
‘‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL
THIRD PARTY REVIEW IN CASES OF RESCISSION.
‘‘(a) NOTICE AND REVIEW RIGHT.—If a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market, before such rescission may take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent, external third party under procedures specified by the Secretary under section 2742(f).
The bill goes to great detail to define all the words used to implement the law. Many of the pages aren't about law at all so much as clearly defining the meaning of words so they cannot be misconstrued later when the law is implemented. To say this legislation is detailed is an understatement. But, where it does discuss the law and changes to implementing health care reform, it is all beneficial to the citizens of the USA. It speaks to an excellant initiative to take away the 'victim' aspect of citizens while returning the role of health insurance companies to provide 'service.'
TITLE II—HEALTH INSURANCE EXCHANGE AND RELATED PROVISIONS
Subtitle A—Health Insurance Exchange
SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE EXCHANGE; OUTLINE OF DUTIES; DEFINITIONS.
(a) ESTABLISHMENT.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
Where the Public Option has its real value is not in replacing insurance companies or providing competition, but, by providing insurance when no other option is available. The Public Option picks up the slack to the citizens of the USA. Literally. I can imagine a health insurance company denying a claim for services due to expense and while the member might have access to an appeal process to reinstate their coverage and receive services from the insurance company; time marches on and illness waits for no one.
That is the ultimate purpose of any health insurance bill, to be sure coverage is available when a person needs it. That is primarily the complaint of so many when it comes to reform. For those that can get covereage, the 'presence' of insurance at the time of need is somewhat tenative all the time. There is little reassurance to any health insurance subscriber that their needs will be covered. With every admission to an emergency room or hospital room for a scheduled procedure, members have to wait in anticipation of receiving coverage and then left with horrible realities when an insurance company decides adversely.
The Public Option is more than simply another 'player' in the market place, it is actual insurance for all needs of any citizen of the USA. It provides coverage when others don't want to. It provides a place for people to turn when their needs are rejected by conventional, private coverage. It has a place beyond adding competition. In my opinion, the competition it supplies to the market place is the least of its value. Its paramount value is that it will cover citizens when no other entity will. And that is why a Public Option is required in any legislation for health care.
If the private sector is to remain autonomous while adhering to the laws of this bill, then a Public Option has to exist when the private sector fails to commit to the needs of its members. That is the primary purpose for The Public Option. It's there. It will provide. Citizens are safe and are no longer at the mercy of profiteers that seek profits over services.
The bill is thoughtful enough to conduct studies regarding the cost of health insurance and employers and individuals. The bill does not simply set rules regarding employer related health care without seeking to understand the viability of the business or individual related to the costs of that health care. On page 83, lines 1 through 11 the bill asks the question, "How is everyone doing?"
IN GENERAL.—The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.
the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.
The complaining by citizens and small business owners just doesn't match what the bill states. Page 86 provides for explanations of 'tiered' plans and needs. What more do people want?
(A) IN GENERAL.—A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.
B) TIERED COST-SHARING FOR AFFORDABLE CREDIT ELIGIBLE INDIVIDUALS.—In the case of an affordable credit eligible individual (as defined in section 242(a)(1)) enrolled in an Exchange-participating health benefits plan, the benefits under a basic plan are modified to provide for the reduced cost-sharing for the income tier applicable to the individual under section 244(c).
ENHANCED PLAN.—A enhanced plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(A).
PREMIUM PLAN.—A premium plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(B).
PREMIUM-PLUS PLAN.—A premium-plus plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner. The portion of the premium that is attributable to such additional benefits shall be separately specified.
Page 91, line 4 through 7
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES AND COMMUNICATIONS.—The entity shall provide for culturally and linguistically appropriate communication and health services.
I am still waiting to find the terrible parts.
OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.
Why go through the trouble of outreach at all if the bill were seeking to victimize them and harm them? The entire allogation that the people of the USA would do harm to any of its citizens is completely abhorrent to our values as a nation.
IN GENERAL.—The Commissioner shall establish a process consistent with this title for enrollments in Exchange-participating health benefits plans. Such process shall provide for enrollment through means such as the mail, by telephone, electronically, and in person.


























