...moving on...

‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.

‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for--

Those words are fairly clear and appropriate . I want to expand on 'fluidity' as a concept to legislative language. Words such as 'unreasonable' or 'reasonable' brings in the judiciary as a partner and will add to the cost of the government. It is my opinion, those words need to be removed and 'actual' figures stipulated. In other words, in defining deductibles a percentage of the cost to a specified percentage limit should be stipulated. And by percentage I mean do the homework and find out exactly what the 'mean' household income is for the USA and stipulate what deductibles are going to be MINIMALLY.

The deductible issue should be clearly stated in a formula to any insurer. That formula would assign a percentage of the Mean American Family Income to health care including cost of the insurance. That formula, written into legislation, should not allow for manipulation and may even benefit some Americans better than others, however, it will be clearly a benefit to the majority of Americans and can be compensated in other ways through increased 'Earned Income Tax Credits' to those families that earn less than the 'mean.'

I mean if the people that care the most about our citizens, namely the Democrats, can't limit the draconian mechanisms of the Republicans, isn't that unethical to the electorate? I believe it is and allows for criticism that should not exist.

Now, to the legislation.

‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;

It means that the items falling under this 'task force' work will be covered. Evidence based means that there is 'sound' reason for a health provider to REQUIRE items for a patient through acceptable ordering procedures now in practice. It limits exploitation of insurance companies to bill for unnecessary items and uphold the dignity of the provider to be sure the citizen has all they need to carry out the 'therapeutics.'

There is absolutely nothing wrong with having a Task Force to set standards and priorities based on current practices that are prudent to a citizen of the country. The real challenge is for the PROFESSIONS to continue to update what indeed is required for their patients to achieve the goal of the therapeutics.' It is up to concerned providers to be sure the Task Force or any other committee making decisions to this effect have complete and current knowledge so 'standards' to insurance providers are appropriate and timely.

Task Forces and Committees is the way the people will speak to the professions and insurance providers. It is the way it is. Citizens need to be involved at this level and I believe there is also Consumer Protections built into all this. Believe me, we have the right President and the right legislature to do this job.

(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and

‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

The government cannot be negligent of its citizens. Standards that apply to immunizations will be honored. There are tried and true methodologies that state what those standards are and there are updates by Health and Human Services to new standards as they are discovered by the professions. This does not place demands on the citizens to comply. It demands the health insurance policies to be sure the coverage is there for those that want it. There will be significant 'evidence' supported provisions in this bill. Evidence means there is research that backs up the need. For any government at any level to demand a private sector comply with established standards there has to be evidence to back up that demand.

‘(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.‘(b) for purposes of this paragraph.

There is nothing ambiguous about that. Preventive care for women to be paid by health care insurers will be established by guidelines by Health Resources and Services Administration (click here) that is a part of the Executive Branch under Health and Human Services.

RNs on the rise: Report shows number of nurses continues to climb (click here)

March 22, 2010

...The HRSA report, “The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses,” also contains comparisons to the organization's eight previous surveys. A final report will be published this summer. More information is available at the HRSA Web site.

That is a good thing as long as they are in practice and not working in other fields that Bachelor prepared nurses can do. It means the cost of health care will come down and that will be reflected by the HRSA reports that can demand changes in the cost to consumers.

‘(5) for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force (click here) regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

Opportunity for Public Comment (click here)

The public comment being taken currently is in regard to renal disease. But, it serves as an example to the access the public has in achieving goals in preventive services. Appropriate health organizations such as National Kidney Foundation (click here) will comment to this agencies to protect citizens and uphold professional standards. I am confident that if the National Kidney Foundation was worried about the standards being set they would seek public opinion is writing to their legislators and otherwise to effect necessary compliance. Citizens have to have faith in organizations that have developed within the democracy to uphold the integrity of the professions and its standards. Everyone cannot be their own advocate, it would take more time than anyone has in a lifetime to do that. Citizens have to be reasonable and trust.

Screening for Breast Cancer (click here)

Release Date: November 2009 Updated: December 2009

READ YOUR NEWSPAPERS. That is why there are newspapers !!!!!!!

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement (click here)

1. U.S. Preventive Services Task Force*

American Cancer Society Guidelines for the Early Detection of Cancer

The American Cancer Society recommends these screening guidelines for most adults.

Breast cancer(click here)

The people at these Executive Branch agencies are important, but, just as important are the independent agencies such as The American Cancer Society. There are checks and balances within our society and that is a good thing. Being sure the health insurance companies pay for preventive services will bend the cost curve down. Short term financial gains for stockholders aren't the same as long term deficit and debt reduction for the nation.

The cost of health care to consumers, not to mention longevity, relies on the 'best practices' to reduce health care costs. That is different than dividends to stockholders and bonuses to CEOs. What is good for the citizen is good for the country.

Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.

‘(b) Interval-

‘(1) IN GENERAL- The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline.

‘(2) MINIMUM- The interval described in paragraph (1) shall not be less than 1 year.

‘(c) Value-based Insurance Design- The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs.

March 3, 2010

Patient-Centered Primary Care Collaborative Unveils New White Paper Aligning Benefits of Value-Based Insurance Design With Medical Home. (click here)

Health Affairs, 26, no. 2 (2007): w195-w203
(Published online 30 January 2007)
doi: 10.1377/hlthaff.26.2.w195
© 2007 by Project HOPE

Value-Based Insurance Design (click here)

Michael E. Chernew, Allison B. Rosen and A. Mark Fendrick

When everyone is required to pay the same out-of-pocket amount for health care services whose benefits depend on patient characteristics, there is enormous potential for both under- and overuse. Unlike most current health plan designs, Value-Based Insurance Design (VBID) explicitly acknowledges and responds to patient heterogeneity. It encourages the use of services when the clinical benefits exceed the cost and likewise discourages the use of services when the benefits do not justify the cost. This paper makes the case for VBID and outlines current VBID initiatives in the private sector as well as barriers to further adoption.

Quality, cost (click here)

...Asked for his definition of health care value, Denis Cortese, MD, president and CEO of the Mayo Clinic, sounds exasperated. “It should be clear at this point to nearly everyone, but I suppose it’s not,” says Cortese. “Value is quality relative to cost. Right now plans do not pay for value. They pay for process. That’s a reason value is hard to agree on, hard for some people to define. But the purpose of process should be to improve value, requiring a joint effort between insurers, providers, payers, and patients. It requires new models of care. Primarily it requires knowing outcomes, and acting on that knowledge.”

A form of benefit design that is value oriented, endorsed by Cortese and others, is growing in popularity, especially among employers. Named value-based insurance design (VBID), it promotes the use of services when the clinical benefits exceed the cost and discourages the use of services when the benefits do not justify the cost. There are many proponents, including several payers and some health plan executives. The classic VBID example is lowering — even eliminating — the cost of treatment-related medications for diabetes patients. In fact, a recent study at the University of Michigan did find that lowering copayments does increase compliance.

The basic idea is to organize care delivery around medical conditions instead of uncoordinated, sequential visits to multiple providers, physicians, departments, and specialties — the existing and prevalent system that VBID advocates say works against value and increases costs. In the current system, everyone is required to pay the same out-of-pocket amount for health care services. But value depends on patient characteristics, so there is enormous potential for underuse and overuse of resources.

Acceptance of that idea relies on a practical definition of value. Cortese has such a definition: value = (outcomes + safety + service)/(cost + time).

That is a practical equation because:

• Cost and time are easily measurable. “The denominator is cost over a period,” explains Cortese. “You determine the value of a service over time.”...

Example:

Congestive Heart Failure. It is a 'symptom' that is treated as a disease. It is a symptom of a weakened heart for whatever reason that occurs, through genetics, heart attack, virus, obesity, diabetes and the list continues.

If a patient is NON-compliant with their medications they will require repeated hospitalizations and it diminishes their quality of life. Congestive Heart Failure is a chronic condition, the benefit of 'compliance' is realized over time after the diagnosis is made. If the medications are 'pivotal' to the best outcomes of treatment regimes/therapeutics then the 'value' is on the medications and how well compliance is achieved. If 'the best value' is for patients to receive uninterrupted medication compliance than it is best to 'fill in the donut hole' in a manner that will be workable for the consumer and those that manufacturer the medication. The 'value' for reimbursement for a physician lies in encouraging 'compliance' through a patient/citizen understanding the importance of taking the medication AS ORDERED. The reimbursement system to the folks involved is based in 'the best value' for the citizen and ultimately for the USA's society.

This requires a great deal of 'judgement' by physicians to 'call the shots' on what exactly is the 'best value' for their patients. It is physician 'top heavy' and requires professional organizations of physicians to be forthcoming in participation to those that will set the standards.

The other aspect is that there has to be 'exceptions' to the rule through dense verifiable medical records that shows any patient that might fall outside the 'compliance' guidelines through no fault of their own, thus, requiring services other than those 'value based.'

I have to run an errand. I'll be back.

H.R. 3590 (click here) as recorded on "OpenCongress"

In the Senate of the United States,

December 24, 2009.

Resolved,That the bill from the House of Representatives (H.R. 3590T) entitled ‘An Act to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes.

AMENDMENTS:

Strike all after the enacting clause and insert the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Patient Protection and Affordable Care Act’.

(b) Table of Contents- The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

It continues from here.

The bill was adapted and renamed from a previous focus. The House decided to abandon the original contents of this 'bill number' to the Senate version S. 1728 - Service Members Home Ownership Tax Act of 2009 (click here). That is all this is about.

Subtitle A--Immediate Improvements in Health Care Coverage for All Americans

Sec. 1001. Amendments to the Public Health Service Act.

‘PART A--Individual and Group Market Reforms

‘subpart ii--improving coverage

‘Sec. 2711. No lifetime or annual limits.

a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—
(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue
Code of 1986) on the dollar value of benefits for any participant or beneficiary.

(b) PER BENEFICIARY LIMITS.—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

Nothing complicated about this. There is no lifetime annual limits in any health care insurance.

I believe there might be a concern regarding annual limits in this verbiage, however, the President has made it clear that needed to be cleaned up. The Reconciliation Act may address this. The wording is a little muddy. And below the insurance companies cannot take back their coverage, except, if there is fraud by the subscriber. So don't lie. No one should ever lie about their health anyway.

Sec. 2712. Prohibition on rescissions.

''A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not take back such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional mis-representation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702© or 2742(b).

Rather than inserting the provisions with the table of contents it is better to accept the content the way it is laid out. The table of contents is extensive and complete, so the substance of the bill starts here:

TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A--Immediate Improvements in Health Care Coverage for All Americans

Part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended--

(2) by redesignating sections 2704 through 2707 as sections 2725 through 2728, respectively;

(3) by redesignating sections 2711 through 2713 as sections 2731 through 2733, respectively;

(4) by redesignating sections 2721 through 2723 as sections 2735 through 2737, respectively; and

(5) by inserting after section 2702, the following:

‘Subpart II--Improving Coverage

‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.

‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish--

That seems fairly clear.

‘(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or

‘(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary.

Unreasonable is a fluid term. Who defines unreasonable? The term was placed into the Senate bill because of concerns of the impact on the industry and whether or not there would be undo constraints on the citizens because of it. One has to remember the Senate bill when it came out of the Finance Committee was supposed to be approved of by the Republicans of that committee. In fact what occurred in the Senate Finance Committee was a lot of betrayal of bipartisanship. Senator Baucus was convinced there would be bipartisan support for the bill because of the work done in the Finance Committee. In fact the Republicans on the Finance Committee turned their backs on bipartisanship and only used their opportunity in committee to try to destroy what the House had begun. Basically, the Republicans in the Senate Finance Committee is what 'set up' all the anger and contention in the nation. They were unfaithful to the public trust afforded them.

I consider 'unfaithfulness to the public trust' a huge ethics issue, however, during the majorities of the Republicans the Ethics Committees were nearly carved to the bone and primarily reduced to unlawful acts being the focus of ethics. That isn't an Ethics Committee, that is a simply a record keeping variety of a judicial ruling. Ethics has to be returned to the Ethics Committees of the House and Senate. It allows too much co-mingling of interest of the private sector with the best interest of the citizen.

‘(b) Per Beneficiary Limits- Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

The language really isn't great here. I don't like the bill singling out the 'individual.' 'per beneficiary' is a focus on the individual. That isn't good. Because it is the individual that is suppose to be protected, not 'the group.' That is to begin with. It allows too much 'play' in an opportunity to attack 'the individual' with the understanding that 'an individual' has different 'qualities' than the group. A group health insurance plan is suppose to protect the individuals in it. This section allows the group to be divided into individuals. I don't like it. The reform is suppose to protect all Americans equally.

The operative words are 'that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act.'

That provision states, that if there is health care insurance in the market place, allowed by laws under Federal and State laws that does not provide 'essential' services they are excluded from the laws of this section. No. That is not the way to treat comprehensive health care reform if one is to protect the nation's citizens. It needs to be understood that every citizen is covered by health insurance to cover all essential needs. Annual physicals and regular 'basic screenings' have to be a part of every American's coverage. If a person decides not to exercise their rights to coverage of those benefits and ignores the value of those benefits to their health there is little anyone can do about it. However, to allow health care insurance companies to actually write policies that exclude essential coverage when the nation is attempting to bend the cost curve down is a violation of the public trust as far as I am concerned. The President made it clear that the legislation was to protect all citizens in the same way and to allow exploitation to continue and allow inflationary costs is simply "W"rong. I hope this is cleared up in reconciliation. It is appropriate that the federal government 'LIMIT' the instruments available to the citizens of the USA while providing the private sector the opportunity to protect them. Excluding such instruments from availability to citizens is the right thing to do. There is no reason for them. Why would there be? All people are the same physiologically. To allow such policies to exist is contrary to COMPREHENSIVE reform. Once a person is insured with 'proper' health care there is no need for any other coverage. That would be duplication of services and allow for exploitation that should not exist. Nothing saying people can't be covered by two insurances as in married folks and their children, but, there really is no need for it. If deductibles are realistic and affordable there is little need for two insurance companies to cover one person. Two insurance companies covering one person increases the cost of health care. Riders such as the 'supplement' to Medicare can be a part of a 'second' policy to cover all deductibles, however, and I can't say this enough, if the deductibles per person are reasonable there is no need for even a rider on their policies to cover all the deductibles. The reason why such instruments exist today is because deductibles are out of control. They are increased while costs to purchase also increases.

I think that is enough about that.

continued...

There are two bills that comprise the Health Care Reform Act of 2010

The first is HR 3590 (click here).

It is titled, "Patient Protection and Affordable Care Act."

The sponsor of the bill is House Representative Charles Rangel (click here). He was maligned in an ethics investigation. Gee, can't imagine why.

The second of the two bill is HR 4872 (click title to entry - thank you).

It is titled, "Reconciliation Act of 2010."

The sponsor of the bill is House Representative John Spratt (click here).

It seems a little silly to read the Reconciliation Bill before the actual bill itself, so I'll start with it. I thought perhaps the President might have signed it last night as he was there for the vote along with Vice President Biden, but, there is a process before that happens. Just hoped it would be ceremoniously set aside, but, not with this President. Everything by the book.

No one has asked the Clintons how they see all this?

The Clinton's effort to pass health care reform was nearly a generation ago. It is a different time and a different nation.



...But there is one very important difference between then and now that could negate or blunt GOP gains: Bill Clinton suffered two major defeats prior to the 94 elections - failure of Hillarycare and what was then the biggest tax increase in America, which was passed by the House by one vote, that of freshman Rep. Marjorie Margolies, D-PA. who was subsequently defeated....

"It's only nine o'clock on my watch." Those were the words of Speaker Pelosi after the vote to the Reconciliation Bill.

I found it more than interesting that the Speaker keeps her wrist watch on California time. That is a pure affection for the people she represents.

Why include education in the bill? I haven't heard a good reason yet. No one knows? It makes perfect sense to me and is directly related to Health Care Reform.

Why pass a bill that educates its health care professionals and workers while handing them over to a dysfunctional loan program? There is a lot of money to nurture new physicians, nurse practitioners and others in the Health Reform Bill. Why not bring it all home in one package? Good job.



The United States House of Representatives passed the Health Care Reform Act of 2010 at 10:45 PM EST.

It then passed the Reconciliation Act to the Health Care Reform Act of 2010 within the hour that followed.

Both bills passed with a clear majority.

The Lady Speaker was on the floor for the Reconciliation Act passage and announced the historic moment and for the second time, THE SECOND TIME a bill was passed to benefit the American people. It was a clear and decisive victory for the citizens of the USA after a struggle that started with a documentary.

I congratulate Speaker Pelosi, Majority Leader Steney Hoyer, House Majority Whip James Clyburn and all those that were unafraid to do the right and best thing for the American people.

Only 220 Americans had the privilege to vote for a bill to save the lives of millions and only one documentarian cared enough to see the need.

It was a great and historic moment for the country and we could not have secured it without the Minority President so dedicated to make it happen.

Thank you from a grateful nation.

On every media service I watched afterward there was admiration and respect for the moment. I did say every media service and I mean it.

Congratulations America, you voted for a moment to be proud of that started with the 2006 elections. There should not be one regret.

The Bantering about The Hyde Amendment is false. They are lying about it being 'comprehensive'. It is NOT.

The ONLY place The Hyde Amendment applies is Medicaid. No place else. So the draconian Stupak Amendment isn't even good law. It has NO precedent. The Stupid Pak Amendment is an insult to the intelligence of women and treats them as if second class citizens unable to discern their own mind.

The Hyde Amendment prevents states from using federal funds under Medicaid to pay for abortions (except under limited circumstances, currently when the mother’s life is in danger or the pregnancy is the result of rape or incest); however, the Hyde Amendment is not permanent law.

The Hyde Amendment was written and attached to an appropriations bill in 1976. It was a reaction to the Supreme Court's decision of 1973 in Roe v. Wade.

The Stupak Amendment is not good law because it goes outside of Hyde. It attempts to control private insurance monies and the federal government has no authority over private insurance dollars when it is subscribed to by a private citizen. Hyde was upheld because it was deemed Congress could control its budget.

Stupak operates on the basis that the church does and the Anti-Abortion Lobby, that life begins at conception. It doesn't. Not physiologically and not legally. The Stupak Amendment is not valid law.

A human embryo is not discernable as any such embryo at conception. It is nothing but a cluster of cells without a specific function. If removed from the uterus, it can be effected by hormones to grow differently as a 'stem cell' has capacity. If a cell, human or otherwise, is not STATIC in its genetic definition at conception it cannot be assigned the status of a human being.

End of discussion.