As I continue to read through the tentative House Bill regarding health care reform, I really don't find any untoward provisions, protections or guarantees. There is no intrusive government. The bill is well thought out, including vital aspects of goverance that will make it a success.
According to the House Bill on page 56, lines starting with 7 through 17, there is a clear procedure for an insurance company to drop coverage on anyone. There are no laws currently that provide for such protections.
‘‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL
THIRD PARTY REVIEW IN CASES OF RESCISSION.
‘‘(a) NOTICE AND REVIEW RIGHT.—If a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market, before such rescission may take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent, external third party under procedures specified by the Secretary under section 2742(f).
It is good law. It protects citizens of the USA against unfair business practices.
The bill goes to great detail to define all the words used to implement the law. Many of the pages aren't about law at all so much as clearly defining the meaning of words so they cannot be misconstrued later when the law is implemented. To say this legislation is detailed is an understatement. But, where it does discuss the law and changes to implementing health care reform, it is all beneficial to the citizens of the USA. It speaks to an excellant initiative to take away the 'victim' aspect of citizens while returning the role of health insurance companies to provide 'service.'
I like the bill. I am impressed by the dedication of the legislators that took the time to do it right. Maybe a better of putting the 'detail' of this law is that is makes considerable effort to close any loopholes so citizens won't be victimized.
The bill "Grandfather's" in existing coverage and provides for appeal processes.
The mainstay of the bill is on page 72, starting with line 1.
TITLE II—HEALTH INSURANCE EXCHANGE AND RELATED PROVISIONS
Subtitle A—Health Insurance Exchange
SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE EXCHANGE; OUTLINE OF DUTIES; DEFINITIONS.
(a) ESTABLISHMENT.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
The Public Option has to exist, but, I believe the reason the President and pundits for the bill state it needs to exist is the least of the reasons for its capacity. The favorite reason stated for the Public Option is to add competition to the market place. It might do that, but, its real value is in its reality to insure the uninsurable.
The bill clearly states their is a fluid relationship between health insurance companies and its members. It is obvious the bill does not want companies removing members from its roles and provides for mitigation and grievance processes to maintain insurance coverage by members. The bill perfers that a health insurance company continue its capacity with new understandings of coverage that would bring fairness to costs, including subscription fees, deductibles and copays.
Where the Public Option has its real value is not in replacing insurance companies or providing competition, but, by providing insurance when no other option is available. The Public Option picks up the slack to the citizens of the USA. Literally. I can imagine a health insurance company denying a claim for services due to expense and while the member might have access to an appeal process to reinstate their coverage and receive services from the insurance company; time marches on and illness waits for no one.
That is the ultimate purpose of any health insurance bill, to be sure coverage is available when a person needs it. That is primarily the complaint of so many when it comes to reform. For those that can get covereage, the 'presence' of insurance at the time of need is somewhat tenative all the time. There is little reassurance to any health insurance subscriber that their needs will be covered. With every admission to an emergency room or hospital room for a scheduled procedure, members have to wait in anticipation of receiving coverage and then left with horrible realities when an insurance company decides adversely.
The Public Option is more than simply another 'player' in the market place, it is actual insurance for all needs of any citizen of the USA. It provides coverage when others don't want to. It provides a place for people to turn when their needs are rejected by conventional, private coverage. It has a place beyond adding competition. In my opinion, the competition it supplies to the market place is the least of its value. Its paramount value is that it will cover citizens when no other entity will. And that is why a Public Option is required in any legislation for health care.
If the private sector is to remain autonomous while adhering to the laws of this bill, then a Public Option has to exist when the private sector fails to commit to the needs of its members. That is the primary purpose for The Public Option. It's there. It will provide. Citizens are safe and are no longer at the mercy of profiteers that seek profits over services.
The bill is thoughtful enough to conduct studies regarding the cost of health insurance and employers and individuals. The bill does not simply set rules regarding employer related health care without seeking to understand the viability of the business or individual related to the costs of that health care. On page 83, lines 1 through 11 the bill asks the question, "How is everyone doing?"
IN GENERAL.—The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.
There is nothing wrong and everything right with performing 'follow up' to legislation as vital as national health insurance reform. The bill provides for review of the options for individuals and employers in relation to opening up options for them as needs require. The bill makes no assumptions of complete knowledge of the need of Americans and their employers. What it does do is provide for transparency to allow changes in the law to include or exclude participants as presented over time. There is a lot correct in that focus.
The bill also goes through great trouble to delineate 'Smallest Employers' from 'Small Employers' to 'Large Employers.' While there isn't exact explanations at this point to their difference in definition, it looks as though the delineation is important and probably allows for certain participation with costs scaled to the viability of the business itself. I really believe there is a lot here for small business owners.
Page 83, lines 12 through 21.
ITEMS INCLUDED IN STUDY.—Such study also shall examine—
the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.
the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.
The complaining by citizens and small business owners just doesn't match what the bill states. Page 86 provides for explanations of 'tiered' plans and needs. What more do people want?
(A) IN GENERAL.—A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.
B) TIERED COST-SHARING FOR AFFORDABLE CREDIT ELIGIBLE INDIVIDUALS.—In the case of an affordable credit eligible individual (as defined in section 242(a)(1)) enrolled in an Exchange-participating health benefits plan, the benefits under a basic plan are modified to provide for the reduced cost-sharing for the income tier applicable to the individual under section 244(c).
ENHANCED PLAN.—A enhanced plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(A).
PREMIUM PLAN.—A premium plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(B).
PREMIUM-PLUS PLAN.—A premium-plus plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner. The portion of the premium that is attributable to such additional benefits shall be separately specified.
Not everyone will have a premium plan available to them if they need cost sharing. Why does that sound fair and equitable?
Page 91, line 4 through 7
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES AND COMMUNICATIONS.—The entity shall provide for culturally and linguistically appropriate communication and health services.
I am still waiting to find the terrible parts.
Page 95, lines 8 through 18, stands in definance of anyone stating handicapped persons/children would be victimized by the bill. Why does the bill go through so much trouble in finding people who may qualify under the provisions of the bill if it were going to eliminate such 'needy' people from insurance services? The entire 'idea' that the USA would harm any handicapped or challenged person or child is simply outrageous.
OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.
Why go through the trouble of outreach at all if the bill were seeking to victimize them and harm them? The entire allogation that the people of the USA would do harm to any of its citizens is completely abhorrent to our values as a nation.
Page 96, lines 4 through 9
IN GENERAL.—The Commissioner shall establish a process consistent with this title for enrollments in Exchange-participating health benefits plans. Such process shall provide for enrollment through means such as the mail, by telephone, electronically, and in person.
