Sunday, April 11, 2010

Today's reading of the Health Care Bill

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


Unknown said...

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.

Anonymous said...

And your qualifications to comment authoritatively on that section Casey Ann are what?

Unknown said...

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.

Anonymous said...

Casey Ann is a homer for this legislation.

Unknown said...

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.

Kingfish said...

Understand but its a question still worth asking and something that remains to be seen as we read through the bill.

Unknown said...

Absolutely - and it may be in another section. It is my understanding (not knowledge) that provider networks are allowed with differential payments.

Anonymous said...

Being a former lobbyist doesn't make one an expert in my book.

Anonymous said...

Casey Ann is a big government Social Democrat who has no problem with the involuntary taking of your dollars to give to others.

Anonymous said...

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.

Los Angeles Times said...

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.

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Trollfest '09

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.

Note: Security provided by INS.

Trollfest '07

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.

Note: Security provided by INS