Jackson Jambalaya

The Senate bill and the reconciliation bill were consolidated, so the page numbers have changed but the sections haven't, so I will pick up where I left off in the last post.

Page 25: Section 1102. Reinsurance for Early Retirees. The government will establish ninety days after the law is enacted, a program to reimburse employer-based plans for part of the cost of insuring early retirees and their dependents. The program ends on January 1, 2014. An individual must be 55 years old and not eligible for Medicare to be considered an early retiree.

Interesting. Employer-based plan must "(2)(A)implement programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions." What are these programs and procedures to be? Doesn't say as it only requires the employer to document the actual cost of of the medical claims.

The end result of this section is the government will pay 80% of claims that exceeds $15,000 and less than $90,000. The payment is to be used for reducing costs, premiums, co-pays, deductibles and other out of pocket expenses, not for general revenue. Section (5) is explicit: Payments "shall not be included in determining the gross income..".

Government will conduct annual audits (Section d, p. 27) of all claims data. Five billion dollars is appropriated for this program (Section e, p. 27). The government also has the authority to stop taking applications for this reimbursement.

Page 28. Section 1103: Immediate Information That Allows Consumers to Identify Affordable Coverage Options. The government must establish by JULY 1, 2010, (get that?) 90 days from last week a website for residents of each state to "identify affordable health insurance coverage options in that State". Um, that should be fun to watch. Create a website in less than 90 days that happens to do all that?

What should the website do? The website should "provide ways for residents of any State to receive information on at least the following coverage options:" health insurance coverage, Medicaid, Medicare, State high risk pool, and the high risk pool offered in this bill under section 1101. (We covered this a few days ago.) The Government will also issue, no more than 60 days after the bill becomes law, a "standardized format" for the information provided on the websites.
Page 28: Section 1104: Administrative Simplification. Yes, the government actually uses that term. Such simplification is seven pages of gobbledygook that covers information systems, data exchanges, and converting health care system to a paperless standard. If you are currently a health care provider reading this post, you will probably want to read this section in more detail.

Copy of Bill