Healthcare Commentary by Paragraph
Pg 30: This section establishes the makeup of the Health Care Benefits Committee. This committee is made up of the Surgeon General, nine members appointed by the President who are neither federal employees nor officers, nine members appointed by the Comptroller General who are neither federal employees nor officers, and no more than eight members who are federal employees/officers who are appointed by the President.
If you read the preceeding section and following sections, you’ll see that what they’re doing is establishing minimum standards for insurers so that when people get a plan (categorized as essential, enhanced, or premium), they know that the plans cover minimums established by law. To say they’re going to decide what benefits you get is just a complete distortion of the bill’s intentions and contents.
Those standards include the mandate that policies use simple language to spell out the coverage and responsibilities. It also establishes the absolute right of patients to dispute denied claims and have an impartial external review of the decisions which is binding on the insurer. Even so, the patient’s right to judicially appeal the decision is specifically maintained.
In short, it stops the kind of garbage insurers have been pulling for years and brings their decisions into the light of day.
Pg 124: This section deals ONLY with the Public Option. If you read earlier in the Public Option section, you’ll find that the majority of these people are going to be Medicare recipients, since that’s where they’ll fall under the new system for their coverage. The people on the public option will therefore get the same rights as Medicare has that were established in the laws governing it. On page 118, it specifically states that EVERYBODY insured under the public option will be guaranteed the right to seek redress through the court system as established by the laws governing Medicar. Nobody loses their right to sue. Page 124 only says that there isn’t a provision for judicial review of PAYMENT RATES or METHODOLOGY. In other words, the insurance companies can’t sue the federal government to change the rates for services it establishes. That means they’ll not only have to comply with minimum standards, but will now also have to compete for business rather than just accepting payments for premiums and keeping them when they deny claims.
Pg 167: In order to make any universal healthcare plan work, it has to be universal. That means everybody buys in. So yes, it does say that anyone who fails to obtain healthcare will be taxed 2.5 percent. But read on. You won’t be taxed if you’re covered by:
- One of the qualified benefits packages (essential, enhanced, premium) which also includes the public option.
- A grandfathered privately paid health insurance plan, i.e. one you had before the new law goes into effect. This actually proves Obama means what he said about keeping the plan you have.
- An existing employer-provided plan
- Medicare
- Medicaid
- Tricare (military members)
- Veteran’s health care for those with disability, etc.
If you add all those in, the only people who would be taxed are pretty much those with no healthcare who decided not to get it. It’s what’s called an incentive to enroll, since it won’t be effective if everybody isn’t covered. That’s what will bring down costs and risk, since insurance is based on amortizing costs across the number of people insured.
Page 280: This ONLY applies to Medicare and Medicaid, not the entire system. And it isn’t designed or focused on denying anyone care. It’s designed to address a problem that has been identified as costing Medicare/Medicaid over $12 Billion a year. For example, estimates are that one in five seniors are readmitted to the hospital in less than a month, often for reasons that could have been easily prevented if dealt with while they were in the hospital. Simple things like giving patients better education on wound care, follow up, medications, etc. That’s all this is designed to remedy. And it isn’t something that suddenly popped up. Here’s a Boston Globe Article from 2008 that explains the whole concept this is designed to deal with. Again, this is totally in sync with trying to make patients healthier, not deny them care. That’s what the focus is on.
Page 341: Read the entire section. Again, this only applies to Medicare-Advantage plans. First of all, it establishes ways that such plans can earn bonuses if they improve and become designated “High Quality Plans” or “Improved Quality Plans.” This type of ranking of the plans already goes on. But this actually pays them incentives to perform better. And in the spirit of the rest of the act, which is to weed out plans that don’t perform for their enrollees, it does give the ability for plans that don’t meet minimum standards to be disqualified. I’m sorry, but that’s what needs to happen. It does away with plans that feed off their insured members while not paying for services or not meeting some sort of minimum standards, and rewards those that provide exceptional service and performance. What the heck’s wrong with that?
Page 354: This doesn’t restrict anyone enrolling in a Special Needs Medicare Assistance Plan. That’s bunk. What it does is introduce an open-enrollment period every year where people can apply for these plans when the system is adjusted to process them efficiently. That’s the same thing practically every employer-based health insurance plan does now, including at my work. However, the act maintains the existing emergency clause in the existing Medicare legislation that allows people to be accepted outside the open-enrollment period if they
“Meet such requirements as the Secretary may determine would benefit from enrollment in such a specialized MA plan described in subparagraph (A) for individuals with severe or disabling chronic conditions who have one or more comorbid and medically complex chronic conditions that are substantially disabling or life threatening, have a high risk of hospitalization or other significant adverse health outcomes, and require specialized delivery systems across domains of care.”
In short, it doesn’t do anything but provide a more efficient way to manage applications for these plans. Again, this is about efficiency of service, not denial of services.
Page 425: Guiding you in death? No way. It’s providing people things they absolutely need to know about. In my mind it ought to start at age 21. I deal probably once a week with an elderly, demented person who doesn’t have a will, living will, or anything else planned out and leaves their family in a lurch. End-of-life planning is a term which has been used in the medical community for decades. And it never meant what the opponents of healthcare reform are saying, and it doesn’t mean it now. Even Jay Seculo from the ACLJ, a renowned Christian attorney, admitted on NPR that the only thing wrong with this portion of the act is the requirement that doctors report back to the government the specifics of what they covered with the individuals, rather than just a generic statement saying it was accomplished. For what it’s worth, I agree with him. People need this counseling and it’s too late to get it when you’re in crisis. So that kind of “guiding you in death” insanity is totally over the hill and inflammatory beyond belief. If scaring people rather than educating them is the object, that’s the way to go.
