The Rooster
"Okeydoke"
Saturday, March 27, 2010
Today is Earth Hour 2010. It occurs at 8:30 PM and that is usually when I blog a subject for the week.
I was going to do a history of the Earth awareness movement, but, I can always cover that on Earth Day which is April 22nd.
So, I've decided to serve my conscience and leave the electrical demands of pursuing a topic tonight to another time.
So, in observation of Earth Hour 2010 I won't be posting tonight.
Good night.
So, I've decided to serve my conscience and leave the electrical demands of pursuing a topic tonight to another time.
So, in observation of Earth Hour 2010 I won't be posting tonight.
Good night.
Supporting the local economies. Very important stuff.
...With the herd in prime condition, (click title to entry - thank you) and the couple lacking food and space to keep them, they frantically called slaughterhouses throughout the state. After several days they found an opening, but their experience highlights a growing problem for small farmers here and across the nation: too few slaughterhouses to meet the growing demand for locally raised meat....
There is an article in the New York Times that is near and dear to my heart. It is supporting local economies. It isn't such a strange concept. The Kosher Market Place started very locally. And while the 'organic and wholesome' markets are entering with more livestock than even the Kosher market place offered, there is a trend of closures to those local Kosher butchers.
The problem is economics and upgrading the facilities. It is my estimation if these two businesses would combine forces and petition their state legislators as well as their federal legislators they might find some funding. The Kosher CULTURE should never lack for enough funding to support its existence. But, it would be have more and varied business if the facility was also servicing the 'organic' and 'range fed' livestock market.
The other alternative is for the farmers to form a co-op and ask from some assistance in purchasing one or more of the former Kosher facilities and upgrading it to carry its demand and allow them to expand. I don't know if there is simply a smaller meat market, but, that can be researched without too much trouble.
Basically, the small family farm operations that enjoy this higher income market are starting to struggle and that is not a good sign.
continued...
There is an article in the New York Times that is near and dear to my heart. It is supporting local economies. It isn't such a strange concept. The Kosher Market Place started very locally. And while the 'organic and wholesome' markets are entering with more livestock than even the Kosher market place offered, there is a trend of closures to those local Kosher butchers.
The problem is economics and upgrading the facilities. It is my estimation if these two businesses would combine forces and petition their state legislators as well as their federal legislators they might find some funding. The Kosher CULTURE should never lack for enough funding to support its existence. But, it would be have more and varied business if the facility was also servicing the 'organic' and 'range fed' livestock market.
The other alternative is for the farmers to form a co-op and ask from some assistance in purchasing one or more of the former Kosher facilities and upgrading it to carry its demand and allow them to expand. I don't know if there is simply a smaller meat market, but, that can be researched without too much trouble.
Basically, the small family farm operations that enjoy this higher income market are starting to struggle and that is not a good sign.
| |||||
 | |||||
| Another U.S. kosher slaughterhouse, another closure (click here) | |||||
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| By Gal Beckerman, The Forward The shuttering of a New York kosher poultry slaughterhouse for serious sanitary violations is once again putting the spotlight on a Hasidic sect, some of whose members have repeatedly defied the law. A federal judge imposed a temporary restraining order and injunction December 29 against further slaughtering and processing at the plant, which serves the ultra-Orthodox enclave of New Square, home to members of the Skver Hasidic sect. The U.S. Attorney's Office for the Southern District of New York had requested these measures after numerous attempts by federal officials since 2002 to get the slaughterhouse to comply with the guidelines of the Poultry Products Inspection Act. The plant had been found by federal authorities to have numerous violations. As reported in a local newspaper,... | |||||
continued...
This is just residual effect from the sleevy Supreme Court decision. That is all this is.
This is what transpires when corporations own Supreme Court Justices and bad rulings result. The lower courts have to allow that precedent with some brevity into their subsequent rulings.
Rulings split on campaign fundraising (click title to entry – thank you)
A three-judge panel rejects a GOP challenge to limits on direct contributions to candidates or political parties. A D.C. appeals court rules that independent groups may spend as much as they wish.
By David G. Savage
March 27, 2010
Reporting from Washington - Federal judges handed down split verdicts on Friday in two separate decisions on campaign fundraising, ruling that the Republican National Committee and other political parties may not seek unlimited contributions from wealthy donors, but independent groups may do so.
The rulings came in a pair of cases testing the legal limits on money in politics.
The RNC and several conservative groups have been filing suits in recent years challenging money limits on free-speech grounds, confident the Supreme Court agrees with their view….
The Health Care Reform Bill passed the House on Wednesday and Humana is sending RNs out to their below 62 Medicare patients on Thursday. Harassment !
From a reliable source I have found out that the day after the Health Care Reform Bill passes the House of Representatives, Humana (knowing it lost Medicare Advantage) doubled their efforts to keep their clientele.
On Thursday, March 25th, Humana started to send Nurse Consultants to their clients under age 62 to evaluate their case and seek to manage their cases over the next few years in an attempt to remove them from Social Security Disability and Medicare and into the private market place and on to Health Care Exchanges.
That is harrasment of the infirmed and exploitation of those dependent on their benefits for any quality of life. These RN CASE MANAGERS are NOT ordered by any physician to carry out this task. They are corporate record keepers seeking illegitimate information and observation while offering to improve the cost of medications to the CITIZENS.
This is all part of the corruption of Medicare Advantage. Since Humana is losing Medicare Advantage patients they are seeking to drive as many handicapped into the private market place as they can before their 'ANNUAL FEDERAL ALLOTMENT' runs out !
Corrupt! Corrupt! Corrupt!
Below is an example of the credentials of a nurse case manager. This is not my source.
On Thursday, March 25th, Humana started to send Nurse Consultants to their clients under age 62 to evaluate their case and seek to manage their cases over the next few years in an attempt to remove them from Social Security Disability and Medicare and into the private market place and on to Health Care Exchanges.
That is harrasment of the infirmed and exploitation of those dependent on their benefits for any quality of life. These RN CASE MANAGERS are NOT ordered by any physician to carry out this task. They are corporate record keepers seeking illegitimate information and observation while offering to improve the cost of medications to the CITIZENS.
This is all part of the corruption of Medicare Advantage. Since Humana is losing Medicare Advantage patients they are seeking to drive as many handicapped into the private market place as they can before their 'ANNUAL FEDERAL ALLOTMENT' runs out !
Corrupt! Corrupt! Corrupt!
Below is an example of the credentials of a nurse case manager. This is not my source.
Lights out in Sydney as world begins Earth Hour
Sydney dims lights for Earth Hour (click here)
The Sydney Opera House, left, and the Harbour Bridge have their lights that usually have structures well lit at night turned off in Sydney on Saturday as part of Earth Hour. Millions of people in more than 100 countries are expected to dim the lights in what has become an annual gesture against global warming.
..."From Brazil to America, to Canada, all the way down to Australia, Japan and India - it's a really diverse set of countries taking part this year," Earth Hour executive director Andy Ridley said (click title to entry - thank you)....
A record 125 countries are taking part. (AFP: Greg Wood)
The Sydney Opera House, left, and the Harbour Bridge have their lights that usually have structures well lit at night turned off in Sydney on Saturday as part of Earth Hour. Millions of people in more than 100 countries are expected to dim the lights in what has become an annual gesture against global warming.
..."From Brazil to America, to Canada, all the way down to Australia, Japan and India - it's a really diverse set of countries taking part this year," Earth Hour executive director Andy Ridley said (click title to entry - thank you)....
A record 125 countries are taking part. (AFP: Greg Wood)
There seems to be a rumor circulating among Congressional Staffers that children aren't immediately covered. "W"rong.
What's the matter Sarah Palin's Governor Perry can't insure this
child's family will be alright.
Joking !
This is reckless endangerment and if anything happens to this child it is a "W"rongful death by insurance carrier !
This is your capitalism without regulation, America. Take a good look at it.
The parents may end up losing their home and income because the hospital bill wasn't covered by their insurance on a child they accepted, through ultrasound, as a child they would love no matter what.
Ask the Anti-Abortionists about this one !
March 26th, 2010 5:27 PM
Newborn with Birth Defect Denied Coverage
Health Care Provider Tells Texas Family Baby's Artery Problem is a Pre-Existing Condition; Won't Pay for Surgery
(CBS) For newborn Houston Tracy, the historic health care overhaul came too late.
Houston, born March 15 at a Texas hospital, suffers from a defect in his arteries. When his parents, Doug and Kim, applied to have his corrective surgery covered under their insurance, they were denied, with their carrier claiming Houston had a pre-existing condition, reports CBS station KTVT.
The Tracys are fighting the decision by Blue Cross and Blue Shield of Texas.
"They kept saying it's preexisting, it's preexisting, but I don't know how it can be preexisting on a baby that was just born," Doug Tracy said. "If it's mandated that everyone have health insurance, than how can one be denied?"
Legislation passed this week by Congress and signed by President Obama that would end the practice of denying coverage to patients with pre-existing conditions does not go into effect until September...
This law could have been passed and signed into law last JULY 2009, but, whom was it that obstructed it !
Health Care Insurance Exchanges don't spring up over night. The Secretary of Health and Human Services had no authority to arrange for them in anticipation or spend any taxpayer monies on contracts to independent companies to begin the process. A bill like that would have never passed through the Senate.
I just got finished ready how 'individuals' will have the ability within 90 days to have coverage under the 'exchanges' set up by this bill.
The press needs to have better sources than this.
This was reported by the Associated Press?
They better get information from the Justice Department attorneys and not Congressional staffers.
Who do they think individuals are?
Most needy children are already covered under S-CHIP. But, for those that aren't there is definitely recourse under this bill through the exchanges.
...Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday....
...Full protection for children would not come until 2014, said Kate Cyrul, a spokeswoman for the Senate Health, Education, Labor and Pensions Committee, another panel that authored the legislation. That's the same year when insurance companies could no longer deny coverage to any person on account of health problems....
When the law was a bill, the House bill, there was special treatment of children in that they would be covered immediately by any government insurance, if they were proven to need it, available at birth as they were immediately citizens and had immediate need for health care. I don't know if that is in effect in 90 days, but, children can get coverage under the provisions that address 'individuals' in the exchanges.
Applications to the exchanges are 'blind' to pre-existing conditions. They insurers in the exchanges cannot ask for that information, it is prohibited.
Maybe folks can't get their mind around that yet.
See, the insurance companies haven't been conducting their business properly. They treat citizens as peasants and seek to mitigate their 'bottom line' by eliminating sick peasants.
THAT is pure moronity.
The way insurance of any kind should be performed is through statistical analysis and 'risk' vs. 'cost.'
The CEOs of the current health care insurance companies are bozos. They don't bother seeking to have a 'long term' goal for any company so much as 'upticks' that supply their next bonus. They don't address the 'stockholders' at all as far as I am concerned given the "Crash of 2008."
At all.
The stockholders are the babies thrown out with the bathwater and that was demonstrated royally with the resignation/retirement of GM's former CEO. He did fine; it was the stockholders that took a bath.
The "Captains of Capitalism" are nothing but greedy little trolls that don't look at the long term gains of any company. This bill eliminates that Plutocracy for real health care.
You all need to get it right, because, the 'tail wagging the Obama administration' within its staffers don't know what they are talking about. Do they like scandals? For some reason? Ambition or doing things differently under this President than they are used to? If they have those problems they should not be staffing Congressional offices.
As a matter of fact there was a report on NPR that addressed the companies that were headed by women. They faired just fine through the Crash of 2008. Why? Because they are long term gamers that seek 'security' over 'boom and bust' and 'the quick buck.'
Friday, March 26, 2010
Here is the latest in cement. Click here. Back to reading.
It didn't imbed well. It needs to be watched to the end to understand the crisis.
And while we are on the subject of the Catholic Church, I don't consider something that happened nearly four decades ago relevant to the Pope as he leads the church forward.
Pope Benedict is a good person. The issues of pedophilia are settled. The 1970s were a different time.
Asking him to step down is a horrible thing to do. The Cardinals that elected him had to know about what was occurring. We witnessed how ill prepared the Bishops were to handle the circumstances in Boston.
The tragedy that is pedophilia within the Catholic Church will go on for some time. There are some remote areas of the world where they have missions and I am quite confident there will be stories told about those as well someday.
The issue is a personal one between those involved and the church. The children that were molested need to file a suit against the church. The real issue is not so much about the pedophilia from so long ago, but, how the current parishoners are 'fairing' through all this. I know for a fact from people I know they want to leave the church and some of the anger is about the monies that have to be paid out.
So, I think Pope Benedict has his hands full in many ways. The Catholic Church needs to come to terms with celibacy and the dangers that it allowed to hide within their churches. I believe that is part of it.
The only problem I can see is that the church has rolled back its progress to return to orthodox ways that are out of step with modern times. Their problems are bigger than the past. The Catholic Church doesn't know how to live in the present with hopes for the future.
And while we are on the subject of the Catholic Church, I don't consider something that happened nearly four decades ago relevant to the Pope as he leads the church forward.
Pope Benedict is a good person. The issues of pedophilia are settled. The 1970s were a different time.
Asking him to step down is a horrible thing to do. The Cardinals that elected him had to know about what was occurring. We witnessed how ill prepared the Bishops were to handle the circumstances in Boston.
The tragedy that is pedophilia within the Catholic Church will go on for some time. There are some remote areas of the world where they have missions and I am quite confident there will be stories told about those as well someday.
The issue is a personal one between those involved and the church. The children that were molested need to file a suit against the church. The real issue is not so much about the pedophilia from so long ago, but, how the current parishoners are 'fairing' through all this. I know for a fact from people I know they want to leave the church and some of the anger is about the monies that have to be paid out.
So, I think Pope Benedict has his hands full in many ways. The Catholic Church needs to come to terms with celibacy and the dangers that it allowed to hide within their churches. I believe that is part of it.
The only problem I can see is that the church has rolled back its progress to return to orthodox ways that are out of step with modern times. Their problems are bigger than the past. The Catholic Church doesn't know how to live in the present with hopes for the future.
Let's get something straight. If CITIZENS are not happy because they didn't get EVERYTHING they wanted in health care reform,...
There are only a very few people to blame and that is the Senate Republicans. They don't see their electorate as citizens needing their rights upheld, they see their electorate as peasants to Wall Street.
Get it right.
And I've seen the best of what the captains of Wall Street can do. Trust them? No.
Sen. Lindsey Graham (R-SC) speaks at the podium about the stimulus package while flanked by Sen. Jim DeMint (R-SC) (L) Rep. Tom Price (R-GA) (2nd-L) and other members of Congress during news conference February 4, 2009 in Washington, DC. Senate Republicans say they are alarmed by President Obama's stimulus package worth nearly $900 billion dollars, which will be voted on later in the week. (Photo by Mark Wilson/Getty Images) Tom Price;Jim DeMint;Lindsey Graham
Get it right.
And I've seen the best of what the captains of Wall Street can do. Trust them? No.
Sen. Lindsey Graham (R-SC) speaks at the podium about the stimulus package while flanked by Sen. Jim DeMint (R-SC) (L) Rep. Tom Price (R-GA) (2nd-L) and other members of Congress during news conference February 4, 2009 in Washington, DC. Senate Republicans say they are alarmed by President Obama's stimulus package worth nearly $900 billion dollars, which will be voted on later in the week. (Photo by Mark Wilson/Getty Images) Tom Price;Jim DeMint;Lindsey Graham
(February 4, 2009 - Photo by Mark Wilson/Getty Images North America)
Section 2701 simply states that insurers no longer can write policies based on a citizen's health status. Basically, the insurer and their wellness will be blind to insurance companies in any pool one enters to get health insurance. The likelihood of having a maximum deductible and high premiums is again reduced by that aspect of the new law.
So when citizens seek health insurance the underwriters to the policy CANNOT ask about pre-existing conditions even for the purpose of setting rates. The cost will be and should be based upon the number of people within that pool and the 'likelihood' of 'risk' to 'cost.'
THEY CAN'T EVEN ASK !!!!!!!!!!
The argument against that is stated as, if a young person wants health insurance and has no pre-existing condition they can't get the best rate available. It doesn't matter, because, as soon as that young person has 'SOMETHING, ANYTHING' go wrong their likelihood of keeping a lower cost policy will be gone. It isn't as though there is security in that point of view, there isn't. Even car accident or ski accident or appendectomy will cause an increase. The only security citizens have is to allow them to set rates based upon 'statistics' of 'occurrence.'
A pool of people will have a 'certain' ability to 'incur' an incident that will cost a health insurer expense. If you are that person and you are not in a pool to the insurer and blind to your risk, regardless of you age, you won't be able to get health insurance and your life is basically ruined.
Why put the people that occur 'expense' at greater risk than those that do? As citizens we are suppose to be equal in our understanding to our rights and Lady Justice is blind to many things except unlawful acts when all is considered. This law is absolutely the way it is suppose to be. By being part of a pool, the citizens are improving all their quality of life and longevity.
The rest of the law reads like this and takes into account age and difference in 'risk' to that age:
(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.
Youth will get a better rate than those in the pool that are older. At the same time, they also receive protection from not ever having health care again the rest of their lives.
I'll continue this later.
Senate passes reconciliation bill (click title to entry - thank you)
By Matthew DoBias
On 56-43 vote, the Senate cleared a set of amendments to a comprehensive package of health reforms signed into law earlier this week by President Barack Obama.
The bill now goes back to the House for final passage later this evening....
continued...
Section 2701 simply states that insurers no longer can write policies based on a citizen's health status. Basically, the insurer and their wellness will be blind to insurance companies in any pool one enters to get health insurance. The likelihood of having a maximum deductible and high premiums is again reduced by that aspect of the new law.
So when citizens seek health insurance the underwriters to the policy CANNOT ask about pre-existing conditions even for the purpose of setting rates. The cost will be and should be based upon the number of people within that pool and the 'likelihood' of 'risk' to 'cost.'
THEY CAN'T EVEN ASK !!!!!!!!!!
The argument against that is stated as, if a young person wants health insurance and has no pre-existing condition they can't get the best rate available. It doesn't matter, because, as soon as that young person has 'SOMETHING, ANYTHING' go wrong their likelihood of keeping a lower cost policy will be gone. It isn't as though there is security in that point of view, there isn't. Even car accident or ski accident or appendectomy will cause an increase. The only security citizens have is to allow them to set rates based upon 'statistics' of 'occurrence.'
A pool of people will have a 'certain' ability to 'incur' an incident that will cost a health insurer expense. If you are that person and you are not in a pool to the insurer and blind to your risk, regardless of you age, you won't be able to get health insurance and your life is basically ruined.
Why put the people that occur 'expense' at greater risk than those that do? As citizens we are suppose to be equal in our understanding to our rights and Lady Justice is blind to many things except unlawful acts when all is considered. This law is absolutely the way it is suppose to be. By being part of a pool, the citizens are improving all their quality of life and longevity.
The rest of the law reads like this and takes into account age and difference in 'risk' to that age:
(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.
Youth will get a better rate than those in the pool that are older. At the same time, they also receive protection from not ever having health care again the rest of their lives.
I'll continue this later.
Senate passes reconciliation bill (click title to entry - thank you)
By Matthew DoBiasPosted: March 25, 2010 - 2:15 pm ET
The bill now goes back to the House for final passage later this evening....
continued...
Thursday, March 25, 2010
The Health Care Law. Maybe Frum should be writing speeches at the DNC headquarters?
That is amazing. He tries to help from his perspective so the Republicans don't continue to destroy their own pahhhhhhhty and he gets kicked out of conservative institutions. That's okay David, you can walk in our direction now.
I left off with Section 1004 (b)
The next section is Subtitle B - Immediate Actions to Preserve and Expand Coverage
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.
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.
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