 F

Conditions :: Partly Cloudy

Humidity :: 99%

Dew Point :: 33 F

Wind :: 34 mph from the West

Wind Gust :: -

Pressure :: 29.97 inches (Rising)

Visibility :: 6.0 miles

Clouds :: Scattered Clouds 9843 ft
Mostly Cloudy 19685 ft
(Above Ground)


Elevation :: 43 ft

The Coldest Reporting Station

Vostok, Antarctica

Local Time :: 2:15 AM VOST on August 21, 2009 (GMT + 06)

Lat/Lon :: 78.4 South and 106.9 East

Temperature :: -107 F

Humidity :: 26%

Dew Point :: -114 F

Wind :: 9 mph from the WNW

Wind Gust :: -

Pressure :: in (Rising)

Visibility :: 12.0. miles

Elevation :: 11220 ft

The weather at Glacier Bay National Park has been (Crystal Wind Chime) melting.


August 18, 2009
Soldotna, Alaska


August 18, 2009
Soldotna, Alaska

It would appear the owner of the building below knew things were coming to this. For Sale sign and phone number intact.

August 18, 2009
Soldotna, Alaska
Photographer states :: A release from a glacial lake in Skilak Glacier caused minor flooding in low lying areas along the Kenai River.



...The water level peaked at 15.06 feet at the Soldotna Bridge. (click title to entry - thank you) At 12:30 p.m. Tuesday, that level reduced to 14.2 feet, said John Mohorcich, Kenai River Center manager.
The normal water level for this time of year at the bridge is anything below 12.7 feet, usually between 11 and 12 feet. When the Skilak Lake glacial dam breaks, it's no surprise that the water level rises 1 1/2 to 2 feet, Mohorcich said.
The National Weather Service issued a flood warning for the Kenai River from Skilak Lake to the city of Kenai on Sunday. That warning remained in place until 4 p.m. Tuesday....



Local Time :: 10:13 AM AKDT (GMT -08)


Lat/Lon :: 58.8° N 137.0° W


Temperature :: 54 F


Conditions :: Mostly Cloudy


Humidity :: 94%


Dew Point :: 52 F


Wind :: 4 MPH from the SE


Pressure :: 29.78 inches (falling)


Visibility :: 10.0 miles


UV :: 2 out of 16


Clouds :: Few 1000 ft
Scattered Clouds 2800 ft
Mostly Cloudy 7000 ft
(Above Ground Level)

Will California get rain?

The absense of the vortex west of the California coast in the water vapor satellite below is a little unusual. It could be due to higher level water vapor in the troposphere that causes and absense on the radar. At any rate, there my be relief coming to California in the way of rain. It might be torrential in its manifestation and that could cause mudslides, but, it might help with the fires. Let's hope there is relief on the way.


August 20, 2009
1630z
UNISYS Visible Satellite Image (click title of entry for 12 hour loop - thank you)





August 20, 2009
1630z
UNISYS Water Vapor Satellite

Two 'interesting' aspects to this satellite image. The first is Bill nearing the USA coastline and in closer proximity of the air masses of "Claudette" and that over Arkansas. The second is the black hole off shore of California. It really isn't absent of water vapor though. If one looks at a 'visual' satellite image it is quite dense with clouds.


August 20, 2009
1517 gmt
Tropical Atlantic Ocean Satellite

"Bill" is tracking more north than west. After it left latitude 20.70 with a central pressure of 945, the hurricane started to slow with a centeral pressures rising and currently is 951. I said it would and it has. The reason is the lack of water vapor once leaving the area of the Intertropical Convergence Zone.

"Claudette" still remains a diffuse air mass over the Gulf States. It is meeting with a cold air mass currently over Okalhoma, Arkansas and Missouri creating turbulent and wet weather.