Wednesday, August 12, 2009

My 1st Attempts at Dissecting the Health Care Bill

Everyone is talking about the Health Care Bill these days – but very few are reading it – beginning with those who may soon be voting on it. That seems to me to be about as effective as deciding a trial based solely on hearsay.

I'm not really interested in what ANY of our elected officials have to say about the Bill at this point, especially if they haven't actually read any of it – I want to know what IT says. I have found time to skim over the first 125 pages or so, and hope to work my way through the next set sooner rather than later. (10% down, 90% to go!) I figure at this point I've read more of it than most of those in the House of "Representatives"!

So, for what it's worth, here's my brief look at an incredibly complex bill:

I didn't have to look further than the title of the bill to get concerned about how realistic this idea can be:
"To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes."
The "for other purposes" may be the most honest part of the bill! But, besides that, how can we provide quality affordable health care for all AND reduce the spending – only through rationing! And yet they are all telling us this is not about rationing.

Page 15 Under this bill it seems fairly clear that the government is going to decide what is an acceptable Health Care plan, instead of the Consumers: "A Health Benefits Plan shall not be a qualified Health Benefits Plan under this division unless the plan meets the applicable requirements…relating to affordable coverage…relating to essential benefits…relating to consumer protection."
So apparently, we, the Consumers, are not capable of deciding whether coverage is affordable or what benefits we might consider essential.

Page 16 explains what coverage will be grandfathered in under this plan: "Subject to the succeeding provisions of this section…means individual health insurance coverage that is offered and in force and effect before the first day of Y1 (explained on page 14 to mean 2013, the first year of this bill's effect) if the following conditions are met: In General…the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1…shall not affect the subsequent enrollment of an individual who is covered as of such first day." (So yes, if we like it, we can keep it, at least as long as we have it – just don't expect to change to anything except the public option.) And then it goes on, "…the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1."

Pages 21 and 22 deal with Insurance Rates that will be permitted to be charged, and then with a study that the Health Commissioner will be required to conduct that looks at those who self-insurance. I was most troubled by the parts on page 21 that are telling insurance companies what they will be allowed to charge: "The premium rate charged for an insured qualified health benefits plan may not vary except as follows:" (and there are only 3 exceptions listed). While this sounds "fair" it seems like the first indication that the government will in fact be telling those "big, bad insurance companies" what they can charge us, "the poor, abused consumers". (Expected result: the government will allow insurance companies to continue to exist – until it just prices them out of the market…)

Pages 24 & 25 continue the theme of the Government dictating the prices. (Does anyone know ANY situation where that has worked well?)
Section 116 is entitled "Ensuring Value & Lower Premiums". I'm already nervous. It starts out by telling us that, "A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner." Help, what's a "medical loss ratio"?

Pages 27 & 28 list the minimum coverage for these policies and then pages 28 & 29 seem to set the amounts that Consumers will be paying: "Requirements Relating to Cost Sharing and Minimum Actuarial Value" It begins with good news for Consumers but not necessarily for those who will be paying the bills: "No cost sharing for preventative services…"

Let's look at some of the highlights on Section 123 Health Benefits Advisory Committee, which begins on page 30: "There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans." Let's start there: What's a "private-public advisory committee"? And I don't have to be a legal or a medical expert to read that they just said a panel of "medical and other experts" will be making recommendations on health benefits. Medical and other experts? Now, who exactly might they be – and if they are not medical experts why do they have any say in what health benefits any of us might or might not be receiving? And by the way, most of the members of this committee will be appointed for 3-year terms by the President. Sorry, I don't see that as being the Constitutional right/responsibility of the President – this one or any other.

Pages 31 and 32 spell out requirements for the membership on this critical committee: "The membership of the … Committee shall at least reflect…experts in racial and ethnic disparities
(say what?)…and at least one practicing physician
(oh good, at least one member will be a doctor!)
or other health care professional (nope, spoke too soon, not necessarily even ONE doctor on this committee to make medical decisions!)…"so that no single sector unduly influences the recommendations of such Committee." So, of the up to 26 members of this committee, 1 may or may not be a doctor.
Then we get to one of the roles of the committee: "The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services..benefits standards…and periodic updates to such standards." (Remember this is a committee that may not even contain ONE doctor on it!)

Page 42: "The Commissioner is responsible for carrying out the following functions…The establishment of qualified health benefits plan standards…including the enforcement of such standards…(all this in the hands of an appointed "Health Czar")

Pages 57 & 58 "Goals for financial and administrative transactions…enable the real-time (or near real-time) determination of an individual's financial responsibility at the point of service, and to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card…I don't even know where to go to comment on that portion, other than to say it makes me really, really nervous! And then it goes on, on Page 59: "…enable electronic fund transfers in order to allow automated reconciliation with the related health care payment and remittance advice…" (So who's going to be transferring money, and from where to where?)

Page 61: "…programs to provide incentives for, and ease the burden of, health care providers who volunteer to participate in the process of setting standards for electronic transactions…an estimate of total funds needed to ensure timely completion of the implementation plan…" (Another nice sounding idea, to set up electronic records – but we don't know yet what it will cost…)

Oh, and I just loved this portion: "There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option." Let's see, they promise us a transparent process, a variety of choices of affordable, quality health insurance, and a public health insurance option. Nope, I don't think we're getting any of those with this bill, starting with transparency!

Page 84: The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans…" Again, where do we even go with a statement like that? And then
Page 85 we start learning about "3 levels of Exchange-participating health benefits plans: basic, enhanced, and premium…" There isn't much more about these 3 levels, at least not in this section.

Page 89: For some reason, the decision has been made here that: "The provisions of the Federal Acquisition Regulation shall not apply to contracts between the Commissioner and QHBP offering entities for the offering of Exchange-participating health benefits plans under this title." So, I hope the concept of FAR wasn't overly important to anyone!

And pages 89 to 91 explain the Standards to offer an Exchange-Participating Health Benefits Plan, including (1) Licensed…, (2) Data Reporting…(including information necessary to administer the risk pooling mechanism…and information to address disparities in health and health care, (3) Implementing Affordability Credits, (4) Enrollment – The entity shall accept all enrollments…subject to such exceptions (such as capacity limitations)…, (5) Risk Pooling Participation…, (6) Essential Community Providers…(6) Culturally and Linguistically Appropriate Services & Communications. The entity shall provide for culturally and linguistically appropriate communication and health services. (So apparently translators will be required…)

I guess this is where we start getting into the funding portion of this idea: Pages 109 & 110: "There is created within the Treasury of the United States a trust fund to be known as the "Health Insurance Exchange Trust Fund"… "Payments from Trust Fund – The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Care Exchange, including payments under subtitle C…Transfers to Trust Fund – Dedicated Payments – There is hereby appropriated to the Trust Fund amounts equivalent to the following: (A) Taxes on Individuals not obtaining acceptable coverage… (B) Employment Taxes on Employers not providing acceptable coverage…(C) Excise Tax on failure to meet certain health coverage requirements…So, am I missing something, or are the taxes mentioned in A, B, and C going to pay for this mandatory Health Insurance? How big are these taxes going to be?!?

Page 111 mentions the role of states in Health Care – and seems to ignore the 10th amendment: "If a state (or group of States…) applies to the Commissioner for approval of a State-based Health Insurance Exchange to operate in the State (or groups of States); and the Commissioner approves such State-based Health Insurance Exchange…(So states can participate in this game, but only if they play by Commissioner approved rules…)

Page 121 shows how payments will work under this plan: "In general – The Secretary shall establish payment rates for the public health insurance option for services and health care providers consistent with this section…"

Pages 124 & 125 have the disturbing news that: "There shall be no administrative or judicial review of a payment rate or methodology established under this section…." (I guess the Commissioner has the last word on all of this…at least that's the way it sounds to me.)

So, for what it's worth, that's what I have seen in the first 125 pages or so. And it's not that I don't think we could improve our Health Care system – I just don't see the government doing it, particularly through a bill such as this.

If we want to look at ways to improve our Health Care, why don't we start by removing the restrictions that keep Health Insurance from looking more like Car Insurance, that can be purchased across state lines, with less government restrictions? And then we should make Health Care Savings plans more accessible – why can't those be offered by banks, and insurers, and NOT have to be used in the same year? That simple change would make those more useful to the Consumers.


  1. Thanks, Cathy. I'll be keeping up with your blog as your research continues...