Healthcare Bill... the possible good.

[bHero]

Disclaimer: I'm an independent... but usually vote republican (about 70/30).

A friend sent me this link to explain what the Healthcare Bill is in plain English. It is attempting to sound neutral, although still has an NPR-Liberal feel to it (minimizing). But it is a great read, includes links to the actual bill, citations and the court ruling.

Timeline

Each Section


It's like a 1000 page document being amendment constantly.

P.S. I hate reddit.com, because it is 99% punditry, demagoguery and histrionics. Funny often, but almost always far left and out of touch with reality. It's a forum and almost completely user driven, however, I suspect this post to be from the Democratic Party since it aligns to current Dem talking points: confusion over the bill.

[bHero]

To be clear, I'm not talking about the economic implications, or the freedoms that may be given up with the passage of the bill. Just what good it aims to do, by the letter. I'm an objective guy and understand this is an immensely complicated question and not taking a side yet. Still studying the issues.

[radhorn2]

Originally Posted by bHero

To be clear, I'm not talking about the economic implications, or the freedoms that may be given up with the passage of the bill. Just what good it aims to do, by the letter. I'm an objective guy and understand this is an immensely complicated question and not taking a side yet. Still studying the issues.

Kinda' like what the road to Hell is paved with, isn't it?

[editionshield]

Thanks for this, bHero. A lot here -- way too much to absorb except over an extended period of time -- but it does look like a pretty good basic resource of details.


There are a lot of questions that remain uncertain, of course. Some answerable at this point, some not.

The biggest, and most fundamental, to me, is about the nature of the plans that will be offered on the exchanges. This is something I've seen very little detailed discussion about. Specifically:

-- What's a ballpark estimate for price-range (per month) of a plan on the exchange? I know specifics have been lacking here because prices will still vary a lot depending on what type of coverage one chooses (among other factors). But it's hard for consumers to know whether (and how much) they'll benefit from the exchanges without at least SOME idea of cost-change.

-- Tied in with the above, more or less, is what KIND of coverage the presumably adjusted premium payments will buy. The biggest problem in the individual market right now is twofold: not only are A) the premiums generally unreasonably (and often unaffordably) high, but B) the coverage provided is generally just not very good.

The goal, I presume, of the exchanges is to provide coverage that is both A) more affordable to most average lower & middle class individuals, and B) more comprehensive in its scope.

It's hard to get any sense of specifics on these matters from the typical bullet-points that are usually presented, which tend to end with, simply, "exchanges will be set up." (Perhaps accompanied by "there will be tax credits to make the exchange plans affordable.")

We need a better definition of "affordable." And we also need to know whether "affordable" includes more comprehensive (and thus more valuable) coverage than what one typically finds in the present market.

[editionshield]

One other point I'm not clear on -- this one is a bit more simple and direct, maybe someone knows the answer (or maybe you've seen, bHero, a place where it's addressed specifically on those linked pages). Here's the question:

-- Does "people with pre-existing conditions can't be turned down" mean that they have to be offered plans AT THE SAME RATES as those without pre-existing conditions? Or just that they have to be offered SOMETHING (at a rate the insurer determines) rather than being rejected outright?

This is a pretty major detail, as I see it, because if insurers are allowed to jack up the rates on those with pre-existing conditions to the point where the premiums simply aren't affordable, then it's basically the same as rejecting them.

It seems to me that the pre-existing clause HAS to mean that such conditions not only can't be cause for rejection anymore, but that they also can't affect the rate offered to those customers.

Any idea if this is the case?

[editionshield]

To illustrate the above, I'm envisioning this conversation (simplified to underscore the point):


Customer: I'd like to purchase an individual health insurance plan, for myself.
Insurer: Fine. Do you have any pre-existing conditions?
Customer: Yes, I've had Type-1 Diabetes since I was 15. But you can't deny me coverage because of that anymore.
Insurer: That's true. We cannot reject you. OK, then, so, your coverage is approved, at a monthly premium of $1,500.
Customer: I can't afford that.
Insurer: Well, sorry. But we didn't reject you, of course; you just refused to buy it.


Can that conversation take place under ACA?

[Burnt Orange]

Originally Posted by editionshield

To illustrate the above, I'm envisioning this conversation (simplified to underscore the point):


Customer: I'd like to purchase an individual health insurance plan, for myself.
Insurer: Fine. Do you have any pre-existing conditions?
Customer: Yes, I've had Type-1 Diabetes since I was 15. But you can't deny me coverage because of that anymore.
Insurer: That's true. We cannot reject you. OK, then, so, your coverage is approved, at a monthly premium of $1,500.
Customer: I can't afford that.
Insurer: Well, sorry. But we didn't reject you, of course; you just refused to buy it.


Can that conversation take place under ACA?

My understanding is that there is a cap on what the rate can be. For example under the law seniors cannot be charged more than three times the premium of a young adult. There is also a similar cap for people with reexisting conditions.
I hear that the insurance lobby wants to change that ratio to 5.

[bHero]

Originally Posted by Burnt Orange

My understanding is that there is a cap on what the rate can be. For example under the law seniors cannot be charged more than three times the premium of a young adult. There is also a similar cap for people with reexisting conditions.
I hear that the insurance lobby wants to change that ratio to 5.

That's how I understand it so far. Currently, the language is such that there is no such thing as pre-existing conditions for people under 19, and for those over it they are currently in a "high risk pool." This pool ends in 2014 (page 30 of the bill).

Some basics of the pool:
Insurer has to pay at least 65% of expenses.
Can not vary by more than 4 to 1 based on age. (premium factor).
If the person is dumped for the condition, they program supposedly picks up the bill and collects from the insurer that dumped them. (page 32) - oversimplification.

And with regards to rates after expiration:
-‘‘(a) PROHIBITING DISCRIMINATORY PREMIUM RATES.—
‘‘(1) IN GENERAL.—With respect to the premium rate
charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
‘‘(A) such rate shall vary with respect to the particular
plan or coverage involved only by—
‘‘(i) whether such plan or coverage covers an individual or family;
‘‘(ii) rating area, as established in accordance with
paragraph (2);
‘‘(iii) age, except that such rate shall not vary by
more than 3 to 1 for adults (consistent with section
2707(c)); and
‘‘(iv) tobacco use, except that such rate shall not
vary by more than 1.5 to 1; and
‘‘(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not
described in subparagraph (A).

--- so, begining in 2014, there is not such thing as pre-existing condition.

People will be charged the SAME RATES, regardless of medical history.

[bHero]

Originally Posted by radhorn2

Kinda' like what the road to Hell is paved with, isn't it?

Absolutely! That is why I'm reading up on it. To try and understand the intent and the execution.

Marx and Friedman both would have destroyed the world if given the opportunity and their intentions.

[editionshield]

Originally Posted by bHero

That's how I understand it so far. Currently, the language is such that there is no such thing as pre-existing conditions for people under 19, and for those over it they are currently in a "high risk pool." This pool ends in 2014 (page 30 of the bill).

Some basics of the pool:
Insurer has to pay at least 65% of expenses.
Can not vary by more than 4 to 1 based on age. (premium factor).
If the person is dumped for the condition, they program supposedly picks up the bill and collects from the insurer that dumped them. (page 32) - oversimplification.

And with regards to rates after expiration:
-‘‘(a) PROHIBITING DISCRIMINATORY PREMIUM RATES.—
‘‘(1) IN GENERAL.—With respect to the premium rate
charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
‘‘(A) such rate shall vary with respect to the particular
plan or coverage involved only by—
‘‘(i) whether such plan or coverage covers an individual or family;
‘‘(ii) rating area, as established in accordance with
paragraph (2);
‘‘(iii) age, except that such rate shall not vary by
more than 3 to 1 for adults (consistent with section
2707(c)); and
‘‘(iv) tobacco use, except that such rate shall not
vary by more than 1.5 to 1; and
‘‘(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not
described in subparagraph (A).

--- so, begining in 2014, there is not such thing as pre-existing condition.

People will be charged the SAME RATES, regardless of medical history.

Thanks bHero. If indeed that's the proper reading/interpretation, that's a big change. And a much-needed one.

[Burnt Orange]

Originally Posted by bHero

That's how I understand it so far. Currently, the language is such that there is no such thing as pre-existing conditions for people under 19, and for those over it they are currently in a "high risk pool." This pool ends in 2014 (page 30 of the bill).

Some basics of the pool:
Insurer has to pay at least 65% of expenses.
Can not vary by more than 4 to 1 based on age. (premium factor).
If the person is dumped for the condition, they program supposedly picks up the bill and collects from the insurer that dumped them. (page 32) - oversimplification.

And with regards to rates after expiration:
-‘‘(a) PROHIBITING DISCRIMINATORY PREMIUM RATES.—
‘‘(1) IN GENERAL.—With respect to the premium rate
charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
‘‘(A) such rate shall vary with respect to the particular
plan or coverage involved only by—
‘‘(i) whether such plan or coverage covers an individual or family;
‘‘(ii) rating area, as established in accordance with
paragraph (2);
‘‘(iii) age, except that such rate shall not vary by
more than 3 to 1 for adults (consistent with section
2707(c)); and
‘‘(iv) tobacco use, except that such rate shall not
vary by more than 1.5 to 1; and
‘‘(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not
described in subparagraph (A).

--- so, begining in 2014, there is not such thing as pre-existing condition.

People will be charged the SAME RATES, regardless of medical history.

Good Job.

[planobob]

The bill should be renamed "The Legal and Actuarial Job Relief and Opportunity Bill." The law is 2000+pages, regulations already exceed 20,000 pages, and now a Supreme Court ruling.

It's going to take attorneys to plunge through all that and actuaries to help everybody comply.

[Burnt Orange]

Originally Posted by planobob

The bill should be renamed "The Legal and Actuarial Job Relief and Opportunity Bill." The law is 2000+pages, regulations already exceed 20,000 pages, and now a Supreme Court ruling.

It's going to take attorneys to plunge through all that and actuaries to help everybody comply.

I am not sure we are reading the same bill. Here is the link.
http://housedocs.house.gov/energycommerce/ppacacon.pdf

I dont know if there is a longer version, but i dont think so. The bill is 974 pages long and is fairly well written. Maybe I am just used to reading legal language, but I had very little issue understanding. The only thing I would like is a week to pour over the entire bill.

[planobob]

Originally Posted by Burnt Orange

I am not sure we are reading the same bill. Here is the link.
http://housedocs.house.gov/energycommerce/ppacacon.pdf

I dont know if there is a longer version, but i dont think so. The bill is 974 pages long and is fairly well written. Maybe I am just used to reading legal language, but I had very little issue understanding. The only thing I would like is a week to pour over the entire bill.

Maybe the version you are reading is condensed from the way bills are submitted. Still 974 pages?

[Burnt Orange]

Originally Posted by planobob

Maybe the version you are reading is condensed from the way bills are submitted. Still 974 pages?

Yup 974 pages, but fairly well written.