House Healthcare Bill Full Of Some Terrible Ideas

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by JimofPennsylvan, Aug 29, 2009.

  1. JimofPennsylvan

    JimofPennsylvan VIP Member

    Jun 6, 2007
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    One alarming effect of the House’s Healthcare bill is that it will as a practical matter force many lower and middle income Americans to enroll in their employer’s sponsored health insurance plan whether they want to or not. The bill does this by excluding people whose employer offers employer sponsored health insurance from being eligible for affordability premium credits (§242(b)(1)). These credits will be of crucial importance to this income segment of Americans to enable them to purchase health insurance especially if one considers that the mandates of this bill will significantly raise the price of health insurance in America. This bill will mandate community underwriting premium pricing essentially, no barring of applicants for pre-existing conditions, no dropping of insurance on enrollees that get sick, no yearly or lifetime benefit limits, free preventive care, modest out-of-pocket limits. Look at some of the states that have only some of these mandates, for example Maine and New Jersey, in these states it has significantly driven up health insurance premiums causing the consequence that in Maine 22 % (twice the national average) are on Medicaid and in New Jersey their uninsured rate is around 15 %. Congress boxing in these Americans like this is absolutely terrible. For some of these American’s their doctor won’t be on their employer plan’s preferred provider list; moreover, there is a lot of good reasons for not going on an employer sponsored plan – the better hospitals in one’s area may not be on the plan’s preferred provider list, the coverage of the plan may not be that good, the reputation of the insurance issuer may be poor in terms of paying on claims and determining coverage. It is somewhat surprising small and middle size business advocacy organizations aren’t calling for the House to scrap this exclusion because this will in all likelihood hurt their ability to hire good people because many of these businesses will only be able to afford bare bone insurance plans and many potential workers who are in the affordability credit program and have a good insurance plan will probably think to themselves why should I take a job with such a business where I will have to give-up the good health insurance coverage I have for me and my family. The House ought to reverse itself here, the tax money of all Americans is being used to pay for this affordability credit program and the distinguishing criteria for eligibility is not defensible. It also doesn’t make any sense from the standpoint that employers whose employees pass on joining the employers sponsored plan still have to pay a fee to the exchange for those employees in the same amount as if they didn’t have an employer sponsored health plan at all (§311(3)). Since the government is getting this money from employers for their employees who decide to join health plans offered on the exchange one would think the government would try to channel some of that money back to these employees, that would seem only fair to those employees.

    The House in its bill is being incredibly foolish with its affordability “cost sharing” credit initiative (that is not the affordability “premium” credit initiative which is an excellent initiative). This “cost sharing” initiative will lower co-pays and co-insurance for Americans that have Exchange offered health insurance and who are in the “affordable credit” program. It is a really bad idea because it is unfair to a large number of Americans who get their health insurance through their employer and because their employer offers health insurance they are not eligible for the “cost sharing” credits but would otherwise be eligible, the indication the number is large is evident if one considers that over fifty percent of Americans get their health insurance through their employer. So what the nation will see is American families with employer sponsored health insurance struggle to pay their “cost sharing” health care bills and other American families with the same or better incomes getting significant help on the same type of bills from the government, the effect will be idiotic and unseemly. The American people will consider this program is unfair all Americans are footing the bill for the program why do some lower income people get help and others don’t? Moreover, it is a bad idea in light of the alarming budget debts America is facing ($9 trillion over the next ten years) which is moving responsible Americans to call for the U.S. government to be very careful on any significant expansion of government and not to pursue any unneeded spending. This program is “unneeded” spending at this point let the government first solve the problem of how to provide affordable quality health insurance to all Americans. The House should keep in mind that the bill does mandate on insurance plans out of pocket limits which helps a great deal on this issue. If the Congress wanted to handle this issue right, in light of the terrible financial straights the country is in, it would distinguish the nature of the medical care the government will help “cost share” on, more specifically limit the help to medical care needed for treatment of serious health problems, since Congress in the bill isn’t making such distinctions it should just scrap the whole initiative.

    The House should scrap the mandate that employers automatically enroll their employees in the employers’ offered insurance plan unless the individual employee opts-out (§312(4)). This is a violation of these employee’s rights, health insurance to too vital and too important to one’s life, the government shouldn’t have a hand in putting people in specific private insurance plans. Obviously the House’s goal here is to get everyone enrolled in a health insurance plan a good goal. The House is on the right track in solving this whole problem by increasing the income tax rate on people who do not carry health insurance §410(a). A further help would be to put in the bill an obligation on the IRS before they issue any refund checks to check the appropriate government data bases to determine if that taxpayer met the requirement of carrying insurance and if that taxpayer didn’t make sure that the penalty tax is deducted from the refund check if the taxpayer hasn’t already paid the penalty tax. Moreover, the bill should require the Secretary of HHS to create a database of all Americans that aren’t meeting their legal requirement to carry health insurance and the bill should notify these individuals’ employers that these employers must increase the withholding tax on these individuals to withhold the penalty tax. Furthermore, the bill should mandate this database be used to stop these individuals from getting any government benefits while their violators including in part, food stamps, LIHEAP, FHA Loans, SBA loans and block them from getting a passport; also, mandate this blocking of services on violators be taken up by the states to compel cooperation on individuals to carry health insurance and ban these violators from being able to get a drivers license – to accomplish this withhold parts of transportation and other funding on states to gain their cooperation on this matter. In addition, utilize this database to ban violators from getting employment with the Federal government, states and county subdivisions for three years from the time they stop being violators. In short, the Congress can reach its goal of basically having all Americans carry health insurance by creating a whole array of penalties violators will face.

    The House is doing a good thing in their bill by eliminating the extra costs on the Medicare system due to Medicare Advantage enrollees over regular Medicare enrollees. But what is a glaring flaw in their bill is not to stop one of the glaring examples of waste and abuse in the Medicare system that experts frequently point out in public discussions on the subject which is the waste brought about by the Medicare system’s acquisition of durable medical equipment. One often hears stories about how Medicare rents medical equipment for beneficiaries and the monthly rental fee is so high that if one would take like four months of this rental fee one could go out and actually outright purchase the equipment being rented, it is absurd and ludicrous. The House in their bill should implement the consensus solution to this problem and have Medicare acquire durable medical equipment through competitive bidding. To be fair to the vendors that become the suppliers through this competitive bid system the government should make the contracts for two to three years which would also facilitate the Medicare system putting into place reliable supplier networks so beneficiaries who need such equipment can get it reliably and not have to go through trying experiences. To accomplish this House members would have to stand firm against the special interests’ lobby who would be opposed to such a change but this is what the American people want this is why they elected the present members they want change from business as usual in Washington, they want the government to work for the American people.

    The most admirable Americans believe that the availability of affordable quality health care is a human right which the American government should provide to the American people. The U.S. government should and can achieve this goal being wise and responsible which calls on the U.S. government not to create unnecessary bureaucracies and not to pursue enormous unnecessary spending to achieve this goal.
  2. ba1614

    ba1614 Silver Member

    May 9, 2009
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    Deep in the Northern Woods
    Interesting read, thanks for sharing,
  3. garyd

    garyd Senior Member

    Dec 19, 2008
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    Except that bare bones plans will now be illegal by government fiat.

    PLYMCO_PILGRIM Gold Member

    Jul 3, 2009
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    America's Home Town
    Actually current plans will be phased out of existence

    The Biggest and Baddest provision turns President Obama into a bald-faced liar. The party line is that if you currently have health insurance, sure, you can keep it. They call this “grandfathering” in your plan. But Section 102: PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE doesn’t protect anything except the government-run “gateways” and “exchanges” because the day you decide to give up your current plan, it’s all over but the shouting because unless you enroll in an employer-provided plan (that must provide no less than exactly the same benefits as the government’s plan), it’s straight into the machine for you.

    These are the key excerpts:

    (a) IN GENERAL- Except as provided in this paragraph, 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.

    (Notice that this is the sum total of verbiage in “this paragraph”. There are NO exceptions. Health insurers may no longer enroll new plan participants.)​

    (c) Limitation on Individual Health Insurance Coverage-

    (1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

    **This means that if a health insurance company wants to stay in business, it must get in bed with the government.**

    (2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.

    ***How very kind of them. Separate insurance policies will be “permitted” by the government. If you didn’t ask “What are excepted benefits?” then you deserve the government we’ve got today and don’t come crying to us when Pater Obama tells you that your life isn’t worth the cost of saving it. But because I’m feeling generous today, I’ll ask the question for you. What are these “excepted benefits”? Well, basically anything except what we all think of as common medical treatments, such as:

    Coverage only for accident, or disability income insurance, or any combination thereof.
    Coverage issued as a supplement to liability insurance.
    Liability insurance, including general liability insurance and automobile liability insurance.
    Workers’ compensation or similar insurance.
    Automobile medical payment insurance.
    Credit-only insurance.
    Coverage for on-site medical clinics
    Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

    Not exactly the “choice” the President, Pelosi, Reid, and those other generous progressives (gag) are leading you to believe, is it?

    So just what happens to your “health care” once the government gets their guaranteed hold of it? Pull out your airsickness bag and read on.

    What is covered:

    From section 122 (Essential benefits)

    (b) Minimum Services To Be Covered-

    (1) Hospitalization.
    (2) Outpatient hospital and outpatient clinic services, including emergency department services.
    (3) Professional services of physicians and other health professionals.
    (4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
    (5) Prescription drugs.
    (6) Rehabilitative and habilitative services.
    (7) Mental health and substance use disorder services.
    (8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
    (9) Maternity care.
    (10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

    (1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

    This is the 2008 list of those “preventative services” from the U.S. Preventive Services Task Force:

    Grade A:

    Cervical cancer screening for women
    Colorectal cancer screening for men and women over 50
    Discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease
    Screening for high blood pressure in adults aged 18 and older
    Screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older nonpregnant women who are at increased risk
    Prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum
    Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit
    Screening for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection
    Screening all pregnant women for HIV
    Screening persons at increased risk for syphilis infection
    Screening all pregnant women for syphilis infection
    Screening all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco
    Screening all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke
    Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care
    Screening for sickle cell disease in newborns
    Grade B:

    One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked
    Genetic counseling and evaluation for women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (breast & ovarian cancer)
    Chemoprevention for women at high risk for breast cancer and at low risk for adverse effects of chemoprevention
    Screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older
    Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk
    Screening all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors)
    Screening and behavioral counseling interventions to reduce alcohol misuse (go to Clinical Considerations) by adults, including pregnant women, in primary care settings
    Screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and followup
    Intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians
    Routine screening for iron deficiency anemia in asymptomatic pregnant women
    Routine iron supplementation for asymptomatic children aged 6 to 12 months who are at increased risk for iron deficiency anemia
    Screening all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults
    Screening women aged 65 and older routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures
    Structured breastfeeding education and behavioral counseling programs to promote breastfeeding
    Primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride
    Screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years


    Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

    ****Pay particular attention to this. It’s your annual out-of-pocket expenses for for anything not included in the Grade A or Grade B list of “preventative items and services”. So although a preventative test may be covered, you’ll still be liable for co-pay expenses to walk in the door to get it. And just like with most plans today, you’ll still be liable to share the costs of fixing anything found wrong with you by those tests.****

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