Right there on the "Committee for Education and Labor" website is full access to not only the House bill, but, all the standard questions regarding the bill. The link to the bill is entitled, "America's Affordable Health Choices Act." Not hard to find. I think it is called transparency.
As expected with any 'document' that is legal and binding, this one starts with an enormous effort to 'define' terms. The reason that occurs is to be 'clear' to the understanding of the law and who it impacts. It is responsible legislation and it is done quite well. I am not saying it makes it easy to read, I am simply saying it is a comprehensive legal format that anyone reading such documents recognizes. There are no attempts to confusion the issue or provide a barrier to understanding, these early words in the bill are standard and necessary.
The numbers in the left hand column of any page are there for only one purpose and that is to reference a written phrase or paragraph. There is no other reason for those numbers. It is correct and concise use of 'space' on a page quite frankly. Literally, a legislator can speak to a particular subject within the legislation by stating, "Page 14, lines 14 through 24." Easy. That by the way is the citation for the statement that begins this historic document as noted below.
Right off the top, the legislation states clearly the purpose of this lengthy document. It sets 'the tone' of the legislation. I preceive it as a benevolent tone.
TITLE I—PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS
Subtitle A—General Standards
SEC. 101. REQUIREMENTS REFORMING HEALTH INSURANCE MARKETPLACE.
(a) PURPOSE.—The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.
Establishing standards is what government does.
Some of the most historically significant legislative acts in the USA were regarding health, a long time ago. The first legislative venture to protecting American's health began with The Air Pollution Control Act of 1955. It later was modified and tightened up over the decades to The Clean Air Act. Some of the legislation regarding this act took us to the place we find ourselves today regarding dangerous carbon dioxide levels. The Clean Air Act Amendments provided for protections from acid rain, tropospheric ozone depletion, prohibited high levels on ground ozone and even entertained the idea of emissions trading.
So, when an American stops to think about health care and setting standards it can be realized we have been at this a long, long time and it has been successful. American legislators know their business and pass very effective legislation on behalf of the people of this country.
There are going to be some changes to the way Health Insurance Companies will be writing their policies to whomever their members are. It is provided for under the "American's Affordable Health Care Choice Act." Such changes has several sound reasons. The "American's Affordable Health Choices Act" (let's just call it AAHCA) demands that affordable health care for all is not simply 'coverage' but 'qualifies' as health care at all. I think the bill says it better than I. Page 15, Lines 1 through 6.
(b) REQUIREMENTS FOR QUALIFIED HEALTH BENEFITS PLANS.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:...
Those six lines on Page 15 tell me I can't be conned into believing I am paying for health coverage only to find out later, when I need it, that the policy has a huge gap from what I expected.
Those six lines will provide for 'qualifications' to call a health insurance policy to be what it is.
That 's never been done before.
Nowhere in any legislation in the history of the USA has a legislative body set pen to paper to DEFINE what QUALIFIES as health insurance. Do you know how valuable that is? Six lines when voted into law in the United States of America will demand EVERY health insurance carrier to qualify as to what they actually claim they are. That is priceless, to us, to our children. We cannot be conned by a company that will take money right up to the point where you need coverage, but, 'Ooops, it doesn't cover that.'
Think about it. There is NOTHING in any legislation in this country that protects citizens from exploitation right to the point where denial of coverage sends a subscriber to the grave. Nothing on the books that will protect anyone in this country. Six lines on Page 15 of the AAHCA will set the demands for identifying a health insurance company according to qualifications by their government. Invaluable and that is just the beginning of this document.
To just contrast as to 'what goes on' now? The health care insurance people now have a 'contract' with its members. It falls under contract law. Consumer protection agencies can act to protect citizens when insurance companies aren't living up to the letter of the 'contract' but any state or federal agency or court cannot provide coverage or demand it regardless of circumstances if it is not written in the contract.
The AAHCA ends all that and provides means for health insurance companies to 'qualify' as such and then provides standards for 'quality, affordable health care.' It is a necessary bill. Vital actually.
Page 19, beginning with line 15 the bill states clearly the 'guarantees' Americans can expect from their health insurance companies. It guarantees people with pre-existing conditions can obtain affordable health insurance, it guarantees people will keep the health insurance of choice through renewal processes. Those pre-exisiting conditions also include mental health and substance abuse rehabilitation.
The bill also protects health insurance companies stating they can reject claims that are fraudulent. This is not completely a one-sided, consumer takes all bill. AAHCA protects health insurance companies as well, recognizing fraud can occur within the health care industry and where it occurs it won't be tolerated.
Within AAHCA there is recognition of the need for studies that provide profiles of consumers. The bill looks to find where services are used, where they are needed and how that impacts cost. In other words the bill provides for continuous quality improvement. I am sure everyone that works in this world understands that concept. Well, the bill doesn't drop the ball at the fifty yard line for a lucky punt in hopes that its length will cover all necessary topics, it remains a 'living' document to follow Americans in their needs and access. It seeks improvement and doesn't leave it to chance. The bill actively wants to be a partner to any health insurance company to assist in containing costs while supplying coverage.
Page 26, lines 16 through 20. An American will receive appropriate and necessary care.
(c) NO RESTRICTIONS ON COVERAGE UNRELATED TO CLINICAL APPROPRIATENESS.—A qualified health benefits plan may not impose any restriction (other than cost sharing)unrelated to clinical appropriateness on the coverage of the health care items and services.
This removes the health care insurer from making decisions best left to a doctor and patient. The health care insurers cannot state what is appropriate or inappropriate when a physician/surgeon is treating a patient. The health insurers can seek cost sharing initiatives to bring down cost, but, not to the point where it is detrimental to the patient's outcome as perscribed by a physician.
Page 26, line 21 begins to describe "ESSENTIAL BENEFITS PACKAGE" which has to include hospitalization, physicians, medications and basically everything an average American would expect to find in a health care policy.
Page 28, line 22 begins to discuss 'cost sharing' in regard to what the limits are for any health insurance company and any 'insured entity' be it an individual, family, parent and child, partner, etc. The Cost Sharing isn't as generous as one might expect. There is to be absolutely no cost for preventive items and services. That is significant, because, it is the entry point where costs are reduced and quality of care is improved. By supplying a cost free service to all Americans at this basic level it opens the door to improving our health care system at every turn. It is vital and necessary.
Page 29, lines 9 through 16 definitively gives everyone a reason to maintain their health with wellness check ups. Page 29, lines 9 through 16 also sets a limit on the cost anyone is expected to pay on an annual basis for their 'interventional medicine' (my words, not theirs). It ain't cheap, but, it is affordable if people are prepared for the worst.
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
It is the kind of thing that one needs a savings account for and NOT necessarily a health care savings account UNLESS one knows there are certain procedures expected in any given year. It is a prudent measure to contain costs to the government and provides for an incentive to save monies with anticipation of perhaps needing them someday. No one will lose their homes over an illness either.
I have to say, I approve of these parameters. It prevents abuse of our health care system while containing the cost to any individual. If a family were 'in need' I can easily see myself running a community benefit to help those that cannot afford the $10,000. It is a reasonable amount. It is not open ended. And here again, it is not mandatory depending on the health insurance company one subscribes to. It is just that it cannot go any higher on any given year.
Page 30, line 11 is the beginning of discussing "The Health Benefits Advisory Committee." It is chaired by The Surgeon General. Thinking back, I wouldn't mind someone like C. Everett Koop setting standards and expectations of our health care system.
It is NOT a 'Death Panel.' As a matter of fact...well, I want to review the words first. These are the words from Page 30, lines 11 through 21:
(b) DUTIES.—
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
In reading these words, it is my opinion the Health Benefits Advisory Committee will go to every means possible to prolong life. Let me explain.
The new President has made his mark in many areas of health care already, besides this bill. He has opened up the field of 'investigational' areas of medicine. He has authorized the investigation of genetic medicine to stop diseases such as diabetes and Alzheimers. Etc. Etc. Etc.
How many times in my lifetime have I heard a patient say, "I can't get that procedure because my health insurance won't cover it." Lots. Americans have died when a procedure such as a bone marrow transplant would have saved them.
It is my opinion The Health Benefits Advisory Board will 'require' certain investigational procedures and medications to be covered by any health insurance provider. In other words, when a child with leukemia can be saved by the transplant of bone marrow there won't be the ability of a health insurance company to say 'no' to proven treatments or those treatments currently engaged in places such as The Cleveland Clinic under the auspices of the CDC.
I don't believe we need to be afraid of The Health Benefits Advisory Board. It will be a benevolent addition to our health care system and will reassure nervous insurace providers that indeed the procedure or medication has been reviewed by the CDC and is proven to have a benefit. It is the extent of the benefit of the medication or procedure that is in question and is why more use of investigational medicine is better than less.
It isn't the kind of thing where people will be required to be guinea pigs either.
In the world as it exists today for Americans that are faced with desperate health outcomes, the 'option' of trying an investigational medication or procedure already approved by the CDC is a matter of consent. It is like going into surgery. The consumer has to be made aware of any and all side effects or dangers linked to the investigational procedure. It is frequently the frustration of physicians or surgeons to be limited in their scope of possibilities in providing care to patients. It is my firm opinion, The Health Benefits Advisory Board will enhance the quality of care in the USA. I like it.
I am going to end here for today. I might simply take Sunday off. I wish you all well and keep your chin up. I trust President Obama. Sincerely. He's a good man, Charlie Brown.
Until later...
