Here again, the bill serves the people of the country and not any fiscal entity that would benefit from the new law it creates. At the forefront of any of this legislation is the citizen and their needs in health insurance reform. The House should be proud of their dedication to the 'best outcome' for Americans outlined in this bill. It is carefully stated to keep 'the people/person' the focus of the law. The Federal Government gives up no authority to retain any of the provisions for its authority regardless of a State or Regional Exchange. That is how it will maintain its oversight to such programs until they are found to be sound and citizens are protected with viability. It's a good thing.
Page 116, Lines 1 through 17, sets up The Public Option for health insurance. This is the beginning paragraph:Subtitle B—Public Health Insurance Option
SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.
ESTABLISHMENT.—For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the ‘‘public health insurance option’’) that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary’s primary responsibility is to create a low-cost plan without comprimising quality or access to care.
It provides for all the same options within any other insurance offered at The Exchange. This option is to be marketed at The Exchange. It provides for data collection to set rates and prices. This is the paragraph on Page 118, lines 4 through 9:
DATA COLLECTION.—The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care.
This data will become an information bank for all health insurance companies. If insurance companies want to sincerely compete in the market place they will have to take into consideration the statistics that will come out of the public option in health insurance. If the companies are to compete for the business of the people taking the public option they will have to come to understand who and why they fall under this provision of the law. Once they understand the 'populous' that subscribes to the public option they can begin to taylor more of their own products to meet the needs of those accepting the public option.
This provision is especially interesting. It provides for access to federal courts to assure Medicare participants they will not lose rights under this new law. Page 118, lines 14 through 22:
ACCESS TO FEDERAL COURTS.—The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.
I see this provision as a means for 'interest groups' such as AARP to litigate any complaints their members might have. Of course, individuals can always bring suit if necessary, but, more than likely if there is something about the law that impinges on the rights of Medicare recipients it will happen in larger numbers than an individual. So this provision would be of particular interest to 'interest groups' as a method to protect their members.
The section regarding The Public Option goes on for quite a few pages. It discusses the particulars of how the option will provide for people. Of most concern so far is the establishment of a provider network that will accept payments under this option. It is based in the rates Medicare pays, however, the Secretary has the authority to increase said payments to providers if there are too few providers for any geographic area. The idea is to have established by Y 4 payments that will support a provider network for this option. That is upto page 124.
There are going to be two levels of physicians. There is to be no compromise in the quality of care or the quality of physicans. But, the two levels are delineation in relation to payment. Page 127, lines 1 through 16. These are levels of physicans for the Public Option.
PHYSICIANS.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes:
PREFERRED PHYSICIANS.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.
PARTICIPATING, NON-PREFERRED PHYSICIANS.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.
The cost for the Public Option will be based on "Affordability Credit." The Affordability Credit will be applied for by persons unable to pay for the entire premium they fall under or their family falls under. The funds to make up the difference will come from the Trust Fund. The Trust Fund must maintain a 90 day balance of funds in the Exchange for anticipated expenditures. Those funds can be appropriated from the General Treasury initially, but, constituted from payments from individuals or companies. That brings us to page 130 of the bill.
During Y1 and Y2 the Affordibility Credit can only be used on the Basic Option. After Y3 the credits can be expanded to other levels of care, however, the difference between the credit and the price of the policy has to be paid by the insured. At no point in time will an Affordibility Credit be transacted into a rebate or refund for cash. They are strickly for the use of purchasing health insurance. The Affordibility Credit is applied to families with incomes 400 percent of the Federal poverty level (or if my math is correct approximately $68,000). The term family may exclude divorced or separated couples depending on their income while raising the family alone. And the term 'income' is to Adjusted Gross Income. There is a formula to apply for calculating the amount a family would pay over a one year plan. Those payments will be broken down into 1/12th of the total to be paid monthly. Not all plans may survive the implementation of the law. If there is limited enrollment of any of the plans, those plans may be dropped from the funding.
Page 137, lines 1 through 3 provides for the scale of premiums for people receiveing Affordibility Credits. The table is on Page 137, to transfer the table here doesn't turn out well enough to make sense of it. The bill goes on to enforce integrity of the provisions, what constitutes income and how it is reported and what constitutes a change in income, etc.
Page 143, line 16 begins to speak to Employer Responsibility in offering health insurance. It goes on to explain the relationship between emloyee and employer, family coverage, percentage of benefit paid, the timeliness of the payment of the benefit, the percentage a company has to pay for its employees. Generally, the employer contribution is 72.5% for individual and 65% for a family. It provides the definition of full time employee, autoenrollment of employees. It addresses the cost of 'Exchange Coverage.' The law allows the Commissioner to set percentages an employer needs to pay for less than full time employees. It also states, a percentage discount on a policy for employees does not constitute payment of the premium. There is also the election by an employee to 'Opt-Out' of any insurance coverage. That action by the employee has to occur in 30 days of the first option for automatic enrollment.
On page 150 the bill starts to explain the law in relation to small businesses and it is here I will stop for this evening.
