Wednesday, April 14, 2010

Today's reading of the Health Care Bill

For a collection of all readings, see sidebar on the right.

Here is today's reading the health care bill. Feel free to clarify or make serious comments about the bill. If corrections are needed or the wrong interpretation is used, feel free to point it out as I'm no authority on this subject by any stretch of the imagination. Fire away.

Page 104. Section 1302: Essential Health Benefits Requirements. Section (b)(1) on page 105 states the following benefits will be included in every plan: Emergency services, hospitalization, maternity and newborn care, mental health and substance abuse treatment, ambulatory patient services, prescription drugs, rehab services and devices, lab services, preventative and wellness services, chronic disease management, and pediatric services. Pediatric services MUST include oral and eye care.

Section (A) on page 106 states the "scope" of the benefits mandated by this section must be equal to the "scope" of the benefits provided under the "typical" employer plan. Who shall determine what is "typical? Why the government of course. It will take a survey of all plans and ensure your plan conforms to the norm.

Section (4)(B) on page 107 states the government will not base use age, disability, or expected length of life in determining coverage, premiums, or benefits.

Once again, the out-of-network issue rears its head. (ii) on page 108 states "is such services are provided out-of-network, the cost-sharing requirement (expressed as a copayment or coninsurance rate) is the same requirement that would apply if such services were provided in- network". So does that mean health insurers can no longer limit coverage or how much they will pay if you use out-of-network services?

Limits are placed on deductibles. A deductible can not exceed $2,000 for an individual plan or $4,000 for all other plans. This can be adjusted if it affects the "actuarial value" of the plan. Huh? Cost-sharing is defined as well. The law defines its as any deductible, copay, coninsurance, or payment made by anyone for a "qualified medical expense" but does not include premiums.

There will be levels of plans (page 114) and to show the government is actually creative, they are called bronze, silver, gold, or platinum. Each level is determined by the percentage of benefits that are covered under the plan as compared to their full value.

Bronze: Plan covers 60% of the full value of the benefits.
Silver: Plan covers 70% of the full value of the benefits.
Gold: Plan covers 80% of the full value of the benefits.
Platinum: Plan covers 90% of the full value of the benefits.

Section (e) on page 116 covers catastrophic plans. It says such plans are qualified if the only people allowed to enroll in them are under the age of 30. It must also offer coverage for three primary care visits. Suppose you are a lawyer, 6 years out of law school, have your own practice, and want to just carry catastrophic coverage but are 33 years old. You will be out of luck and unable to purchase a catastrsophic plan.

Section (f) on page 118 also requires the insurer to offer a "child-only plan" for those under the age of 21 if it offers a regular plan as well.

Copy of Bill

3 comments:

Pete said...

Is this a description of the government provided plans or regulations pertaining to commercial plans?

Section (4)(B) on page 107 states the government will not base use age, disability, or expected length of life in determining coverage, premiums, or benefits.

So no age rating? This is a huge transfer of wealth from Generation Y to the Baby Boomers. I wonder when all the 20 somethings will figure that out.

Also, coinsurance on out of network = coinsurance on in network? Huh? Whoever wrote this is clueless.

That's just for starters.

Kingfish said...

That is what I am wondering. I'm starting to think there is going to be no difference in coverage between in and out of network.

Also, the bill already states several times age can't be used to determine premiums and coverage in other areas. Risk underwriting is pretty much abolished.

However, you can go over to NMC or the JFP and read someone else's take on the bill that is based on some bullet points or an essay written by someone who hasn't read the bill. Over here, we are doing it the hard way, we are reading ALL of it.

Anonymous said...

A cautionary CNN Fortune article that discusses rating here. As with all Ponzi schemes, sooner or later this one will implode and take our country into the economic abyss with it.

Buy more guns and more ammunition. Guns and ammo will be extremely valuable when the coming anarchy breaks out.


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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).


Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.


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Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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