HR3200: The House plan for health care reform
Submitted by R. Neal on Wed, 2009/07/15 - 8:04am

Here is the 1000+ page bill, and here is a summary. Here is the House combined committee overview page with lots of links and discussion.

Reading through the first 200 or so pages related to health insurance coverage, following are some highlights as I understood them:

continued...

Affordable coverage and consumer protections:

• Sets medical loss ratios for insurance companies and plans, provides rebates to policyholders if not met.

• Prohibits rescission except in provable cases of fraud, provides for independent appeals process.

• Prohibits exclusions for pre-existing conditions or limitations of benefits based on health-related factors.

• Standardized electronic claims filing

• Standardized electronic eligibility determination at point of service

• Requires timely payment of claims.

• Disclosure of plan terms and conditions, financial disclosures, enrollment data, claims denials, rating practices, and cost-sharing in "plain language."

• Guarantees issue and renewability

Guaranteed essential benefits:

• Hospitalization, outpatient, and emergency room services

• Professional services of physicians and other health professionals

• Related equipment and supplies

• Rehabilitative services

• Mental health and substance use disorder services

• Preventive services

• Maternity care

• Infant and children care, oral, health, vision, and hearing for under 21

• Sets annual limits for out of pocket cost sharing

• No annual or lifetime limits

• No cost sharing for preventive services

• Premiums may vary by age

• Premiums may vary by premium rating area (geographic?)

• Provider networks must meet standards of adequacy

• Must provide 70% of full actuarial value of benefits

• Additional provisions for "enhanced" and "premium" plans

Health Insurance Exchange:

• Individuals eligible to obtain coverage unless enrolled in another plan or have other acceptable coverage or are eligible for Medicare, Medicaid, or VA.

• Employers eligible to enroll employees if certain requirements are met.

• Provides affordability credits for individuals up to 400% of poverty, with tiered cost-sharing for those with employer provided plans with premiums exceeding 11% of income.

• Automatic Medicaid enrollment if exchange determines individuals are eligible.

• Plans must provide essential benefits package, participating insurance companies may also offer enhanced and premium plans if they are already provided in their service area.

• Available only to individuals and smallest employers (10 employees or fewer) the first year. Phased in for larger employers over three years or more.

• States may opt out of federal program and operate their own exchange.

• Participating insurance plans must meet certain requirements, such as providing information for risk pooling and providing for implementation of affordability credits.

• Consumers pay premiums directly to insurance companies, exchange commission will provide consumer assistance with choosing plans.

• Participating insurance companies regulated by federal and state government.

Public Option:

• Available only through the exchange.

• Meets requirements of exchange basic, enhanced and premium plans.

• Government may outsource administration, but not risk.

• Geographically adjusted premiums that fully finance health benefits and administrative costs.

• Provider payment rates same as Medicare plus 5% for the first three years.

• Payment rates for prescription drugs will be negotiated.

• Provider network is the same as Medicare unless provider opts out of public option.

Shared Responsibility:

• Individuals required to obtain acceptable coverage or pay penalty equal to 2.5% of income into the exchange.

• Employers must provide insurance and pay a substantial part of the premium or pay penalty of 8% of payroll into the exchange.

• Employers must automatically enroll employees unless employee opts out, in which case employers must pay 8% of employees wages into the exchange.

• Employers with payroll under $250,000 are exempt from the 8% rule, graduated percentage up to $400,000 in payroll.

• Employers prohibited from "steering" employees away from employer plan into individual exchange plan.

• A small business tax credit is available for businesses who provide employee insurance.

• Additional tax surcharge on high income individuals (1% if over $350,000, 1.5% if over $500,000, 5.4% if over $1,000,000). The 1% and 1.5% surcharges double after two years if federal health care savings targets are not met.

There are 800 more pages dealing with changes to Medicare and Medicaid that I have not studied.

On the whole, these are pretty good changes. My main objection is the focus on employer provided insurance. Health insurance must be divorced from employment.

It is not clear if individual plans available through the exchange are portable from state to state. It is also not clear whether lower income individuals who are self-employed or underemployed will be able to afford the basic essentials plan, which is pretty good insurance and presumably won't be cheap, even with affordability credits. And if they work for someone who doesn't provide insurance or they opt out of their employer's plan, it does not appear that they directly benefit from the 8% employer penalty in terms of premium reduction.

On the plus side, employers who are providing insurance and paying more than 8% will likely opt out and pay the 8% instead. This means more people end up in the exchange pool with individual policies, which is where everyone should be whether it's the public option or some other plan.

I don't understand why new taxes on high-income individuals (or the employer penalties) are needed to pay for this. If most individual and group insurance is provided through the exchange and the exchange is managed as a single risk pool, the premiums should pay for the coverage including the affordability credits.

At any rate, after looking at some of the details it's not a bad start. It addresses exclusion and rescission, provides other consumer protections and efficiencies, and includes a public option. It does not appear to address portability, and it does not remove employment from the equation. Allowing states to opt out of the exchange dilutes the purpose of the exchange and could lead to a whole new set of problems. It's ridiculously complicated, and it's certainly not single payer or anything close to it. But maybe it's better than nothing, assuming it can be done.

Topics:
143
vote
metulj's picture

It addresses exclusion and

Submitted by metulj on Wed, 2009/07/15 - 8:55am.

It addresses exclusion and rescission, provides other consumer protections and efficiencies, and includes a public option. It does not appear to address portability, and it does not remove employment from the equation. Allowing states to opt out of the exchange dilutes the purpose of the exchange. It's ridiculously complicated, and it's certainly not single payer or anything close to it.

Exclusion and rescission are key components as these are "juice" money for health insurance companies. Basically, it is a way of profiting from not honoring contracts, or, better, playing Calvinball with the contracts in order to profit. The public option is head-scratchingly complicated. If I want to be in the public option, I should be able to just ask for it if I think it is going to be better than my current plan. Tough shit for the insurance companies if they can't compete on price. They should have thought of that long ago when they started treating people in this country's health like bank accounts.

Right now, our monthly coverage is $539 for a private family plan (self-employed). It excludes my wife's pre-existing condition perpetually and basically is there in case one of us breaks a leg or the like as it only provides modest coverage for me because I had a high cholesterol count once in 1999. They've already tried to deny coverage on several things based on that one incident alone, including things that have nothing to do with my ticker (which is fine). If it comes in $1 under that $539 and expands my coverage by the Nth degree, then good bye BCBS.

I do like the 5% more than Medicare payment as red meat for providers.

The tax on the wealthy is weird and stinks of make-work class distinction.

True happiness is knowing you are a hypocrite. -- Ivor Cutler

Seppuku is in a way the ultimate awful libertarian act -- Frank Popper

FreedomForAll's picture

The bill outlaws private health insurance

Submitted by FreedomForAll (not verified) on Thu, 2009/07/16 - 9:05am.

Read closely. Page 16. You will no longer have the option of purchasing a private health insurance plan! You can keep an existing plan, but you can not buy a new one. Scary. I don't want gov health insurance. Look at the wait times in Canada and the UK. I know people in Canada, and they hate their system. Try waiting 2 years or longer to be assigned a family doctor. Sad.

tanzarian's picture

Haha I wish

Submitted by tanzarian on Thu, 2009/07/16 - 2:53pm.

this bill would make the U.S. system more like Canada's. Rest assured, your right to get hosed by private insurance will remain intact.

Anyway, the House bill is certainly an improvement over the status quo. It would eliminate some of the worst practices of insurance companies like rescission, and with the subsidies at least those without coverage now will be able to get basic care.

HonestyInMedicine's picture

Lots of scary stuff in HR 3200

Submitted by HonestyInMedicine on Sun, 2009/07/19 - 12:54pm.

www.healthplanspecialists.com

You are absolutely right. If you didn't have an individual policy in force before the first day this plan would go into effect you wouldn't be able to apply and get another one. In fact all you can do is keep the individual plan you have now because it doesn't even allow the insurers to keep marketing the plan to new individuals.But you may not even be safe doing that because carriers might decide they don't want to continue to cover insureds if they can't keep selling new policies. I saw that happen when Rhode Island legislators mucked up the state health insurance regulations so badly that all the national carriers except one left the state and one gave 90 days notice to it's Rhode Island insureds that they better find other coverage because they were leaving the state.

I've also been licensed in Massachusetts and the Mandate they have there now has resulted in FEWER more expensive choices and as would follow, fewer people with insurance-- the EXACT OPPOSITE of what they wanted to achieve-- (and our elected officials are using Massachusetts as a MODEL if you can believe it). Small businesses are being told that they can't have the deductibles they chose because they are too high, thereby forcing them to spend more money!

It KILLS the individual health insurance market! It would also wipe out short-term medical plans (in states that have them) which are fantastic alternatives to expensive renewable plans. The only way you can keep the plan you have now is "if the issuer does not enroll any individuals in such coverage if the 1st effective date is on or after Y1"

Another concern is how the "care" will be delivered and who it will be delivered to at the school based health clinics. On page 994 it says it will be given to students "in accordance with Federal, State and Local laws governing obtaining guardian or parental consent".

Of course under the Patriot Act, there is no such thing as parental consent. It is all about complying with Uncle Sam including sticking your arm out to receive mandatory drugging in the event of a pandamic real or manufactured. If the vaccinations aren't safe and you end up paralyzed, tough luck. You have no recourse. You can't sue the drug company that made the vaccine because the Patriot Act protects them from lawsuits due to side effects of the vaccine in a pandemic.

Seems like the states better get in gear and start to put their proverbial FEET down and get those Sovereignty bills passed that make it clear to the Federal Government as per the Constitution, that this kind of control over its residents will not be tolerated or allowed!

reform4's picture

You don't know how to read government speak, do you?

Submitted by reform4 on Sun, 2009/08/02 - 4:56pm.

Page 16 refers to the fact that new plans have to abide by the new rules of the exchange. They are not 'outlawed'.

For employer-provided health insurance meeting requirements for deduction as health care coverage under federal law, federal regulation already applies via ERISA. But private plans (those individually purchased) are regulated by the states under the provisions of the McCarran-Ferguson Act of 1945, which places private health insurance under state control.

So the question is how to enforce the mandates upon insurers -- the must-issue and the flat-rate-pool mandates -- without overturning McCarran-Ferguson. Neither Congress nor the majority of states want the Federal government to be in the business of regulating insurance in general. Simply amending McCarran-Ferguson to exclude health insurance as a state-regulated class doesn't work either, because it's not all health insurance that Congress wants to regulate, just primary health insurance. Supplemental policies are of supreme disinterest to Congress and they're quite happy to let the states continue regulating those. Besides, insurers could raise some legal actions if Congress tried to regulate already-issued insurance that was issued under McCarran-Ferguson.

So the solution that the wonk assigned the task of making this happen arrived at was to create a new ERISA-eligible group for all future private insurance to be offered through -- the Health Insurance Exchange. This starts on page 72 of the bill. Since it is an ERISA-eligible group, it can be regulated through ERISA without touching McCarran-Ferguson in general. But then comes the task of how to make all private insurance be offered via the Exchange. And the solution the wonk devised was to outlaw the issue of new private policies that were Exchange-eligible, which is done on page 16, which would force all new private policies to be issued via the ERISA-regulated Exchange rather than via the state-regulated McCarran-Ferguson private market. In short, it's a work-around for McCarran-Ferguson which avoids the necessity to have to actually change McCarran-Ferguson -- existing private insurance policies can still be regulated by the states, it's just that new private insurance that meets primary insurance requirements must go thru the Exchange where it can be regulated under federal ERISA rules instead. And wingnut heads explode upon reaching page 16, and they erupt shouting "ObamaCare outlaws private insurance!" without ever getting to page 72.

R. Neal's picture

Yes, to all that, and I also

Submitted by R. Neal on Wed, 2009/07/15 - 8:59am.

Yes, to all that, and I also like the part about minimum medical loss ratios with rebates if they are not met. There is a lot of stuff in there the insurance companies are going to fight and fight hard.

On the other hand, the federal government is going to sell policies for them. The lineup will look like:

Public option: basic essentials
BCBS: basic essentials + foot massages and free LCD TV for $5/mo. extra
Cigna plan: basic essentials + a pony for $10/mo. extra

But seriously, I am actually concerned that the "basic essentials" that would be required are slightly better than the "Buick" (i.e. not quite Cadiallac) plan I have now, so my premiums will probably go up. But I am quite happy to pay them just to have insurance, especially if we get a law that they can't arbitrarily drop me or deny coverage.

metulj's picture

Actually, I would pay more

Submitted by metulj on Wed, 2009/07/15 - 10:50am.

Actually, I would pay more for coverage that was actually coverage rather than BCBS which is something more akin to feudal sporting chance than actual coverage.

True happiness is knowing you are a hypocrite. -- Ivor Cutler

Seppuku is in a way the ultimate awful libertarian act -- Frank Popper

gonzone's picture

yes

Submitted by gonzone on Wed, 2009/08/12 - 5:07pm.

Amen to that.
After I finally found a great general practitioner BCBS, in their ultimate death panel wisdom, decided he could not be "in network" and so I have to pay out of pocket a lot extra to see him.
And don't get me started on my sucky drug coverage called Medco, a mail order only piece of garbage that I pay good money for.
I'm tired of rationed medical care, especially when it's rationed by bean counters for increased profits.
I promise to sign up immediately when a good public option becomes available, regardless of costs.

"If ignorance is bliss, why aren't more people happy?"

R. Neal's picture

One interesting point about

Submitted by R. Neal on Wed, 2009/07/15 - 10:15am.

One interesting point about the medical loss provisions.

This bill pegs it at 70% for the "basic essentials" plan. This pretty much confirms what many have said, that there is 30% overhead for administration and profits and bonuses in our current insurance system.

This bill codifies it. Not sure that's a good thing. Single payer eliminates most of it.

reform4's picture

70% vs. 98%?

Submitted by reform4 on Sun, 2009/08/02 - 5:03pm.

Why would anyone want a product that was 70% effective when another product is 98% effective?

mjw's picture

Taxes for subsidies

Submitted by mjw on Wed, 2009/07/15 - 1:58pm.

The tax surcharge is mostly to cover the cost of subsidies for premium payments for those not eligible for Medicaid. Basically, since this isn't an all-in-one single payer plan, where some new tax or tax surcharge would take the place of all premiums (personal and employer), Medicare taxes (personal and employer), state taxes used for Medicaid, etc., you have a mix of existing premiums, mostly at first going to existing insurance plans, a new employer tax for the Wal-Marts of the world, and premiums for those who can afford it going into the public exchanges.

However, you still need money to cover the subsidies for poor people, the employer tax you won't be getting for small businesses under the cap, plus the cost of any new things you do like setting up a commission to determine the best and most cost-effective medical practices. This plan will cost about $100 billion dollars a year more than it can generate itself, which is actually a pretty good deal given that you will be providing insurance to 40-odd million people who don't have it now. That's about $2000 dollars a year per person, which is a deal, especially since most people who don't have insurance now have pre-existing conditions or don't make enough money to be able to afford coverage.

metulj's picture

"That's about $2000 dollars

Submitted by metulj on Wed, 2009/07/15 - 2:28pm.

"That's about $2000 dollars a year per person, which is a deal, especially since most people who don't have insurance now have pre-existing conditions or don't make enough money to be able to afford coverage."

And that $2000 is way better than the increases in costs past on to us providers who give these unfortunate people health care. It's a win.

True happiness is knowing you are a hypocrite. -- Ivor Cutler

Seppuku is in a way the ultimate awful libertarian act -- Frank Popper

Stimulating the economy as best we can!

redmondkr's picture

I know people in Canada, and

Submitted by redmondkr on Thu, 2009/07/16 - 9:13am.

I know people in Canada, and they hate their system.

Yeah, right.


Visit us at:

The Home

PennyWise's picture

CBO’s view of pending HC legislation

Submitted by PennyWise (not verified) on Thu, 2009/07/16 - 3:59pm.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_OVERHAUL?SITE=TXHA...

Synopsis: HOLD ONTO YOUR WALLETs America!

reform4's picture

The CBO Study...

Submitted by reform4 on Sun, 2009/08/02 - 5:05pm.

.. if you read it said that there are savings, but the government might have to pay more money out in social security benefits because we might live longer with better health insurance!

So, if you're all opposed to that kind of expenditure, feel free to walk in front of a bus when you turn 65. Otherwise, the objection is kinda silly.

Brian A.'s picture

AMA on board?

Submitted by Brian A. on Thu, 2009/07/16 - 4:00pm.

They're giving a tentative nod.

I wonder if this will provide much wind in the sails?

Brian A.
I'd rather be cycling.

archcrone's picture

The one thing that doesn't

Submitted by archcrone (not verified) on Fri, 2009/07/17 - 7:57am.

The one thing that doesn't get mentioned here, is that this plan won't kick in until 2013.

The other thing that is glaringly missing from the discussion is capping pharmaceuticals, medical devices and procedures. Every industrial nation that has a universal healthcare system also CAPS what pharmaceuticals can charge patients. That in and of itself would save millions if not billions in health care.
And here is an example of how gouging patients has worked.

R. Neal's picture

You are correct about 2013.

Submitted by R. Neal on Fri, 2009/07/17 - 12:19pm.

You are correct about 2013. It references "Y1" and "Y2" etc. throughout. In the definitions, it says:

(25) Y1, Y2, ETC..—The terms ‘‘Y1’’ , ‘‘Y2’’,‘‘Y3’’, ‘‘Y4’’, ‘‘Y5’’, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.

Nobody's picture

Any money needed for this

Submitted by Nobody (not verified) on Sun, 2009/07/19 - 12:37pm.

Any money needed for this plan will most likely come from a tax on purchases that we make, extra tax on our earnings, it seems that people that aren't directly paying for the plan will be paying indirectly for it. So people that do not have money do pay for health coverage now, will be paying for it in the future if this goes through, and maybe be paying more than now. isn't that right?????

Mary Alice`'s picture

HR 3200

Submitted by Mary Alice` (not verified) on Sat, 2009/07/25 - 10:15am.

These are some alarming points in this bill that you missed Mr. Neal or you did not understand

All American citizens being ordered to have a National ID Card (page 58)

US government to have immediate access to every American citizens bank accounts (page 59)

All property owned by Doctors in the US to be determined by government (page 317)

All American citizens ordered to give the US government power of attorney over their living wills (page 425)

The US government given a new power to determine who and how their citizens die (page 427)

End of Life plan for each American citizen ordered by the government (page 429)

US government to decide on who, and who can’t be married (page 489)

These are very significant facts in this bill, don't you think so?

Andy Axel's picture

Your

Submitted by Andy Axel on Sat, 2009/07/25 - 12:01pm.

Your search:

hxxp://www.google.com/search?client=safari&rls=en-us&q=All+American+citizens+being+ordered+to+have+a+National+ID+Card+(page+58)
+US+government+to+have+immediate+access+to+every+American+citizens+bank+accounts+(page+59)
+All+property+owned+by+Doctors+in+the+US+to+be+determined+by+government+(page+317)
+All+American+citizens+ordered+to+give+the+US+government+power+of+attorney+over+their+living+wills+(page+425)
+The+US+government+given+a+new+power+to+determine+who+and+how+their+citizens+die+(page+427)
+End+of+Life+plan+for+each+American+citizen+ordered+by+the+government+(page+429)
+US+government+to+decide+on+who,+and+who+can’t+be+married+(page+489)&ie=UTF-8&oe=UTF-8

returned 23,000 results in Google.

Anyone ever heard of a section/subsection reference?

____________________________

Dirty deeds done dirt cheap! Special holidays, Sundays and rates!

reform4's picture

If they were facts, they might be...

Submitted by reform4 on Sun, 2009/08/02 - 5:20pm.

.. but they're not. There's so much bull***t here it's almost not worth addressing. But here it goes:

p.58- relates to electronic transfer of medical records, it simply ALLOWS a card, much like your private health insurance card, be used to identify you in the plan. It's not an ID card. I dare you to find where it says this is a national ID card. Read the text.

p.59- Ever heard of EFT? It's used for DEPOSITING payments, much like the law ALLOWS (at your option) your tax refund to be put into your bank account. By the way, I met an older gentleman in court last week whose private insurance company put a lien on and froze his personal bank account, so if you think your bank accounts are safe under private plans, you're dead wrong.

p.317- Read the subject line. This page states that in order to qualify for certain exceptions, the physicians are not allowed to increase their stake in a facility that they refer patients to. Right now, a doctor can refer patients endlessly and needlessly to outside labs and facilities that they own to pad their bank accounts. To obtain cost control, the bill seeks to address this waste. Doctors can still own what they owned before, they can still build more, but they can't get as much government money as they used to with these self-referrals.

p.425, 427, 429- All this has been refuted numerous times. Just read this: http://nebraska.statepaper.com/vnews/display.v/ART/2009/07/30/4a70f03e2324a

p.489- huh? Did you even read this? This section refers to the inclusion of marriage and family counseling services as a covered treatment. There's nothing in there about who can/can't be married.

Mary Alice, I'm sorry to say, you're either an idiot or a tool. I regret to say I don't know which is deserving more of pity.

cat's picture

Pg 58

Submitted by cat (not verified) on Wed, 2009/08/12 - 4:49pm.

If you look at lines 12 and 13, it does say Identification card

R. Neal's picture

I wonder if it's anything

Submitted by R. Neal on Wed, 2009/08/12 - 5:00pm.

I wonder if it's anything like the Blue Cross Blue Shield card I have now? I don't leave home without it!

redmondkr's picture

Fox appears to have made a

Submitted by redmondkr on Sat, 2009/07/25 - 11:12am.

Fox appears to have made a tactical decision to permit the inmates full run of the asylum.


Visit us at:

The Home

R. Neal's picture

We welcome the benevolent

Submitted by R. Neal on Sat, 2009/07/25 - 1:31pm.

We welcome the benevolent tyranny of our new overlords.

redmondkr's picture

God forbid that the

Submitted by redmondkr on Sat, 2009/07/25 - 2:04pm.

God forbid that the government should ever have the power to dictate who can or cannot get married.

Oh, wait.


Visit us at:

The Home

HARRY HUDAK's picture

HR 3200

Submitted by HARRY HUDAK (not verified) on Sun, 2009/08/02 - 3:29am.

Anyone buying into this, I have a Bridge in Brooklyn I can sell you cheap!

gonzone's picture

damn

Submitted by gonzone on Wed, 2009/08/12 - 5:16pm.

It's just one lie after another from the frothing wingnuts.

How much you wanna bet this lying dumbass doesn't own that bridge? Heh.

I'm leaving BCBS far behind just as soon as a good public option becomes available.
Period.
And you would too if you had a lick of sense.
Simple math problem, 30% overhead versus 2% overhead, which is better and most efficient?

"If ignorance is bliss, why aren't more people happy?"

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

Post new comment

The content of this field is kept private and will not be shown publicly.
  • Lines and paragraphs break automatically.
  • Web page addresses and e-mail addresses turn into links automatically.

More information about formatting options

CAPTCHA
This question is used to make sure you are a human visitor and to prevent spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Shortcuts

Log in

Upcoming events:



User login

Citizen Blog-O-Rama

Local Media Yokels

Nashville Media Cats

Daily Rag

Film at 11

Wire Reports



TN Progressive All-Stars

Nearby:

Beyond:

At large:

Government:

Media: