March 22 – 26 is World Water Week

Diesel is cheaper than any other fuel. It is also dirtier.

Oilfield Company Failed to Report Fracking Violations to EPA -- Documents (click here)

By MIKE SORAGHAN of Greenwire

Published: March 23, 2010

...BJ Services Co. acknowledged in January 2008 (The EPA under Bush) to investigators from the House Oversight and Government Reform Committee that it had violated a 2003 agreement not to use diesel in specific types of hydraulic fracturing. When that was disclosed last month, a BJ Services executive said that the company had "self reported" the violation to EPA.

But EPA says the company never told agency officials. And documents show the company has twice since then told the environmental agency that it has always been in compliance with the agreement....

"BJ Services continued through January to tell us they had not" used diesel in fracturing, said EPA spokeswoman Enesta Jones....

EPA Administrator Jackson Outlines New Vision for Clean, Safe Drinking Water(click here)

Release date: 03/22/2010

Contact Information: Enesta Jones, jones.enesta@epa.gov, 202-564-7873, 202-564-4355 En español: Lina Younes, younes.lina@epa.gov 202-564-9924, 202-564-4355

WASHINGTON - In a speech today at the Association of Metropolitan Water Agencies (AMWA) annual conference in Washington, D.C., U.S. EPA Administrator Lisa P. Jackson announced the agency is developing a broad new set of strategies to strengthen public health protection from contaminants in drinking water. The aim is to find solutions that meet the health and economic needs of communities across the country more effectively than the current approach. EPA is also announcing a decision to revise the existing drinking water standards for four contaminants that can cause cancer.

"To confront emerging health threats, strained budgets and increased needs -- today's and tomorrow's drinking water challenges -- we must use the law more effectively and promote new technologies," said EPA Administrator Jackson. "That means fostering innovation that can increase cost-effective protection. It means finding win-win-win solutions for our health our environment and our economy. And it means broad collaboration. To make our drinking water systems work harder, we have to work smarter."...

WHILE IN Bolivia...

BOLIVIA CELEBRATES WORLD WATER DAY WITH CALL FOR RaTIONAL USE (click here)

NAM NEWS NETWORK Mar 23rd, 2010

LA PAZ, March 23 (NNN-PRENSA LATINA) – Bolivia began celebrations of the World Water Day established by the United Nations N 17 years ago with a call the rational use of water.

According to the Minister of Environment and Water María Esther Udaeta, a Water Fair will also be held in La Paz this weekend to attract the public, especially young people.

The United Nations (UN) choose ”Clean Water for a Healthy World” as theme for World Water Day this year, which sums up importance of supplying superior water to improve people’s health and living conditions....

Is Water a Human Right? (click here)

Juliette Terzieff | Bio | 23 Mar 2010
As the United Nations spearheaded efforts to mark World Water Day on Monday, scarcity was at the top of the agenda. And with an increasing number of communities around the world lacking sufficient water supplies, the push to classify access to potable water as a basic human right is gaining ground among a variety of stakeholders....

I don't care if weeding through this takes a year, okay?

The health care insurance industry will NOT create a mesh work of deception to the peasants in this country.

...continued from previous...

‘(c) Standard Hospital Charges- Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.

‘(d) Definitions- The Secretary, in consultation with the National Association of Insurance Commissions, shall establish uniform definitions for the activities reported under subsection (a).

‘SEC. 2719. APPEALS PROCESS.

‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall implement an effective appeals process for appeals of coverage determinations and claims, under which the plan or issuer shall, at a minimum--

‘(1) have in effect an internal claims appeal process;

‘(2) provide notice to enrollees, in a culturally and linguistically appropriate manner, of available internal and external appeals processes, and the availability of any applicable office of health insurance consumer assistance or ombudsman established under section 2793 to assist such enrollees with the appeals processes;

‘(3) allow an enrollee to review their file, to present evidence and testimony as part of the appeals process, and to receive continued coverage pending the outcome of the appeals process; and

‘(4) provide an external review process for such plans and issuers that, at a minimum, includes the consumer protections set forth in the Uniform External Review Model Act (click here) promulgated by the National Association of Insurance Commissioners and is binding on such plans.’.

The Uniform External Review Model Act is being implemented as this bill becomes effective. Its purpose is to bring equity to all the appeal processes and hearing in regard to health care insurance. It is a good idea and brevity in that it takes review processes out of the hands of insurance companies that deny benefits to those Americans that need them. It will be an opportunity to weigh the benefits of 'value' and new technologies with investigative capacity to save lives as a component to value. It is necessary in today's Wall Street environment of draconian companies that view human beings as peasants as well as disposable people with families that will benefit from their life insurance rather than their HEALTH insurance.

SEC. 1002. HEALTH INSURANCE CONSUMER INFORMATION.

Part C of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-91 et seq.) (click here) is amended by adding at the end the following:

The states have no room to complain. There will be additional funding to provide support to its citizens as the health care insurance transitions to a user friendly structure.

‘SEC. 2793. HEALTH INSURANCE CONSUMER INFORMATION.

‘(a) In General- The Secretary shall award grants to States to enable such States (or the Exchanges operating in such States) to establish, expand, or provide support for--

‘(1) offices of health insurance consumer assistance; or

‘(2) health insurance ombudsman (click here) programs.

‘(b) Eligibility-

‘(1) IN GENERAL- To be eligible to receive a grant, a State shall designate an independent office of health insurance consumer assistance, or an ombudsman, that, directly or in coordination with State health insurance regulators and consumer assistance organizations, receives and responds to inquiries and complaints concerning health insurance coverage with respect to Federal health insurance requirements and under State law.

‘(2) CRITERIA- A State that receives a grant under this section shall comply with criteria established by the Secretary for carrying out activities under such grant.

There is no reason for any State to ignore this opportunity to provide more support to their citizens in regard to health care insurance. There is not a case on record whereby State Regulators PREVENTED injury, deterioration or death of a citizen due to the draconian practices of the health insurance industry. This new law will provide every citizen with the opportunity to have health insurance and every State should rise to that directive and enforce the new standards.

The 'existing' review process through appeals is all contained within the health care insurance companies themselves and they have proven UNTRUSTWORTHY.

‘(c) Duties- The office of health insurance consumer assistance or health insurance ombudsman shall--

‘(1) assist with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process of the group health plan or health insurance issuer involved and providing information about the external appeal process;

‘(2) collect, track, and quantify problems and inquiries encountered by consumers;

‘(3) educate consumers on their rights and responsibilities with respect to group health plans and health insurance coverage;

‘(4) assist consumers with enrollment in a group health plan or health insurance coverage by providing information, referral, and assistance; and

‘(5) resolve problems with obtaining premium tax credits under section 36B of the Internal Revenue Code of 1986 click here).

This section is frequently accessed in bills other than health care reform to set appeal processes. This bill seeks sound content in existing law and the appeals process to health care with insurance companies are no different. These are procedures are familiar to corporate attorneys so the cost to any of this is negligible to an upstart. The corporations are now going to have to weigh their attorney costs along with providing care as they should to their peasants.

The down side to any of the appeal processes is that the peasant is suffering from illnesses that need attention NOW !

‘(d) Data Collection- As a condition of receiving a grant under subsection (a), an office of health insurance consumer assistance or ombudsman program shall be required to collect and report data to the Secretary on the types of problems and inquiries encountered by consumers. The Secretary shall utilize such data to identify areas where more enforcement action is necessary and shall share such information with State insurance regulators, the Secretary of Labor, and the Secretary of the Treasury for use in the enforcement activities of such agencies.

The above statute is quality control to focus on where appeals are mostly being conducted so the federal authorities can decide if the appeals are draconian and unnecessary to the peasants.

‘(e) Funding-

‘(1) INITIAL FUNDING- There is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $30,000,000 for the first fiscal year for which this section applies to carry out this section. Such amount shall remain available without fiscal year limitation.

$30 million US? That's all? Fine. Why do I especially feel like a peasant at this point?

‘(2) AUTHORIZATION FOR SUBSEQUENT YEARS- There is authorized to be appropriated to the Secretary for each fiscal year following the fiscal year described in paragraph (1), such sums as may be necessary to carry out this section.’.

This might be an improvement to the $30 million to initiate the quality assurance to the peasants in regard to their health care insurance. There are after all 50 states and other USA territories and native lands.

At 8:56 AM Pacific Time the Health Care Reform Bill was signed into law.

The Big Blue Book is going to be signed today. It will end the saga of health care reform in the USA, at least for now.

5 Reasons Republicans Should Let Go of Health Care (click title to entry - thank you)

I love that picture of the President and Vice President after the vote to the Reconciliation Bill. That is Vice President Biden and President Obama after the vote to the Reconciliation Bill was passed. President Obama spoke to the nation. Of course Vice President Biden will be near the Senate when the Reconciliation Bill comes to the floor for a vote.

The Republicans need to change their view of taxes. They always brag about how much they donate to charities. Well, they can think of their additional taxes as a social donation to the health of FELLOW Americans.

The Florida Attorney General, Bill McCollum has absolutely no case against the Health Care Reform Bill which he intends to file a petition to declare it unconstitutional law as soon as it is signed. He stated that the bill is allowing a commerce of taxes and regulation where none exists and does not provide services. He PROTECTED the mandatory car insurance bill the State of Florida has by stating there is an 'exchange' of goods in demanding insurance for all motorists because people have the 'pleasure' of driving their car.

He went on to say the federal health care bill is like saying someone in their easy chair at home is actually engaged in commerce where there is no good exchanged. Right. The argument doesn't hold water. The highest level of bankruptcies occur over health care bills. There is plenty of use of homes in the USA that go to foreclosure due to health care costs. He doesn't have an argument. So while that Florida man is sitting in his 'easy chair' in his home without engaging in health care, there is some point in time when he will need it and seek it and might require it if in an accident with his car, but, it will also keep him sitting in that easy chair in his home.

The size of the document is amazing to most who view it. It is significant. It is also sadly unfortunate the bill has to achieve that volume to mandate regulation of the unthinkable in the USA by the health insurance industry.

‘SEC. 2718. BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.

‘(a) Clear Accounting for Costs- A health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, submit to the Secretary a report concerning the percentage of total premium revenue that such coverage expends--

The health care insurance companies have to had the Secretary of Health and Human Services a spread sheet of costs and benefits vs. profits for 'each plan year.'

‘(1) on reimbursement for clinical services provided to enrollees under such coverage;

‘(2) for activities that improve health care quality; and

(3) on all other non-claims costs, including an explanation of the nature of such costs, and excluding State taxes and licensing or regulatory fees.

The Secretary shall make reports received under this section available to the public on the Internet website of the Department of Health and Human Services.

‘(b) Ensuring That Consumers Receive Value for Their Premium Payments-

‘(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAYMENTS- A health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, provide an annual rebate to each enrollee under such coverage, on a pro rata basis, in an amount that is equal to the amount by which premium revenue expended by the issuer on activities described in subsection (a)(3) exceeds--

In other words, the Secretary of Health and Human Services will review the balance sheets of the insuring companies and determine they have made a ? reasonable ? profit WITHOUT exploitation of costs. Once that profit is realized for each company there will be a determination to the EXCESS of monies paid by the enrollees to provide their care. There is a great deal of incentive to enrollees here as well. The incentive is to stay well and achieve wellness to the extent their physical conditions allow it. If their insuring companies have monies that are in excess of costs and profit then that is to be refunded to the enrollees as a rebate for each 'benefit year.' There is a strong incentive for insurers to 'get it right,' because, to issue checks whenever a benefit year is ended is an additional expense to enrollees and stockholders. They also don't want to get caught with their hand in the 'till and referred by the Secretary to the Justice Department for further investigation.

I really don't expect to hear any criticism about this either, as the health care industry has been corrupt to the core. There was testimony from within their own corporate structure as to how they played god in determining life and death of peasants. End of discussion.

‘(A) with respect to a health insurance issuer offering coverage in the group market, 20 percent, or such lower percentage as a State may by regulation determine; or

The bill makes room for States. There is absolutely no reason for any State to have a court action.

The percentages are generous to the amount the companies can keep in their coffers over and above operating costs. It would be wise to for the State Regulatory Agencies to monitor the compliance with a mandate to maintain health insurance coverage. The reason being that if the costs are too high as opposed to the 'value' they deliver there will higher non-compliance, people will suffer and the cost to the State and Federal government will escalate while the savings to the country will be hurt.

‘(B) with respect to a health insurance issuer offering coverage in the individual market, 25 percent, or such lower percentage as a State may by regulation determine, except that such percentage shall be adjusted to the extent the Secretary determines that the application of such percentage with a State may destabilize the existing individual market in such State.

Some of the more angry lords and ladies of the Republican Right Wing are stating they will sell their shares in the companies that insure the country and/or have unions. They akin it similar to the boycott of apartheid. Imagine that Desmond Tutu and Nelson Mandella has boycotting American Health Care Reform. The Right Wing ANYBODY are legitimately 'wackos.' If they boycott go right ahead. It is more stock futures for the rest of us to own and from the look of the insurance stocks these days, I doubt anyone is giving it up. So, for those that want to sell their stocks in companies that have unions, go ahead, do it today ! Don't wait not one more day. The peasants are longing to purchase your shares.

(2) CONSIDERATION IN SETTING PERCENTAGES- In determining the percentages under paragraph (1), a State shall seek to ensure adequate participation by health insurance issuers, competition in the health insurance market in the State, and value for consumers so that premiums are used for clinical services and quality improvements.

This sets up parameters the States need to comply to in order to issue different percentages. It requires participation by the public to add to the dynamics the State Regulators will issue law.

‘(3) TERMINATION- The provisions of this subsection shall have no force or effect after December 31, 2013.

After that date the laws begin on January 1, 2014.

On with 'the read.' To some the bill may seem superfluous, but, to many Americans it is the difference between life and death.

Former Bush speechwriter tells GOP: Democrats’ passage of health care is actually ‘our’ Waterloo. (click title to entry - thank you)

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves. At the beginning of this process we made a strategic decision:...

The Republicans always treat the electorate as if they are manipulative 'head cases.' Peasants. Why bother educating them?

That statement by David Frum, a Canadian American conservative journalist active in both the United States and Canadian political arenas, is correct. The party of 'No' did make a strategic decision. To 'kill the bill' was to sink the Obama Presidency. We heard it over and over again. The Republicans CHRONICALLY place themselves FIRST POLITICALLY before the needs and best interests of the American people. All the time. They don't care about people. They care about money and that does not always equate to the best outcome of 'the peasants.'

In Arizona the State Income Tax is among the lowest in the nation, yet, they are chronically complaining about the cost of illegal immigrants on their health care system and the cost of maintaining State Parks. They have gone so far as to continue to ignore their MORAL OBLIGATION by paying 'enough' State Income Tax to support their responsibilities including the heritage to precious places of nature in their State Parks.

Arizona has the MOST draconian Senators in the country and the most extreme. If the citizens of Arizona were to add a half a percent to their State Income Tax their problems would be solved and their complaining would end. Will they do it? No, they'll wait for the federal government to recognize the problems they face and intervene. What should occur is the federal government should see the neglect of the State government to GOVERN and take them to court to do the right thing for their children.

So, if the Republicans continue to NOT GOVERN rather than take care of citizens it will destroy its own party if it hasn't already.

HOWEVER, the Democrats cannot afford to become lazy after their victory.



One thing that concerns me about the Health Insurance Industry is the potential for a cartel. I hope there is enough interest in that to be sure there is an Anti-Trust clause to prevent that from occurring. Each company is not the same. There is no reason for them to raise rates in unison to exploit the insured.

I am going to go through this section and opt to finish my sleep rather than a cup of coffee. I don't 'do' substances. It is a health care thing I have.

‘(b) Wellness and Prevention Programs- For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:

This is a necessary provision that is intended to bend the cost curve down. If wellness and prevention programs can be competently handled by 'trainers' and/or 'educators' that will cut down on the visits to providers that could charge far more for their services. It is also more economical if the professionals that provide wellness and prevention services hold group meetings and clinics to reduce the cost to the insured/peasants.

The list here are no-brainers. The 'idea' of having professionals that even provide holistic or non-traditional services that are PROVEN effective in patients/peasants increases the job market and improves the tax base of the economy.

‘(1) Smoking cessation.

Imagine having the right to be reimbursed for "Weight Watchers" so long as DOCUMENTED progress can be validated. Nice. "Weight Watchers," by the way is a great and long lived program. It is very vigilant of its participants so far as including necessary nutrients in any one day. There encourage participants to drink anywhere from two to three glasses of milk per day. They derive their recommendations from standard sources.

‘(2) Weight management.

Imagery, massage or other tried and true techniques can all be legitimate under health care coverage. And probably encouraged to be so. Why wait for the need to go to Cancer Treatment Centers of America? Do it before it happens.

‘(3) Stress management.

Health maintenance. If one is going to 'do' "Weight Watchers" the level best thing to do along with the diet is to exercise and then maintain the weight loss by continuing that 'HABIT.'

‘(4) Physical fitness.

This is a counseling sort of thing. Nutrition counseling.

Nutrition counseling (click here) is an ongoing process in which a health professional, usually a registered dietitian, works with an individual to assess his or her usual dietary intake and identify areas where change is needed. The nutrition counselor provides information, educational materials, support, and follow-up to help the individual make and maintain the needed dietary changes.

‘(5) Nutrition.

American Heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood (click here)

Rae-Ellen W. Kavey, MD; Stephen R. Daniels, MD, PhD; Ronald M. Lauer, MD; Dianne L. Atkins, MD; Laura L. Hayman, PhD, RN; Kathryn Taubert, PhD

‘(6) Heart disease prevention.

It is all about developing good health habits and diet and exercise.

"Let's Move" (click here)

That would be a more than nice gesture to include the First Ladies initiative in health care insurance policies to the peasants.

‘(7) Healthy lifestyle support.

Living with Diabetes (click here)

‘(8) Diabetes prevention.

‘(c) Regulations- Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall promulgate regulations that provide criteria for determining whether a reimbursement structure is described in subsection (a).

On the passage above the Secretary has 2 years to decide whether the benefits within this section are to be included in any information to peasants. Depending on the decision by the Secretary there will be then six months for the GAO review.

‘(d) Study and Report- Not later than 180 days after the date on which regulations are promulgated under subsection (c), the Government Accountability Office shall review such regulations and conduct a study and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report regarding the impact the activities under this section have had on the quality and cost of health care.

I'll be back later.

It has to start somewhere. Everyone knows that Israel is buidling in East Jerusalem, but, not everyone agrees.

The reason it is inequitable is because Israel has proprietary authority in East Jerusalem and the Palestinians do not. They worry about their heritage and their access. This isn't about land as Israel wants it to be, it is about culture.

It isn't about just access. It is about belonging. The culture of Palestine needs a presence as a claim to belonging. Different than deed restrictions. It really is more of a sovereignty issue for Palestine then Israel is willing to admit.

It is only a bit ludicrous to allow Palestinians 'access' while excluding them from sovereign rights. It is one thing to be able to live in Jerusalem as opposed to visiting it and walking among the homes of Israelis. I would think Israel would recognize that danger to its citizens. The people of Israel could become the targets of hatred if there isn't willingness in resolving this issue and then what good are homes?



The settlements in Jerusalem

...Pointing to what he has described as a national consensus in Israel over its claim to all of Jerusalem, Netanyahu told AIPAC that all Israeli governments had carried out construction in what he termed the city's "Jewish neighborhoods" since 1967.

"Everyone knows, everyone -- Americans, Europeans, Israelis certainly, Palestinians -- everyone knows that these neighborhoods will be part of Israel in any peace settlement. Therefore, building them in no way precludes the possibility of the two-state solution," he said.

In her speech, Clinton said new construction in East Jerusalem or the West Bank "undermines mutual trust and endangers the proximity talks" that are the first step toward full negotiations, suspended since December 2008.

"It exposes daylight between Israel and the United States that others in the region could hope to exploit. And it undermines America's unique ability to play a role -- an essential role, I might add -- in the peace process."

But she said U.S. support for Israel was "rock solid, unwavering, enduring, and forever."...

...continued from before, including the cartoons of the health care reform politics...

Still in the context of the disclosure by the insurance company.

‘(H) a statement that the outline is a summary of the policy or certificate and that the coverage document itself should be consulted to determine the governing contractual provisions; and

‘(I) a contact number for the consumer to call with additional questions and an Internet web address where a copy of the actual individual coverage policy or group certificate of coverage can be reviewed and obtained.

‘(c) Periodic Review and Updating- The Secretary shall periodically review and update, as appropriate, the standards developed under this section.

Nothing unusual about any of this.

‘(d) Requirement tTo Provide-

‘(1) IN GENERAL- Not later than 24 months after the date of enactment of the Patient Protection and Affordable Care Act, each entity described in paragraph (3) shall provide, prior to any enrollment restriction, a summary of benefits and coverage explanation pursuant to the standards developed by the Secretary under subsection (a) to--

There is a window of vulnerability of three years. As consumers of health care insurance I would ask my health care insurance company if their standards are within the provisions of the Reform Act? If the reply is no, then find out if there are other insurance companies already meeting that goal.

Below is simply the people to whom the information has to be disclosed.

‘(A) an applicant at the time of application;

(B) an enrollee prior to the time of enrollment or reenrollment, as applicable; and

‘(C) a policyholder or certificate holder at the time of issuance of the policy or delivery of the certificate.

All that language is simply common sense, but, do to the dysfunction of the judiciary in being particular in regard to language the reform bill is forced to spell everything out. It is contract law. Common sense is not a judges forte.

Below is the vehicle, being particular, of which the policy needs to be accessible. Other laws apply here as well, including any handicap laws which would require either brail or recording/audio access of the insurance policy.


‘(2) COMPLIANCE- An entity described in paragraph (3) is deemed to be in compliance with this section if the summary of benefits and coverage described in subsection (a) is provided in paper or electronic form.

Below describes whom exactly is going to be issuing policies to citizens.

(3) ENTITIES IN GENERAL- An entity described in this paragraph is--

‘(A) a health insurance issuer (including a group health plan that is not a self-insured plan) offering health insurance coverage within the United States; or

‘(B) in the case of a self-insured group health plan, the plan sponsor or designated administrator of the plan (as such terms are defined in section 3(16) (see immediately below) of the Employee Retirement Income Security Act of 1974).

Established language. Constitutional. Smart, very smart.

(16) (click here)

(A) The term “administrator” means—

(i) the person specifically so designated by the terms of the instrument under which the plan is operated;

(ii) if an administrator is not so designated, the plan sponsor; or

(iii) in the case of a plan for which an administrator is not designated and a plan sponsor cannot be identified, such other person as the Secretary may by regulation prescribe.

(B) The term “plan sponsor” means

(i) the employer in the case of an employee benefit plan established or maintained by a single employer,

(ii) the employee organization in the case of a plan established or maintained by an employee organization, or

(iii) in the case of a plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan.

Back to the main Reform Bill:

This is just notification to the insured of a modification to a policy. The notice has to be at least 60 days from effectiveness. It would provide time to find another policy if the modification causes hardship to the insured. The companies unable to turn applicants that means there would be options to changing from one plan to another provided there were such options within an employees benefits. Otherwise, they would have to look outside the employer's offerings.

‘(4) NOTICE OF MODIFICATIONS- If a group health plan or health insurance issuer makes any material modification in any of the terms of the plan or coverage involved (as defined for purposes of section 102 of the Employee Retirement Income Security Act of 1974 - click here) that is not reflected in the most recently provided summary of benefits and coverage, the plan or issuer shall provide notice of such modification to enrollees not later than 60 days prior to the date on which such modification will become effective.

If an insurer does not notify an insuree it is a fine of $1000.oo per occurrence. So, if a company has insurance for 1000 people that means the fine is one million US. The fine is prohibitive in large enrollments. It is probably prohibitive in small or individual enrollments because the policy premiums would not cover most of the fine. I don't believe that is a slap on the wrist. I think this provision also gives brevity to the insured to sue if there was no notice and there are services sought and used that are no longer covered. If the insurer does not notify a certain provision is no longer covered that opens up liability to the insurer for negligence in the case of subsequent expenses by the enrollee. Civil suits.

‘(f) Failure tTo Provide- An entity described in subsection (d)(3) that willfully fails to provide the information required under this section shall be subject to a fine of not more than $1,000 for each such failure. Such failure with respect to each enrollee shall constitute a separate offense for purposes of this subsection.

‘(g) Development of Standard Definitions-

These are the definitions not already covered elsewhere. This is important because it states the 'minimum' language the Secretary of Health and Human Services is to define that will be carried in insurance policies. It also does not limit the language to become dysfunctional if the terms of such contracts expand. The danger here is that language will change and if not standardized 'well' could contradict the meaning of 'common sense' language and turn the entire contract into alphabet soup. I believe there should be language included here that limits how 'strange' the legaleze can get. I do not believe 'contract law language' can have exotic derivatives that the financial industry enjoys or should I say exploits. That is a better word, the Secretary of Health and Human Services needs to write into this provision that no contract law language in regard to health insurance will be exotic or exploitive. She might want to consider naming a source of such language as well such as The Oxford Dictionary. It is unfortunate it has to go that far.

‘(1) IN GENERAL- The Secretary shall, by regulation, provide for the development of standards for the definitions of terms used in health insurance coverage, including the insurance-related terms described in paragraph (2) and the medical terms described in paragraph (3).

‘(2) INSURANCE-RELATED TERMS- The insurance-related terms described in this paragraph are premium, deductible, co-insurance, co-payment, out-of-pocket limit, preferred provider, non-preferred provider, out-of-network co-payments, UCR (usual, customary and reasonable) fees, excluded services, grievance and appeals, and such other terms as the Secretary determines are important to define so that consumers may compare health insurance coverage and understand the terms of their coverage.

‘(3) MEDICAL TERMS- The medical terms described in this paragraph are hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, emergency medical transportation, and such other terms as the Secretary determines are important to define so that consumers may compare the medical benefits offered by health insurance and understand the extent of those medical benefits (or exceptions to those benefits).

‘SEC. 2716. PROHIBITION OF DISCRIMINATION BASED ON SALARY.

The President of the company pays the same price as the janitor. The cost to the janitor cannot be higher for health care insurance to compensate the CEO's contribution to the cost of the plan. Maybe I should have used the word peasant. The peasants of a company can't be 'tapped' for higher premiums so the CEO doesn't have to pay a dime.

‘(a) In General- The plan sponsor of a group health plan (other than a self-insured plan) may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee or otherwise establish eligibility rules that have the effect of discriminating in favor of higher wage employees.

However, the peasants can be paying less than the CEO. However, that is to only occur if there are other peasants paying lower in the same 'status' work. In other words if a newly higher peasant is required to pay higher premiums that an peasant of ten years seniority it would be wrong and that cannot be done. The newly hired peasant cannot contribute to the CEOs premiums when the others don't.

‘(b) Limitation- Subsection (a) shall not be construed to prohibit a plan sponsor from establishing contribution requirements for enrollment in the plan or coverage that provide for the payment by employees with lower hourly or annual compensation of a lower dollar or percentage contribution than the payment required of similarly situated employees with a higher hourly or annual compensation.

‘SEC. 2717. ENSURING THE QUALITY OF CARE.

Ah, oh. There are reporting requirements to be 'in place' within two years of the President's signature. I can understand why all this doesn't start for a few years. There is compliance developed and written by the Secretary of Health and Human services that has to be in place to 'require' all the provisions of this law be honored. So, it takes time. The laws took time to write and the expression of the law takes time to develop and implement.

‘(a) Quality Reporting-

‘(1) IN GENERAL- Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures that--

And there is a lot to put in place. Standards of which health is to be reported and then the actual data, where it will be recorded and how it will be used to establish standards for insurance. It is a huge job. A lot has to be done in two years and I am pleased it will be completed under the first term of this President.

‘(A) improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection and Affordable Care Act, for treatment or services under the plan or coverage;

Hospital readmissions are one of the biggest problems in skyrocketing health care costs. The Secretary of Health and Human services has to get this right to help with the cost curve. Part of it is the 'value cost' system mentioned earlier and filling in the gaps to health care so that costs are not prohibitive to 'best value outcomes.' We already know the methodology the Secretary will implement, it is a matter of getting it done. The methodology was previously noted with 'value of care.'

‘(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;

These all relate to the cost curve and its inherent effect to improve it as well as improve the wellness of Americans and HENCE the goal of better quality of life. Good health is directly related to quality of life.

QUALITY OF LIFE IS A HUMAN RIGHTS ISSUE.

(C) implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and

‘(D) implement wellness and health promotion activities.

‘(2) REPORTING REQUIREMENTS-

A lot of the language here is self explanatory, clear and concise.

‘(A) IN GENERAL- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall annually submit to the Secretary, and to enrollees under the plan or coverage, a report on whether the benefits under the plan or coverage satisfy the elements described in subparagraphs (A) through (D) of paragraph (1).

‘(B) TIMING OF REPORTS- A report under subparagraph (A) shall be made available to an enrollee under the plan or coverage during each open enrollment period.

(C) AVAILABILITY OF REPORTS- The Secretary shall make reports submitted under subparagraph (A) available to the public through an Internet website‘(D) .

‘(D) PENALTIES- In developing the reporting requirements under paragraph (1), the Secretary may develop and impose appropriate penalties for non-compliance with such requirements.

It is my belief other administrations will exploit the Exceptions in (E). So, compliance is everything and there are breaks for those that exceed expectations. I believe that is a mistake. There should be limits to the exceptions that do not extend beyond two enrollee periods.

‘(E) EXCEPTIONS- In developing the reporting requirements under paragraph (1), the Secretary may provide for exceptions to such requirements for group health plans and health insurance issuers that substantially meet the goals of this section.

The next section is in regard to Wellness and Prevention Programs. It is nearly 8PM and I'm taking a break for awhile. I'll try to cover more after about 1 AM.

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‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.

‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age. Nothing in this section shall require a health plan or a health insurance issuer described in the preceding sentence to make coverage available for a child of a child receiving dependent coverage.

This states that parents can extend their coverage for dependent children. It also states the children that were covered and become 'independent' of their parents' coverage is not automatically eligible for the health care insurance they enjoyed for 18 to 26 years of their life, not including pre-natal care.

I thought C.O.B.R.A. allowed that, but, I could be mistaken. I am fairly certain this is one of the provisions that was changed in the Reconciliation Act of 2010.

Qualifying Events for Covered (click here)
Dependent Children
�� The parent-employee dies;
�� The parent-employee’s hours of employment are reduced;
�� The parent-employee’s employment ends for any reason other than his or her gross misconduct;
�� The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
�� The parents become divorced or legally separated; or
�� The child stops being eligible for coverage under the plan as a “dependent child.”

‘(b) Regulations- The Secretary shall promulgate regulations to define the dependents to which coverage shall be made available under subsection (a).

The Secretary of Health and Human Services has the right to define 'dependents.' That can change with every administration though. I don't like that.

(c) Rule of Construction- Nothing in this section shall be construed to modify the definition of ‘dependent’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of the cost of coverage.

The definition that the Secretary of Health and Human Services is law. There is no other definition such as the one in the Tax Code that applies. The Senate bill was completely 'designed' to alienate the electorate from the achievements of this administration. It is very hostile. Very. There should never be a bill that removes the rights of citizens, so much as increases them. This provision was specifically written to victimize the citizens of the USA. There was one purpose in mind and that was to 'kill the bill.'

‘SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.

‘(a) In General- Not later than 12 months after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to enrollees a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. In developing such standards, the Secretary shall consult with the National Association of Insurance Commissioners (click here) (referred to in this section as the ‘NAIC’), a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.

The only way States can complain about States' Rights is if their regulations are tighter than the ones passed by the federal government. The States have to live up to the higher of the two standards and improve the quality of life of their citizens. The States do not have the 'right' to impoverish their people in regard to their quality of life if federal regulations demand it.

Health Care Reform Bill Draws Measured State Regulators' Response (click here)

By PHIL GUSMAN
Published 3/22/2010

NU Online News Service, March 22, 3:32 p.m. EDT

State insurance commissioners said they will work to implement aspects of federal health care reform where they are required to do so, but acknowledged that state legislatures could still challenge the reforms.

Oklahoma Commissioner Kim Holland, who is secretary treasurer of the National Association of Insurance Commissioners (NAIC) said during a teleconference she expects her state’s legislature may push back against the upcoming federal law.

Oklahoma is a conservative state, and the health care reform bill represents “extraordinary preemption.” she said.

In that case, she said, it is the role of insurance commissioners to provide impartial information as it is requested so that the legislators can make decisions.

Kansas Insurance Commissioner Sandy Praeger, who is chair of the NAIC Health Insurance and Managed Care Committee agreed, stating that regulators are responsible for making sure that when legislatures do make decisions, those decisions are based on accurate information and experiences from insurance departments.

Speaking to the threats of lawsuits that have cropped up from some states since the passage of the bill in the House of Representatives, Commissioner Praeger said such actions will not delay insurance commissioners from beginning work on implementing reforms where they are required to do so....

The Constitutional challenge to the Health Care Reform Bill will also be defeated here:

...“State regulators (click here) are best positioned to perform rate review and many of us do so with great success,” said Jane L. Cline, NAIC President and West Virginia Insurance Commissioner. “Some, however, have not been given the authority by their state legislatures to review and deny unjustified increases. We believe that a federal backstop could help encourage these legislatures to provide that authority.”

“It is absolutely critical that the state role in assuring the solvency of health plans and promoting competitive markets be preserved,” said Sandy Praeger, Chair of the NAIC Health Insurance and Managed Care Committee and Kansas Insurance Commissioner. “Protecting consumers from high premiums remains a priority, but it is even more important to protect them from insolvency.”

Vice-Chair of the NAIC Health Insurance and Managed Care Committee and Pennsylvania Insurance Commissioner Joel Ario pressed insurers to support reforms that would reduce the fragmentation of health insurance pools. “One problem with premium increases is that rates go up a lot more for some people than for others,” he said, noting that premiums in a reformed marketplace would be more stable for all Americans....

The Obama Administration was thorough in calling in all the authorities to the dynamics of the bill. They didn't leave a stone unturned and that defeat any challenge to the bill.

...Members of the NAIC met with President Barack Obama (click here) and Health and Human Services Secretary Kathleen Sebelius to discuss rate increases in the health insurance industry. The meeting, which also included top health insurance executives, was called to address recent significant rate increases as part of a larger discussion on how to improve health insurance markets for all consumers....

NAIC’ is an age old non-profit organization that has a lot of clout. It was established in 1871 and has advised State Regulators for that entire time. They are the quinessential authority on the health care insurance industry and how States interface with those companies. If this organization says the States need guidance and interference by the federal government than the States are out of bounds when it comes to screaming about Constitutionality. The people of the USA rely on their 'infrastructure' to discern what is best in policy and legislation, that is exactly the course President Obama took. There is no challenge to the bill here.

Everybody has been CONSULTED.

‘(b) Requirements- The standards for the summary of benefits and coverage developed under subsection (a) shall provide for the following:

(1) APPEARANCE- The standards shall ensure that the summary of benefits and coverage is presented in a uniform format that does not exceed 4 pages in length and does not include print smaller than 12-point font.

No fine print.

‘(2) LANGUAGE- The standards shall ensure that the summary is presented in a culturally and linguistically appropriate manner and utilizes terminology understandable by the average plan enrollee.

Grammar and spelling count. If health insurance companies are selling their products to the citizens of the USA then they have to speak their language in ways they understand.

‘(3) CONTENTS- The standards shall ensure that the summary of benefits and coverage includes--

‘(A) uniform definitions of standard insurance terms and medical terms (consistent with subsection (g)) so that consumers may compare health insurance coverage and understand the terms of coverage (or exception to such coverage);

Nothing unclear here.

‘(B) a description of the coverage, including cost sharing for--

All the costs have to be relieved along with the coverage the policy provides.

‘(i) each of the categories of the essential health benefits described in subparagraphs (A) through (J) of section 1302(b)(1) of the Patient Protection and Affordable Care Act; and

‘(ii) other benefits, as identified by the Secretary;

The Secretary has considerable power here to fine tune the benefits as they are to be addressed by the insurance companies, however, there is nothing in the verbiage that indicates the Secretary can 'diminish' any benefits. It clears states, "other benefits." That is a clear understanding there are MORE and not LESS benefits for the insured.

‘(C) the exceptions, reductions, and limitations on coverage;

The policies have to include in readable format the above. This is consumer protection and seeks to limit the ability to commit fraud. ie: ERISA and the fraud in Medicare Advantage. It will all be controlled by demands for explicit language. It is really unfortunate the American people have been 'worked over the coals' so to speak by this industry. It is plainly clear the legislative bodies of the USA don't trust them at all. Very unfortunate.

‘(D) the cost-sharing provisions, including deductible, coinsurance, and co-payment obligations;

‘(E) the renewability and continuation of coverage provisions;

The critics of this legislation simply do not recognize the damage the health care insurance industry has done to the people of this nation. They don't take this issue seriously.

‘(F) a coverage facts label that includes examples to illustrate common benefits scenarios, including pregnancy and serious or chronic medical conditions and related cost sharing, such scenarios to be based on recognized clinical practice guidelines;

And the legislators in the House and Senate that opposed this bill for political fodder are divisive as well as unethical. To actually allow it to continue for over 20 years and do NOTHING. Wow. And to realize the opportunity came in the way of a minority President dedicated to the 'people' and maintain a posture of 'obstructionism?' Double wow.

‘(G) a statement of whether the plan or coverage--

‘(i) provides minimum essential coverage (as defined under section 5000A(f) of the Internal Revenue Code 1986); and

‘(ii) ensures that the plan or coverage share of the total allowed costs of benefits provided under the plan or coverage is not less than 60 percent of such costs;

The bill provides for ''minimal essential'coverage as stated in a military bill which contains health and dental coverage for the military. It states the 'benefits' of any policy will be no less than 60% of the cost to the consumer. That is a low percentage, but, the consumer will at least know it. This is exactly why there needs to be a Public Option. That low percentage qualifies for 'mandatory coverage' but allows a lot of cost to fall on the shoulders of the consumer.

Using 'standard issue' government language also prevents any unconstitutionality as well.

A BILL (click here)

To amend the Internal Revenue Code of 1986 to ensure that health coverage provided by the Department of Defense is treated as minimal essential coverage.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. TREATMENT OF DEPARTMENT OF DEFENSE HEALTH COVERAGE AS MINIMAL ESSENTIAL COVERAGE.

(a) In General- Section 5000A(f)(1) of the Internal Revenue Code of 1986, as added by section 1501(b) of the Patient Protection and Affordable Care Act, is amended--

(1) by striking clause (iv) and inserting the following new clause:

`(iv) medical coverage under chapter 55 of title 10, United States Code, including coverage under the TRICARE program;';

-CITE-
10 USC CHAPTER 55 - MEDICAL AND DENTAL CARE                 01/05/2009  (click here

(2) by striking `or' at the end of clause (v);

(3) by striking the period at the end of clause (vi) and inserting `; or'; and

(4) by inserting after clause (vi) the following new clause:

`(vii) the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under section 349 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103-337; 10 U.S.C. 1587 note).'.

(b) Effective Date- The amendments made by this section shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act and shall be executed immediately after the amendments made by such section 1501(b).

I need to pause here for awhile.

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