I left off with Section 1004 (b)
The next section is Subtitle B - Immediate Actions to Preserve and Expand Coverage
SEC. 1101. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.
(a) In General- Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.On July 14, 2010 these provision take effect under this provision until January 2, 1024 when the mainstay of the law comes into effect.
(b) Administration-
(1) IN GENERAL- The Secretary may carry out the program under this section directly or through contracts to eligible entities.
The language is clear. The Secretary of Health and Human Services will administer the program out of her office or she will have 'contracts' with reputable and dependable individuals, companies or otherwise to administer the law as written so the department has assistance with the transition.
(2) ELIGIBLE ENTITIES- To be eligible for a contract under paragraph (1), an entity shall--
These are the conditions the Secretary has to adhere to when contracting outside entities to carry out the law.
(A) be a State or nonprofit private entity;
There is just one objection that hasn't been written into the law. I don't see this happening with a novice or new start up company. I would expect the Secretary to have a good idea as to what entity would be best and most reputable and most trustworthy to carry out the new law.
(B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and
(C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals.
(3) MAINTENANCE OF EFFORT- To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into.
(c) Qualified High Risk Pool-
Definition most likely as to whom exactly is comprising a High Risk Pool.
(1) IN GENERAL- Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2).
(2) REQUIREMENTS- A qualified high risk pool meets the requirements of this paragraph if such pool--
This is very suspenseful. Reading all these requirements before the requirements makes it suspenseful by the time the legislation finally gets around to it.
(A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage;
(B) provides health insurance coverage--
(i) in which the issuer’s share of the total allowed costs of benefits provided under such coverage is not less than 65 percent of such costs; and
That means there can be a profit of any policy written that reflects a surplus amount to the INSURED of no more than 35%. That would be the profit the company that is supplying the insurance can charge under the law. The reason that exists is because there is NOT in place regulatory agents trained and able to carry out the law that will take effect January 1, 2014 which limits profits to 20%.
The issuer cannot charge astronomical costs to any individual to provide a PROHIBITIVE mechanism to keep citizens from obtaining the policies. In other words, these polices are the ones that the insurance industry has proven to discard as unprofitable. Hm.
(ii) that has an out of pocket limit not greater than the applicable amount described in section 223(c)(2) of the Internal Revenue Code of 1986 (click here) for the year involved, except that the Secretary may modify such limit if necessary to ensure the pool meets the actuarial value limit under clause (i);
This is only a guess, but, I estimate that most of these policies will fall under and be protected by this provision from the above statute.
(C) Safe harbor for absence of preventive care deductible
A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for preventive care (within the meaning of section 1871 of the Social Security Act, except as otherwise provided by the Secretary).
That means the insurers can call these policies 'high risk' and apply the deductibles that the law states are maximum to the policies, BUT, they cannot apply hideous deductibles to those policies.
And these would be the WORSE case deductibles for these policies:
(B) in the case of an eligible individual who has family coverage under a high deductible health plan as of the first day of such month, the lesser of—
(i) the annual deductible under such coverage,
or
(ii) $5,150.
If I am reading the statue quoted above correctly, the annual deductible is no more than $5,150. The portion that discusses MONTHLY also states this:
(2) Monthly limitation
The monthly limitation for any month is 1⁄12 of—
Therefore, the deductible to any insured in any given month to any high risk, high deductible POOL member will not exceed more than $429.17, plus the premiums. And of course, the premiums to this pool will be shared on a large scale basis of many members so that one member is not receiving exorbitant premiums. The premiums will be consistent throughout the 'pool member.'
(2) High deductible health plan
(A) In general
The term “high deductible health plan” means a health plan—
(i) which has an annual deductible which is not less than—
(I) $1,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage, and
(ii) the sum of the annual deductible and the other annual out-of-pocket expenses required to be paid under the plan (other than for premiums) for covered benefits does not exceed—
(I) $5,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage.
(C) ensures that with respect to the premium rate charged for health insurance coverage offered to eligible individuals through the high risk pool, such rate shall--
(i) except as provided in clause (ii), vary only as provided for under section 2701 of the Public Health Service Act ( the title used for the Public Health Service Act is Title 42 (click here)
The problem is the 'on line' version of the Public Health Service Act is divided into 'chapters' which would then contain 'sections' of which lies 'section 2701.' There is no search engine on that website and makes it a little tedious to find it. I will trust the 'entities' that will administering that law will be able to find it.
(as amended by this Act and notwithstanding the date on which such amendments take effect);
The Public Health Service Act, Title 42, was one of the first legislative measures by the new country's congress. Let me see when it was written, something like 1792. Sorry, it is NOT that old, it just seemed like it. The law was written in 1944. It has been amended many, many, many times over which led me to believe it was written hundreds of years ago and not decades. So the statement above about 'not withstanding the date on which such amendments, etc' is simply a legal issue to include the date of enactment of the amendment.
But, before going any further it looks as though the legislators have done all they could to keep the cost somewhat reasonable. It looks as though the most any insurer, up to January 1, 2014, can charge to any insured in this 'high risk pool' is approximately $5000.00 annually plus premiums as decided by the administrator of the POOL. That premium can only be 'marked up' 35% of determined costs the insurer can PROVE are theirs to pay.
It sounds like a lot and it is, however, that is better than having no insurance. People without insurance run the risk of feeling hopeless, justifying their lack of physician attention due to lack of coverage, turn to non-traditional methods of 'healing' and could subsequently die due to self diagnosis and self medicating. It is a good investment for the meantime until the mainstay of the bill takes effect. The 'key' here is mandatory vs non-compliant. The 'key' is budgeting and seeking help with the cost as it arises where one can. Sometimes that means asking for help if one sincerely needs it AND possibly qualifying for other assistance programs if the cost is too 'out of reach.'
I hesitate to say this is a 'give away' to health insurers. I don't believe it is. That 35% profit could disappear if the company isn't administering their own responsibilities correctly. There is also the monitoring that goes along with all this to be sure costs are 'correct' and kept in check as the current administration realizes and has made a high priority the fact that people drop their coverage if they need monies for other purposes over and above health insurance coverage when they aren't feeling ill.
The law is not designed to alienate people or serve an empty purpose. There are insurances today that don't even cover that much for a lot more than is reasonable to pay.
90 days from now, we'll know for sure.
(ii) vary on the basis of age by a factor of not greater than 4 to 1; and
(iii) be established at a standard rate for a standard population; and
(D) meets any other requirements determined appropriate by the Secretary.
I'll pick up again tomorrow.
