Here is the bad news from the House of Representatives with a timeline for the most massive bailout ever -- the bailour of the private for-profit insurance industries. Looks like they have until 2018 to make all the money they can. And guess who will run the "public" option. Yep, you got it. Private for-profit insurers.
Based on this, I think we should tell liberal Democrats to dump health reform NOW or we will dump Democrats. No bill at all is better than a bailout of the private insurance industry at taxpayer expense.
Prepared by the Committees
on Ways & Means, Energy & Commerce, and Education & Labor October
29, 2009 1
America’s Affordable (HAR HAR HAR -- THE JOKE'S ON YOU, MR TAXPAYER) Health
Choices (OH YEAH, YOU GET TO CHOOSE WHICH DNGEROUS INSURANCE PRODUCT YOU ARE FORCED TO BUY) Act
Implementation Timeline
2010
INSURANCE MARKET REFORMS
ENDS HEALTH INSURANCE
RESCISSIONS: Prohibits abusive
practices whereby health insurance companies rescind existing health insurance
policies when a person gets sick as a way of avoiding covering the costs of
enrollees’ health care needs.
NEW LIMITS ON PRE-EXISTING
CONDITION EXCLUSIONS: Prior to the
bill’s complete prohibition on pre-existing condition exclusions beginning in
2013, reduces the window that plans can look back for pre-existing conditions
from 6 months to 30 days and shortens the period that plans may exclude
coverage of certain benefits. It also prohibits insurers from limiting or
denying coverage based on acts stemming from domestic violence.
BAN ON LIFETIME LIMITS: Prohibits insurance companies from placing lifetime
caps on coverage.
IMMEDIATE SUNSHINE AGAINST
INSURER PRICE GOUGING (RATE REVIEW): Discourages
excessive price increases by insurance companies through review and disclosure
of insurance rate increases.
ENACTS ADMINISTRATIVE
SIMPLIFICATION: Begins adopting and
implementing administrative simplification requirements to reduce paperwork,
standardize transactions, and greatly diminish the administrative burdens and
associated costs in today’s health care system.
ENSURING VALUE (MEDICAL LOSS
RATIO): Specifies that health plans
spend a minimum of 85 percent of premium dollars on medical care, while making
sure that such a change doesn’t further destabilize the current individual
health insurance market.
INCREASE DEPENDENT AGE FOR
POLICIES THROUGH AGE 26: Allows those
through age 26 not otherwise covered to remain on their parents’ policies at
their parents’ discretion.
COBRA EXTENSION: Allows individuals to keep their COBRA coverage until
the Exchange is up and running. [NOTE: This is separate from the Recovery
Act provisions that provide premium assistance for selected groups.]
ENSURING RECONSTRUCTIVE
SURGERY FOR CHILDREN: Requires plans
to pay for reconstructive surgery for children with deformities.
LIMITATION ON
POST-RETIREMENT REDUCTIONS OF RETIREE HEALTH BENEFITS: Prohibits
employers from reducing retirees’ health
benefits after those retirees have retired, unless the reduction is also made
to benefits for active participants.
GRANTS TO STATES FOR IMMEDIATE HEALTH REFORM INITITATIVES: Builds on
an existing grant program to enhance
incentives for states to move forward with a variety of health reform
initiatives prior to 2013.
IMPROVED BENEFITS
CREATES REINSURANCE FOR
EARLY RETIREES: Creates a new
temporary reinsurance program to help offset the cost of coverage for companies
that provide early retiree health benefits for those ages 55-64.
IMMEDIATE HELP FOR THE
UNINSURED (INTERIM HIGH-RISK POOL): Creates
a $5 billion fund, modeled after the President’s plan, to finance an immediate,
temporary insurance program for those who are uninsurable because of
pre-existing conditions.
NEW LONG-TERM CARE PROGRAM
(CLASS ACT): Creates a new,
voluntary, public long-term care insurance program to help purchase services
and supports for people who have functional limitations. Benefits are a daily
or weekly cash benefit to help people with functional limitations purchase the
services and supports needed to maintain personal and financial independence.
CLASS would supplement, not supplant, traditional payers of long-term care
(e.g. Medicaid and/or private long term care insurance).
ESTABLISHES THE HEALTH
BENEFITS ADVISORY COMMITTEE: Establishes
within 60 days of enactment the Health Benefits Advisory Committee—led by the
Surgeon General and made up of health care experts, health care providers and
patients—provides recommendations on the essential benefits package to the
Secretary of HHS for approval.
PUBLIC HEALTH IMPROVEMENTS
INCREASES FUNDING FOR
COMMUNITY HEALTH CENTERS: Provides
increased funding for community health centers that will allow them to double
the number of patients served over the next five years.
IMPLEMENTS NEW PREVENTIVE
HEALTH SERVICES PROGRAM IN COMMUNITIES:
Provides immediate funding for preventive services at the community and local
level to address public health problems such as obesity, tobacco use, and
diabetes.
EXPANDS PRIMARY CARE,
NURSING AND PUBLIC HEALTH WORKFORCE: Increases
access to primary care by sustaining the current efforts to increase the size
of the National Health Service Corps. Primary care and nurse training programs
are also immediately expanded to increase the size of the primary care and
nursing workforce. Ensures that public health challenges are adequately
addressed.
EMPLOYER WELLNESS PROGRAMS: Establishes a grant program for employers to promote
healthy behaviors among their employees.
MEDICARE AND MEDICAID IMPROVEMENTS
BEGINS TO FILL IN THE
MEDICARE PART D DRUG DONUT HOLE: Provides
for a 50% discount on brand-name drugs in the Part D donut hole, and immediately
shrinks the size of the donut hole by $500 in 2010. The donut hole continues to
be narrowed over the coming years until it is fully eliminated by 2019.
IMPROVES PREVENTIVE HEALTH
COVERAGE IN MEDICARE & MEDICAID: Eliminates
cost sharing for preventive services to encourage wider use of preventive care
for Medicare beneficiaries. Requires State Medicaid programs to cover
preventive services recommended to the Secretary of HHS based on evidence, such
as tobacco cessation counseling for pregnant women.
ALLOWS STATES TO COVER
LOW-INCOME INDIVIDUALS WITH HIV: Gives
States the option of extending Medicaid coverage to HIV-positive individuals
and provides enhanced federal matching payments for the costs of care.
INCREASES REIMBURSEMENT FOR
PRIMARY CARE IN MEDICAID: Brings
reimbursement for primary care services in Medicaid up to Medicare levels with
100% federal funding (phased in over several years).
PROVIDES FOR 12-MONTH
CONTINUOUS ELIGIBILITY IN CHIP: Provides
continuity of care for children by requiring that states provide 12-month
continuous eligibility for children in the CHIP program
CREATES MEDICARE ACCOUNTABLE
CARE ORGANIZATIONS AND MEDICAL HOME PILOT PROGRAMS: Requires the
Secretary to set specific benchmarks for
expansion of these programs and to test them in a variety of settings and
geographic regions. If the initial pilots prove successful, the Secretary is
directed to continue expanding them on a large-scale basis.
2011
ELIMINATES BARRIERS TO
ENROLLMENT IN MEDICARE LOW-INCOME SUBSIDY FOR PART D DRUG PROGRAM:
Eases burdens on enrollment so more low-income
beneficiaries can get the financial help they need to make health care
affordable.
NEW PROTECTIONS IN MEDICARE
ADVANTAGE: Limits cost-sharing for
services in Medicare Advantage plans to no more than cost-sharing in
traditional Medicare, and provides for bonus payments to high-quality plans.
ESSENTIAL BENEFITS: In preparation for reform, the Health Benefits
Advisory Committee reports their recommended essential benefits package to the
Secretary of HHS for adoption.
Additional federal funds to
states with high unemployment. Assists
States in maintaining access to
Medicaid services during the
recession by extending the current Recovery Act increase in federal Medicaid
payments to states with high unemployment rates. Prepared by the
2012
IMPROVES LOW-INCOME
PROTECTIONS IN MEDICARE: Increases the
assets test limits in the Part D drug program and Medicare Savings Programs to
ensure that more low-income beneficiaries get the financial help they need to
make their health care affordable.
EXTENDS MONTHS OF COVERAGE
OF IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT PATIENTS: Lifts the
current 36-month limitation on Medicare
coverage of immunosuppressive drugs for kidney transplant patients who would
otherwise lose this coverage on or after January 1, 2012.
2013
HEALTH INSURANCE REFORMS: Implements comprehensive health insurance reforms that
prohibit insurance companies from engaging in discriminatory practices that
enable them to refuse to sell or renew policies due to an individual’s health
status. In addition, insurance companies can no longer exclude coverage for
treatments based on pre-existing health conditions. The legislation also limits
their ability to charge higher rates due to health status, gender, or other
factors, and permits premiums to vary only by age (no more than 2:1), geography
and family size.
HEALTH INSURANCE EXCHANGE: Opens the Health Insurance Exchange to individuals
without other coverage and to small employers with 25 or fewer employees. This
new venue will enable people to comparison shop for standardized health
packages. It facilitates enrollment and administers affordability credits so
that people of all incomes can obtain affordable coverage.
PUBLIC HEALTH INSURANCE
OPTION: Creates a new public health
insurance plan option that is available only within the Health Insurance
Exchange. It competes on a level playing field against private health plans and
will inject competition into the many parts of our country without a
competitive health insurance market. Because it doesn’t operate at the behest
of investors, it will be able to offer stiff competition to private
insurers—forcing them to compete on cost and quality for the first time.
AFFORDABILITY CREDITS: Makes Health Insurance Affordability Credits available
through the Exchange to ensure people can obtain affordable coverage. Credits
are available for people with incomes above Medicaid eligibility and below 400%
of poverty who are not eligible for or offered other acceptable coverage. They
apply to both premiums and cost sharing to ensure that no families
face bankruptcy
due to medical expenses.
INDIVIDUAL RESPONSIBILITY: Requires individuals to obtain acceptable health
insurance coverage or pay a penalty of 2.5% of their income that is capped at
the cost of the average cost of qualified coverage.
EMPLOYER RESPONSIBILITY: Employers are required to offer coverage to their
workers and their workers’ families with minimum contributions and meet
standards for that coverage or pay a penalty of
8% of their payroll to help offset the cost of their workers obtaining coverage
through the Exchange. Employers have a grace period and are not required to
meet the benefit standards until 2018.
PROTECTS SMALL BUSINESS: Small businesses with annual payrolls below $500,000
are exempt from requirements to offer or contribute to coverage, including the
8% payroll contribution for failure to provide health benefits to their
workers. The 8% requirement is phased in for small businesses with an annual
payroll between $500,000 and $750,000.
SMALL BUSINESS TAX CREDITS: Provides certain lower-wage small businesses that
choose to provide health coverage with a new tax credit worth up to 50% of the
amount paid by a small employer for employee health coverage. The credits are
available on a rolling basis for the first two years that an employer offers
qualified coverage.
EXPANDS MEDICAID
ELIGIBILITY: Expands Medicaid to 150%
of poverty to ensure that people obtain affordable health care in the most
efficient and appropriate manner. The expansion is fully federally funded in
2013 and 2014; thereafter states pay 9% and the federal government pays 91%.
PROTECTS THE HEALTH OF
NEWBORN BABIES: Provides temporary
Medicaid coverage for up to 60 days for babies who are born without proof of
other health coverage.
2014
INITIATES AN AFFORDABILITY
TEST FOR EMPLOYER-SPONSORED COVERAGE: Opens
the Health Insurance Exchange to individuals who have an offer of
employer-sponsored
coverage, but for whom that coverage would be unaffordable because the premium
would absorb more than 12% of their family income. People who meet this test
will be able to enter the Exchange and are eligible for affordability
credits based
on their incomes.
HEALTH INSURANCE EXCHANGE
EXPANDS: Opens the Health Insurance
Exchange to small businesses with 50 or fewer employees.
ENSURING VALUE IN MEDICARE
ADVANTAGE (MEDICAL LOSS RATIO): Requires
Medicare Advantage plans to spend a minimum of 85 percent of premium dollars on
medical care.
2015
EXPANDS HEALTH INSURANCE
EXCHANGE: Opens the Health Insurance
Exchange to small businesses with 100 or fewer employees and provides the
Health Choices Commissioner the authority, from 2015 forward, to continue
expanding the Exchange to larger employers as the system is ready to handle
increased capacity. Prepared by the
Committees on Ways & Means, Energy & Commerce, and Education &
Labor October 29, 2009 6
2018
EMPLOYERS OUTSIDE THE
EXCHANGE ARE REQUIRED TO MEET ESSENTIAL BENEFITS PACKAGE: The grace
period ends for employer-sponsored plans to
meet the health insurance standards. All employer-sponsored coverage and health
insurance offered within the Exchange is required to meet benefit and
contribution standards.
Sally Gellert
said:
 |
... Disgusting! Weaker and weaker, later and later. It looks like our fight will be going on for a long time to come. |
Patty Brown
said:
|
... While it is not single-payer health care, I like some of the provisions enough to at least vote for it against the status quo. We are dying out here people!! |
Arnold Lewis
said:
|
... You bastards! There is not one honest person in our government, not one person not a whore to the big business, not one person with the guts to absolutely be honest and call a whore a whore! This is exactly why this country is failing in every factor. Where is the integrity of people who sacrifice their personal concern to make sure that they they will be reelected? What kind of money does it take to buy any elected official? Explain just why i should vote for a Democrat again? I have no party that i can rely upon to make decisions that honor the American public. There is no Hell hot enough, no ocean deep enough, not punishment strong enough for any of you! Trust me, I'll vote for anyone with the guts to start a party for Social Democracy! It is painfully obvious that Michael Moore is right, and that the SOB Milton Friedman has compromised your brains - and your pocketbooks! |
Micki
said:
|
... This is a boon to the private insurance companies, pure and simple. The Democrats are handing the medical-insurance-drug industrial complex profits on a silver platter. I noted that the bill provides for a 50% discount on BRAND-NAME DRUGS in the Part D donut hole. Why not a 50% discount on generics, too? It's obvious why not -- because brand name drugs are exponentially more expensive than generics, so the "discount" will cost the citizen more out-of-pocket than is necessary, but will guarantee profits for the drug companies (since they pont up the $$$$ for re-election campaigns). I'm disgusted. |
Susan Daly
said:
|
... IMMEDIATE SUNSHINE AGAINST INSURER PRICE GOUGING (RATE REVIEW): Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases Wow! Am I missing something? I don't see anything that prevents the insurer from leaving me with a high deductible and/or high co-pay policy as the only AFFORDABLE choice. |
Sue J
said:
|
... The term "level playing field" should advise us that they think this is a game. Use of a game metaphor is insulting enough to those of us with serious health conditions and the families of those who suffer and die but the fact that the metaphor is a cover for the corporate welfare of a plan crippled in it's ability to compete adds insult to injury. The people who govern us trivialize our physical, emotional and financial suffering. The insurance purchase mandate is like telling a woman who has been raped to marry the perpetrator to legitimize the act. They think it will be more palatable by calling it INDIVIDUAL RESPONSIBILITY: Requires individuals to obtain acceptable health insurance coverage or pay a penalty of 2.5% of their income that is capped at the cost of the average cost of qualified coverage. Don't you want to know where the penalty fees will go when people are too strapped to buy a "plan" that has no price controls? |
Jack_238
said:
|
... This is almost identical to Massachusetts plan. The insurance they offer through Commonwealth Care (Mass. version of an exchange) are limited and economically useless to the consumer. Because of my age, even though my health is just fine, I can pay over $800 a month for coverage that has not lifetime cap. It does have a yearly cap, believe it or not it is $8000 besides all the co-pays and deductibles. Do the math, I will pay more than that each year. If I want to put that money in the bank and hope not to get sick, Massachusetts says I will be fined and if I don't pay it, I am a criminal. I think anyone passing a law like this and those collecting the money are the real criminals in this case. Doesn't being forced by a government to buy a private corporation seem undemocratic, un-American, and provide proof of who is really running things? Massachusetts is bankrupt. The governor is about to layoff thousands more. He will not answer questions about how the payments from the tax payers to the insurance companies are responsible for at least most of the economic problems in Mass. The democrats have proven to be the little brothers of the republican party again. Obama and the rest of the spineless, unethical democrats have played into the republican party trap still again. Trying to please the right, and maintain the flow of money into the democratic party from the insurance industry, they try to win the votes on the right and forget who voted them into the executive branch and both legislative houses, they will lose the votes they have and not get any from the right. (Maybe you no longer wonder why the democratic party is getting more "donations" from the insurance lobby than the republicans.) |
Burt in Denver
said:
|
... What are the penalties for the INSURANCE COMPANIES that violate the rules (if anyone can objectively figure them out)? The "Public Option" appears to be very ambiguous - what does it mean? Civil disobedience comes to mind. |
Skywalker Payne, RN
said:
|
... I have been supporting Single-Payer for decades. While this proposed "reform" has countless weaknesses, it is a beginning. It's failures will lead to true reform. However, being currently involved with a dispute with the Dept. of Health and Human Services, the thought of it successfully managing a Single Payer health option is not encouraging. HHS is one bureaucratic sham and appears incapable of communicating in plain english or engaging in equitable economic policies. As with any real change in this country, from the end of slavery to civil rights legislation, we must be prepared for the long fight. Patience and persistence will lead to Single Payer, until then we must become more sophisticated in our political efforts and find media advocates. |
nate
said:
|
... it's cheaper for the government to put everyone on medicare and they're paying for this scheme with cuts TO medicare, then claiming medicare is broke. then they're claiming they're making it an even playing field, why should we do that? to allow the rip off to continue folks! take the torches and pitch forks and march!! |
Susan Daly
said:
|
... You do realize the the "Affordability Credits" that will be payed by the government (taxes) will be handed directly to the for-profit private insurer. We couldn't make it more expensive to the taxpayer if we tried!!! |
