You’ve heard rumors. You’ve heard threats. Have you heard the truth? Have you actually read the legislation that so many are screaming about (on both sides of the fence)?
You’ve heard the Obama administration asking the American public to turn in anyone who speaks against (or as they say “incorrectly”) about health care reform. (You may turn me in. Please just promise me you’ll read until the end if you do. If you aren’t willing to read until the end, then you don’t have any business turning ANYONE in for fishy behavior except yourself…for failing to get involved in the future of our country.) FYI: They have now, reportedly, shut down the e-mail address so you can no longer turn people in; not even yourself. Rumor is that they had too many people playing games & turning in the President & members of Congress. I'm not even joking. By the way, this is not new. Bush did the same thing during his administration when he was attempting to pass medicare reform. Again, it's not about right or left. They're more alike than many of us would like to believe.
Despite my reasons for not supporting this legislation, I have been called "unpatriotic". Ironically, I can find nothing MORE patriotic than getting involved in legislation that is being put before our Congress; whether you agree with it or not. Our country was FOUNDED on dissent, and on us having the right to dissent in the future. Yet WE’RE the unpatriotic ones? Although frankly, with how they’ve made “Patriot” a dirty word, I’m surprised ANYONE would want to be considered one. Me?…call me “unpatriotic” any day! Still, through all of the threats, bullying, and name-calling from BOTH sides, have you heard the TRUTH?
How do I find out the truth? I dissect a bill. How do I dissect a bill? How do I decide if I will support a bill or not? Where do I get my information? From the legislation itself. That way, no one is coloring my view. No one is telling me what to think or why their way is better. I am reading the actual legislation itself; not someone else’s interpretation of it.
I must be honest here and tell you that I do not support universal health care in any form. Why? I don’t believe the federal government has the Constitutional right nor obligation to provide for the health care of the citizens of our country; and certainly not for those who have chosen to come here on an illegal basis. In other words, I really don’t care WHAT is in any bill that proposes universal health care. I don’t support it. That’s a huge reason why I have been relatively silent on this issue up until now.
I also don’t agree with the fact that they are attempting to push this bill through so quickly. This is no rumor, folks. President Obama said himself that he wanted it passed by the end of July before they went on break in August. It didn’t happen then, but I expect them to pick it back up in quick order once they return in September. The bottom line is that we HAVE to give our representatives, senators, and the American people adequate time to read legislation before it is voted on. Anything less is unacceptable!
That being said, there is a LOT floating out there on BOTH sides of the fence about this bill. Since there are many who DO support universal health care should the legislation be right, I feel it’s necessary to break it down line-by-line and find out exactly what this legislation (which is only one of several bills currently pending regarding health care) actually says.
Also, I have been accused of not being a patriot for the mere fact that I oppose this legislation. They say that many out there who are talking about why they don’t agree with the bill are lying.
So are they? There’s only ONE way to find out who is telling the truth about any particular piece of legislation. You must read it. (Unless you take into account the fact that what’s in the actual legislation is irrelevant to me because I oppose the very idea of universal health care on a federal level. But I digress.)
Shall we? The healthcare bill, in all of its 1100 page glory…line by line…with commentary by me. Because it’s still not illegal in this country to speak out against something. Due to the incredible (and excessively long) length of this bill, I will do this in several parts. (And please also note that what I dissect today may very well be different by the time our Senators and Representatives actually return to DC in September.)
Typically, I send you to Open Congress to find the full text of a bill.
Unfortunately, I have tried on many occasions over the course of a couple of weeks to access the full text on Open Congress to no avail. Alternatively, you can find the full text on the Library of Congress website.
Let’s start in the beginning. My notes will be in (parenthesis) and bold italics.
Purpose: “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” (“…for other purposes”? I don’t like when legislation doesn’t specifically state what it does or does not intend to do. This is not a good start.)
SEC. 100. (a)(2) BUILDING ON CURRENT SYSTEM- This division achieves this purpose by building on what works in today's health care system, while repairing the aspects that are broken. (Medicare, Medicaid, VA, & other military health care systems are seriously broken as is. The government is not acknowledging this. How can one fix what one does not acknowledge is broken?)
SEC. 100. (a)(3)(D) initiates shared responsibility among workers, employers, and the government (No one should be responsible for providing for our care but US. It is not the right nor the obligation of the government to provide insurance for us nor is it the right of our employers to do so. It is a privilege, but not a RIGHT for our employers to provide health coverage.)
SEC. 100. (a)(4) HEALTH DELIVERY REFORM- This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government. (Increase quality? Anyone who has been in health care or who knows someone who receives government health care knows first hand that government health care and quality do NOT go hand in hand. Again, a key here is recognizing WHAT is broken. If you acknowledge that the kitchen faucet doesn’t work right, but then try to replace the sink to fix it, you ARE changing something RELATED to the broken problem, but you’re still not ACTUALLY fixing the problem. After the old sink is replaced with a new one, the faucet will STILL leak…because you didn’t fix the ACTUAL problem. Think that’s an illogical comparison? Tell me how it’s feasible for a government that is KNOWN for inadequate care and more red tape than we could ever imagine to take over our ENTIRE health system?)
(The rest of Section 100 consists of an outline. This section is what will be expounded upon later so we’ll skip the rest of it for now.)
SEC. 111 A qualified health benefits plan may not impose any pre-existing condition exclusion (This is pretty self-explanatory. The question to be answered here is what exactly constitutes a “qualified” health plan. This makes it sound like there will be some plans where you CAN be excluded based on pre-existing conditions.)
SEC. 113(a) In General- The premium rate charged for an insured qualified health benefits plan may not vary except as follows (They can’t raise your premiums…unless. Basically this is no different than what we have now. Your premium can be higher based on your age, where you live, & how many people are in your family.)
SEC. 116. ENSURING VALUE AND LOWER PREMIUMS.(a) In General- A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio. (Honestly, I have no idea what this means. It appears to be saying that if someone doesn’t spend a certain level on health care in any given year then they will be refunded a portion of their premiums. I could be completely off on this, though. Anyone?)
SEC. 122 (c)(1)There shall be no cost-sharing…for preventive items and services (as specified under the benefit standards), including well baby and well child care. (I take this to mean preventative services, which are thus far only clearly defined as including well-baby and well-visits, will be covered at 100% with no co-payments or co-insurance on our part.)
SEC. 122 (c)(2) (A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed…
(B)…$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.
(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance. (This is basically the deductible for the plan. They will guarantee you that you will pay no more than $5,000 per person or $10,000 per family the 1st year. That amount will go up each year. Wonder if they’ll take into account how much they’re charging us in NEW taxes each year before they consider increasing the amount we’ll have to spend out of pocket?)
SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.(a)(1)There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans. (I imagine that this is part of where people are getting that the government will determine what treatments you are and are not allowed to have. In a way they’re right. However, that’s something you’ll find with ANY insurance company. They all have a panel of “experts” who say what should and shouldn’t be covered. If this is what they’re saying is the “euthanasia” portion of the plan, I’m not buying it. This looks like a standard insurance benefits advisory committee.)
SEC. 123. (b)(1)Health Benefits Advisory Committee shall recommend…benefit standards…and periodic updates to such standards. …the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(3) PUBLIC INPUT- The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED- In this subtitle, the term `benefit standards' means standards respecting--
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing…(I included as much of this section as I did to further show that it really does appear that the purpose of the Health Benefits Advisory Committee is no different than it would be with any other insurance company. They decide what the plan will & won’t cover. We may not like their decisions, but again, that’s no different than it is with any other insurance company. There may be something later that proves the rumor of euthanasia concerns to be true. However, I’m not seeing it in this section.)
SEC. 132. REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS. (I’m not going to list this entire section here. The bottom line is that they will offer the ability to appeal decisions, coverage limitations, &/or air grievances. This section gives information on how and through whom that will take place.)
SEC. 144. HEALTH INSURANCE OMBUDSMAN. (b) Duties- The Qualified Health Benefits Plan Ombudsman shall…
(1) receive complaints, grievances, and requests for information submitted by individuals;
(2) provide assistance with respect to complaints, grievances, and requests…including--
(A) helping individuals determine the relevant information needed to seek an appeal of a decision or determination;
(B) assistance to such individuals with any problems arising from disenrollment from such a plan;
(C) assistance to such individuals in choosing a qualified health benefits plan in which to enroll; and
(D) assistance to such individuals in presenting information under subtitle C (relating to affordability credits)...
(For those unfamiliar, the job of an Ombudsman is typically to be a patient-advocate. I don’t see this as being a bad thing to have; provided they actually advocate for the patient and not their employer. THIS is where I see a HUGE conflict-of-interest coming into play. As it stands now, Ombudsmen are hired by the state to speak &/or advocate on behalf of patients at private and government facilities. I can see a problem arising if the same company that hires the Ombudsmen (the government) is the one against whom the Ombudsmen has to advocate.)
SEC. 161. ENSURING VALUE AND LOWER PREMIUMS.(a)Title XXVII of the Public Health Service Act is amended by inserting after section 2713 the following new section:
SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.
(a) In General- Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.
(b) Uniform Definitions- The Secretary shall establish a uniform definition of medical loss and methodology for determining how to calculate the medical loss ratio. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans.'
(I’m going to show my extreme ignorance here. I have absolutely NO idea what this is talking about. It appears to me as if they’re saying that if a certain amount is not spent in a year then they will refund a portion of the premiums to consumers. Maybe that’s what I’m DREAMING it’s saying. Can anyone give further clarification here? I’d greatly appreciate it.)
SEC. 162. ENDING HEALTH INSURANCE RESCISSION ABUSE. (b) Secretarial Guidance Regarding Rescissions- Section 2742 of such Act (42 U.S.C. 300gg-42) is amended by adding at the end the following:
(f) Rescission- A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (This is saying that your insurance; whether a government, employer-provided, or private policy, cannot be cancelled unless you have committed fraud.)
SEC. 163 (This section talks about making pretty much everything we can electronic although this is nothing new. Most of that was done in the stimulus plans that have been passed in the past year. They also assure us that all information received will be protected as it currently is under HIPPA & will be held secure and not used for any purpose other than is necessary to process claims and provide health care.)
That brings us to Section 201. I’ll pick up where I left off later. If you have any questions, please feel free to e-mail me at amy@thoughtsofTHATmom.com. In an effort not to be too overwhelming with legislation that is over 1,000 pages long, I’ll be breaking this up into at least 4 parts covering Sections 100, 200, 300, & 400. If I find I need to break it up further from there, then I’ll do so.