Here is today's reading of the health care bill. If you are reading this for the first time, I've been reading the health care bill page by page and posting each reading here so you can follow along. Most of you don't have time to read a 2500 page bill so I'm taking this slowly and digesting each section online. After we read the health care bill, we will then tackle the reconciliation. Unfortunately, they are not combined into one text yet so this is how we have to do it. See the sidebar on the right side of the page for a collection of all readings.
Page 86. Section 2705: Prohibiting Discrimination Against Individual Participants and Beneficiaries Based on Health Status. The bill bans any pricing or coverage based on any type of medical history. The insurer can not use any previous claims in determining premiums or coverage either. It states none of the following factors can be used for such purposes: health status, medical condition (including mental illness), claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, and "any other health status-related factor determined appropriate by the Secretary."
Doesn't matter how healthy you are or if you are someone with a chronic illness, the insurance company must consider everyone the same when calculating premiums. The bill does allow the insurer to offer a discount or reward based on participation in a wellness program (p. 87), but it has to be offered to everyone. The program has to "promote health or prevent disease". Neither health status or any of the other listed factors can be considered for the discount.
The wellness program can include reimbursement for gym memberships, diagnostic testing that offers rewards and is not based on the results, waiving copays and deductibles for preventative care related to a health condition, costs of smoking cessation programs regardless of "whether the individual quits smoking", or rewarding individuals for attending "health education seminars". The discount or rewards are limited to 30% of the "cost of employee-only coverage under the plan." This can apply to dependents if they participate in the program as well. The Secretary can even sweeten the deal by increasing the discount up to 50%. However, there is on actual exclusion and that is if the program would be unreasonable for someone with a medical condition that would render the program useless.
The bill also directs the Secretary to choose ten states for a demonstration project for the wellness section just discussed. If successful, he can expand it to all states.
Page 97. Section 2706: Non-discrimination in Health Care. An insurance plan "shall not discriminate" against "any health care provider who is practicing within the "scope of its license or certification". Does this mean insurance companies can no longer offer better coverage and payments based on whether a provider is "in-network"?
Page 98. Section 2707: Comprehensive Health Insurance Coverage. All plans must include essential benefits package mentioned in Section 1302(a) (Can be found on page 104). Health insurers "must" offer child-only plans.
Page 99: Section 2708: Prohibition on Excessive Waiting Periods. Waiting periods are limited to a maximum of 90 days when applying for health insurance coverage.
Copy of bill
Sunday, April 11, 2010
Today's reading of the Health Care Bill
Subscribe to:
Post Comments (Atom)
11 comments:
Page 97, Section 2706 does not apply to out of network providers. This is fairly common language in insurance law and refers to nondiscrimination between types of providers. For example, a nurse practitioner (and not just a physician) has to be reimbursed for a covered service if she's licensed to provide it.
And your qualifications to comment authoritatively on that section Casey Ann are what?
I lobbied for psychologists and nurse practitioners in Maryland (and nationally) for many years. As you might imagine, this language was very important to those providers. I was informed by friends in DC that it was in the new bill.
Hope this meets your standards.
Casey Ann is a homer for this legislation.
I am definitely a "homer", but I have been refraining from making any comments. The one I did make was noncontroversial (I hope) and I thought you might like to know the reason for that language.
Understand but its a question still worth asking and something that remains to be seen as we read through the bill.
Absolutely - and it may be in another section. It is my understanding (not knowledge) that provider networks are allowed with differential payments.
Being a former lobbyist doesn't make one an expert in my book.
Casey Ann is a big government Social Democrat who has no problem with the involuntary taking of your dollars to give to others.
A Google search convinces me that the §2706 provider nondiscrimination provision was intended to ensure that state licensure boards, not the feds, will have control over what fields of medicine are practiced in each state.
Its primary proponents were chiropractors.
The first comment was correct.
Healthcare overhaul won't stop premium increases
Public outrage over double-digit rate hikes for health insurance may have helped push President Obama's healthcare overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future.
And now, with some major companies already moving to boost premiums and others poised to follow suit, millions of Americans may feel an unexpected jolt in the pocketbook.
[~~ more ~~]
The lack of muscle is stoking concerns that more rate jumps -- and an angry backlash from ratepayers -- could undermine support for implementing the healthcare overhaul.
Post a Comment