Questions about Health Care Reform--things you don't know
08 Jul 2011, 1:29 am
AceOfSpades wrote:
It's funny that people were screaming "SOCIALIST!" when Obama seems like a corporate dick sucker more than anything else.
Why is anyone surprised that Crony Capitalism cannot be readily distinguished from burocratic socialism?
When capitalism merges with the State, we have Fascism With A Smile and that looks very much like Socialism.
ruveyn
08 Jul 2011, 8:22 am
Well, at least they did something. It isn't perfect, but it is a step in the right direction.
President Nixon made an effort. He and the Congress couldn't agree on the details, so it collapsed. If Congress and the President could have agreed on at least something back then, it would have been at least a small step in the right direction. So that, by now, the program might have been perfected.
08 Jul 2011, 8:38 am
simon_says wrote:
1, There will be new options available under the exchanges. The coverage levels are mandated for those.
Wrong: The insurance exchanges will only be available for people who cannot get health insurance through their employer, Medicaid, or Medicare. You cannot drop off of your employer's plan and go onto the insurance exchange to get better coverage. If your employer has a self-funded grandfathered plan (like mine does) they do not have to comply with the coverage levels, so you can end up with insurance that does not include things like chemotherapy, dialysis treatment, physical therapy, mental health, maternity, etc. If you get cancer, your only option would be to quit your job, declare bankruptcy, and go on Medicaid--is that an improvement? If you don't believe me, go read the legislation and point out where I am wrong here.
2. See 1.
3. Even if true, more will still get treatment and coverage. And the punishment can be adjusted.
4. Annual limits already existed and are to be phased out by 2014. Until then the caps are made higher.
http://blog.pomcogroup.com/?p=76
I am not aware of annual limits going away: from what I read, insurance companies will still be able to impose these forever.
5. Temporary stop gap until 2014, when insurers can't deny you.
Your assertion that nothing will get better is just silly. Many uninsured are likely to get swept into Medicaid anyway. Things will certainly be better for them than having nothing. For the rest, cheaper policies will be available on the exchanges.
As I indicated before, the insurance exchanges will be available to less than 10% of the population: those lucky souls will get good coverage while the rest of us become chronically underinsured as insurers slash benefits and engage in "regulatory avoidance" which is now a cottage industry.
check this video out on YouTube that instructs companies on how to avoid PPACA mandates
http://www.youtube.com/watch?v=j5OoIDlP1v0
Listening to less talk radio would be my advice.
Wrong: The insurance exchanges will only be available for people who cannot get health insurance through their employer, Medicaid, or Medicare. You cannot drop off of your employer's plan and go onto the insurance exchange to get better coverage. If your employer has a self-funded grandfathered plan (like mine does) they do not have to comply with the coverage levels, so you can end up with insurance that does not include things like chemotherapy, dialysis treatment, physical therapy, mental health, maternity, etc. If you get cancer, your only option would be to quit your job, declare bankruptcy, and go on Medicaid--is that an improvement? If you don't believe me, go read the legislation and point out where I am wrong here.
2. See 1.
3. Even if true, more will still get treatment and coverage. And the punishment can be adjusted.
4. Annual limits already existed and are to be phased out by 2014. Until then the caps are made higher.
http://blog.pomcogroup.com/?p=76
I am not aware of annual limits going away: from what I read, insurance companies will still be able to impose these forever.
5. Temporary stop gap until 2014, when insurers can't deny you.
Your assertion that nothing will get better is just silly. Many uninsured are likely to get swept into Medicaid anyway. Things will certainly be better for them than having nothing. For the rest, cheaper policies will be available on the exchanges.
As I indicated before, the insurance exchanges will be available to less than 10% of the population: those lucky souls will get good coverage while the rest of us become chronically underinsured as insurers slash benefits and engage in "regulatory avoidance" which is now a cottage industry.
check this video out on YouTube that instructs companies on how to avoid PPACA mandates
http://www.youtube.com/watch?v=j5OoIDlP1v0
Listening to less talk radio would be my advice.
I read the legislation almost in its entirety--I don't listen to talk radio. You need to get educated on this, and that doesn't involve looking at Whitehouse bullet points, it involves reading the legislation.
08 Jul 2011, 10:34 am
pandabear wrote:
It doesn't "screw over" most people. Most people will come out ahead, compared to what the Republicans would have wanted, which would have been to screw over everyone who isn't rich.
But, a lot of people might not see significant improvements, particularly at the bottom of the socio-economic ladder. Still, it is (hopefully) better than nothing.
But, a lot of people might not see significant improvements, particularly at the bottom of the socio-economic ladder. Still, it is (hopefully) better than nothing.
Given you admit those at the bottom won't see improvements under Obamacare, it sounds like it's Obamacare that "screws over everyone who isn't rich".
How do you know what "Republicans would have done"? The only example we have, Romneycare, substantially improved things for those at the bottom.
Sweetleaf
Veteran
Joined: 6 Jan 2011
Age: 35
Gender: Female
Posts: 34,991
Location: Somewhere in Colorado
08 Jul 2011, 11:14 am
pandabear wrote:
Well, at least they did something. It isn't perfect, but it is a step in the right direction.
President Nixon made an effort. He and the Congress couldn't agree on the details, so it collapsed. If Congress and the President could have agreed on at least something back then, it would have been at least a small step in the right direction. So that, by now, the program might have been perfected.
President Nixon made an effort. He and the Congress couldn't agree on the details, so it collapsed. If Congress and the President could have agreed on at least something back then, it would have been at least a small step in the right direction. So that, by now, the program might have been perfected.
fining people for not being able to even afford healthcare under obamacare or whatever is not a step in the right direction.
08 Jul 2011, 12:00 pm
Silas wrote:
3. Most health insurance companies will continue to deny coverage for serious claims
The fine from the government for not providing care (coverage) for a given illness will be $100 a day. Health insurance CEOs have already been saying behind closed doors that they will pay the $100 a day fine until the person dies rather than cover a million dollar illness.
The fine from the government for not providing care (coverage) for a given illness will be $100 a day. Health insurance CEOs have already been saying behind closed doors that they will pay the $100 a day fine until the person dies rather than cover a million dollar illness.
Ask the Ford Motor Company how well that strategy worked for them with the Pinto. This is precisely the kind of calculus that justifies punitive damage awards.
I am still gobsmacked that the United States governments pay more, per capita, for health care than Canadian governments do, and we can, for those fewer dollars, provide universal, medically necessary care with better health outcomes in areas such as life expectancy and infant mortality. I don't suggest that our system is perfect--far from it, but in its fundamental conception it seems to have far more merits than flaws. I am not sure that the same claim can be made for the far more expensive US system.
At the end of the day individuals will pay. You will pay through taxes, through premiums, through direct costs, or through the losses resulting from untreated or improperly treated illness. It seems to me that attempts to control individuals' costs are, "penny wise and pound foolish."
_________________
--James
08 Jul 2011, 12:10 pm
Quote:
I am not aware of annual limits going away: from what I read, insurance companies will still be able to impose these forever.
Annual caps for policies are ending in 2014. Until then rules are in place to minimize their impact. After 2014, per beneficiary caps (annual or lifetime) are still allowed for covered non essential health benefits as defined by PPACA. Essential care is defined by the law and caps on specific non-essential items won't be preventing you from accessing essential and expensive items like chemotherapy, etc.
Quote:
Sec. 1001. Amendments to the Public Health Service Act.
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
Quote:
‘‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
Quote:
I read the legislation almost in its entirety--I don't listen to talk radio. You need to get educated on this, and that doesn't involve looking at Whitehouse bullet points, it involves reading the legislation.
I can look at your claims and see what you are.
In addition to your other errors I think you are misreading the penalties. There are civil penalties, excise tax penalties and always the possibility of civil action to correct the insurers implementation of policy. There are many levers they can use and it's certainly more painful than it was previously. If more pain is required, they can adjust it. They will be tweaking variables for decades.
It's true that exchanges are for non-employer plan people but there are some controls on employer plans as well. If more regulation is required to make them effective, which remains to be seen, that can be addressed in Congress.
I have no confidence in your analysis given your errors. We'll see what happens.
08 Jul 2011, 1:34 pm
visagrunt wrote:
Silas wrote:
3. Most health insurance companies will continue to deny coverage for serious claims
The fine from the government for not providing care (coverage) for a given illness will be $100 a day. Health insurance CEOs have already been saying behind closed doors that they will pay the $100 a day fine until the person dies rather than cover a million dollar illness.
The fine from the government for not providing care (coverage) for a given illness will be $100 a day. Health insurance CEOs have already been saying behind closed doors that they will pay the $100 a day fine until the person dies rather than cover a million dollar illness.
Ask the Ford Motor Company how well that strategy worked for them with the Pinto. This is precisely the kind of calculus that justifies punitive damage awards.
I am still gobsmacked that the United States governments pay more, per capita, for health care than Canadian governments do, and we can, for those fewer dollars, provide universal, medically necessary care with better health outcomes in areas such as life expectancy and infant mortality. I don't suggest that our system is perfect--far from it, but in its fundamental conception it seems to have far more merits than flaws. I am not sure that the same claim can be made for the far more expensive US system.
At the end of the day individuals will pay. You will pay through taxes, through premiums, through direct costs, or through the losses resulting from untreated or improperly treated illness. It seems to me that attempts to control individuals' costs are, "penny wise and pound foolish."
Interesting that you should mention punitive damage awards because that's another key aim of the republican agenda - tort reform. Not just in healthcare either. The goal is basically to call lawsuits frivolous and promise savings to the people via reduced insurance rates.
Unfortunately, it's total crap because insurance rates have not been reduced in states that have enacted such caps on punitive damages and the end result is a loss of power from both the consumers and the juries. Large corporations, such as insurance companies, are taking full advantage of the legal system and are basically free from lawsuit fears (a judgement of $1 million really doesn't even affect a company like United Healthcare so why should they change their practices?). We the people are really way more f*cked than most of us even realize.
With healthcare, it basically comes down to whether you think it should be a right or a privilege. If you believe it's a right, as I and most other civilized nations do, then it should fall under the role of the government. If you believe it's a privilege, then it is treated it as a commodity for businesses to profit from.
There's just such a blatant conflict of interest when it comes to for-profit insurance companies. The less they pay out - the more they profit. It really is that simple. There is no practical way to remove this conflict between what's in the best interest of the consumer vs. the best interest of the company. I don't like Obamacare either because it does not solve this basic problem.
08 Jul 2011, 4:00 pm
simon_says wrote:
Quote:
I am not aware of annual limits going away: from what I read, insurance companies will still be able to impose these forever.
Annual caps for policies are ending in 2014. Until then rules are in place to minimize their impact. After 2014, per beneficiary caps (annual or lifetime) are still allowed for covered non essential health benefits as defined by PPACA. Essential care is defined by the law and caps on specific non-essential items won't be preventing you from accessing essential and expensive items like chemotherapy, etc.
Quote:
Sec. 1001. Amendments to the Public Health Service Act.
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
Quote:
‘‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
Quote:
I read the legislation almost in its entirety--I don't listen to talk radio. You need to get educated on this, and that doesn't involve looking at Whitehouse bullet points, it involves reading the legislation.
I can look at your claims and see what you are.
In addition to your other errors I think you are misreading the penalties. There are civil penalties, excise tax penalties and always the possibility of civil action to correct the insurers implementation of policy. There are many levers they can use and it's certainly more painful than it was previously. If more pain is required, they can adjust it. They will be tweaking variables for decades.
It's true that exchanges are for non-employer plan people but there are some controls on employer plans as well. If more regulation is required to make them effective, which remains to be seen, that can be addressed in Congress.
I have no confidence in your analysis given your errors. We'll see what happens.
You are correct about the annual limits: they will be phased out for all health plans in 2014 -that is a good thing.
What you fail to realize is the difference between fully insured plans and self-insured plans. See
http://www.shrm.org/hrdisciplines/benef ... unded.aspx
The PPACA mandates regarding "Essential Health Benefits" which basically state that a health plan needs to offer fundamental, basic healthcare coverage for things like maternity, cancer treatment, physical therapy, or in the case of Autism, stuff like ABA do not apply to self-funded plans. These are the "controls on employer plans" you are talking about.
Self-funded health plans fall under federal jurisidction and are exempt from ALL state regulations. They are defined under ERISA.
Almost 60% of Americans are on self-funded plans. We are talking about over 100 million people.
I have 2 Autistic children (and I'm probably on the spectrum myself) and my kids get NO autism treatment whatsoever through my insurance at work. No physical therapy, ABA, counseling, -nothing. When I brought up the PPACA with human resources I was quickly given an education about how our self-funded plan (Blue Cross Blue Shield) is exempt from ALL PPACA mandates save for lifetime maximums on coverage. That's it.
Even the regulatory change in 2010 that told insurance companies that they could no longer charge copays, deductibles, etc. for preventitive medicine do not apply. I get charged hundreds of dollars for physicals and my wife gets slammed for mammograms, etc. Why? Our plan is also "grandfathered", so it doesn't have to abide by the 2010 mandates either.
How long can companies grandfather their plans and avoid the regulation?
Forever
In anticipation of PPACA, companies all over the US self-insured and slashed their health benefit packages, and are now engaged in "regulatory avoidance" strategies. Tens of millions of Americans have seen their benefits decrease and their deductibles, premiums, and copays skyrocket.
Obama had one chance to really help people with Autism find healthcare, and he threw all of us under the bus. Instead of giving us a public option, or forcing ALL companies to comply with the Essential Health Benefit provisions, he created huge loopholes for insurance companies and employers to dodge the PPACA.
Unfortunately, most people, including yourself, are not aware of this. People didn't read the legislation, and the news media didn't know about the devil in the details. I found out the hard way when I tried to get meaningful coverage for myself and my kids.
08 Jul 2011, 4:13 pm
ruveyn wrote:
AceOfSpades wrote:
It's funny that people were screaming "SOCIALIST!" when Obama seems like a corporate dick sucker more than anything else.
Why is anyone surprised that Crony Capitalism cannot be readily distinguished from burocratic socialism?
08 Jul 2011, 4:39 pm
pandabear wrote:
When evaluating potential employers, it is certainly important to examine the benefit schemes.
Agreed
However, the last 3 employers I have had, all had self-funded health plans. None of them offered an Autism benefit.
In this economy, few people can switch jobs 6-7 times before finding one that has decent insurance.
I suspect that 90% of employers will be self-funded within 10 years, and the PPACA will turn into a big waste of paper.
The insurance companies are already dumping millions into Obama's reelection campaign, so go figure.
08 Jul 2011, 4:43 pm
Silas wrote:
simon_says wrote:
Quote:
I am not aware of annual limits going away: from what I read, insurance companies will still be able to impose these forever.
Annual caps for policies are ending in 2014. Until then rules are in place to minimize their impact. After 2014, per beneficiary caps (annual or lifetime) are still allowed for covered non essential health benefits as defined by PPACA. Essential care is defined by the law and caps on specific non-essential items won't be preventing you from accessing essential and expensive items like chemotherapy, etc.
Quote:
Sec. 1001. Amendments to the Public Health Service Act.
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS
‘‘SUBPART II—IMPROVING COVERAGE
‘‘Sec. 2711. No lifetime or annual limits.
‘‘Sec. 2712. Prohibition on rescissions.
‘‘Sec. 2713. Coverage of preventive health services
Quote:
‘‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
23 ‘‘(a) PROHIBITION.—
VerDate Nov 24 2008 09:39 Dec 29, 2009 Jkt 089200 PO 00000 Frm 02034 Fmt 6652 Sfmt 6203 E:\SENENR\H3590.EAS H3590 wwoods2 on DSK1DXX6B1PROD with BILLS
2035
HR 3590 EAS/PP
1 ‘‘(1) IN GENERAL.—A group health plan and a
2 health insurance issuer offering group or individual
3 health insurance coverage may not establish—
4 ‘‘(A) lifetime limits on the dollar value of
5 benefits for any participant or beneficiary; or
6 ‘‘(B) except as provided in paragraph (2),
7 annual limits on the dollar value of benefits for
8 any participant or beneficiary.
9 ‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With re
10spect to plan years beginning prior to January 1,
11 2014, a group health plan and a health insurance
12 issuer offering group or individual health insurance
13 coverage may only establish a restricted annual limit
14 on the dollar value of benefits for any participant or
15 beneficiary with respect to the scope of benefits that
16 are essential health benefits under section 1302(b) of
17 the Patient Protection and Affordable Care Act, as de
18 termined by the Secretary. In defining the term ‘re
19 stricted annual limit’ for purposes of the preceding
20 sentence, the Secretary shall ensure that access to
21 needed services is made available with a minimal im
22pact on premiums.
23 ‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall
24 not be construed to prevent a group health plan or health
25 insurance coverage from placing annual or lifetime per ben-
1 eficiary limits on specific covered benefits that are not es
2sential health benefits under section 1302(b) of the Patient
3 Protection and Affordable Care Act, to the extent that such
4 limits are otherwise permitted under Federal or State
5 law.’’.
Quote:
I read the legislation almost in its entirety--I don't listen to talk radio. You need to get educated on this, and that doesn't involve looking at Whitehouse bullet points, it involves reading the legislation.
I can look at your claims and see what you are.
In addition to your other errors I think you are misreading the penalties. There are civil penalties, excise tax penalties and always the possibility of civil action to correct the insurers implementation of policy. There are many levers they can use and it's certainly more painful than it was previously. If more pain is required, they can adjust it. They will be tweaking variables for decades.
It's true that exchanges are for non-employer plan people but there are some controls on employer plans as well. If more regulation is required to make them effective, which remains to be seen, that can be addressed in Congress.
I have no confidence in your analysis given your errors. We'll see what happens.
You are correct about the annual limits: they will be phased out for all health plans in 2014 -that is a good thing.
What you fail to realize is the difference between fully insured plans and self-insured plans. See
http://www.shrm.org/hrdisciplines/benef ... unded.aspx
The PPACA mandates regarding "Essential Health Benefits" which basically state that a health plan needs to offer fundamental, basic healthcare coverage for things like maternity, cancer treatment, physical therapy, or in the case of Autism, stuff like ABA do not apply to self-funded plans. These are the "controls on employer plans" you are talking about.
Self-funded health plans fall under federal jurisidction and are exempt from ALL state regulations. They are defined under ERISA.
Almost 60% of Americans are on self-funded plans. We are talking about over 100 million people.
I have 2 Autistic children (and I'm probably on the spectrum myself) and my kids get NO autism treatment whatsoever through my insurance at work. No physical therapy, ABA, counseling, -nothing. When I brought up the PPACA with human resources I was quickly given an education about how our self-funded plan (Blue Cross Blue Shield) is exempt from ALL PPACA mandates save for lifetime maximums on coverage. That's it.
Even the regulatory change in 2010 that told insurance companies that they could no longer charge copays, deductibles, etc. for preventitive medicine do not apply. I get charged hundreds of dollars for physicals and my wife gets slammed for mammograms, etc. Why? Our plan is also "grandfathered", so it doesn't have to abide by the 2010 mandates either.
How long can companies grandfather their plans and avoid the regulation?
Forever
In anticipation of PPACA, companies all over the US self-insured and slashed their health benefit packages, and are now engaged in "regulatory avoidance" strategies. Tens of millions of Americans have seen their benefits decrease and their deductibles, premiums, and copays skyrocket.
Obama had one chance to really help people with Autism find healthcare, and he threw all of us under the bus. Instead of giving us a public option, or forcing ALL companies to comply with the Essential Health Benefit provisions, he created huge loopholes for insurance companies and employers to dodge the PPACA.
Unfortunately, most people, including yourself, are not aware of this. People didn't read the legislation, and the news media didn't know about the devil in the details. I found out the hard way when I tried to get meaningful coverage for myself and my kids.
I can vouch for this BS too. I also have a child on the spectrum who is ineligible for any and all services, diagnostics, etc., relating to autism through his current medical plan (my husband and I currently have no coverage) in spite of our state law requiring insurance companies to cover autism-related services. Oh, and it's a state-run plan. The irony is really painful here.
So, guess who's been picking up the tab for his services - the taxpayers. He, like most children on the spectrum, receives his services through the school district who in turn is reimbursed by medicaid. But it's up to the school district to decide which services are needed and which are not. Generally, only services directly related to academic achievement are approved, which seems fair considering that other medical and mental health issues shouldn't really be their burden to begin with. But this set-up is obviously not serving the best interest of the child.
One way or another, we all pay. The process could be so much more streamlined and transparent than it is now. It's all just a mad shuffle and dodge with consumers getting the short end of the stick. I think it's time we shift our thinking from consumer to patient.
08 Jul 2011, 5:13 pm
Sure, Ill bite. Let's see..
Grandfathered plans are just ones that employers voluntarily maintained before PPACA. They generally want happy employees, which is one reason they offered benefits. If their benefit plan is not competitive, their workplace will be seen as less attractive. There is a natural desire to stay competitive so...
Losing grandfathered status is to be decided by regulators. Here we go: The Interim Final Rule (a list of reasons a plan will lose grandfathered status).
http://www.groom.com/resources-505.html
http://www.icemiller.com/enewsletter/Be ... l_Rule.htm
There is an extensive list of reasons in the 2cd link. Changing details of the plan usually does it. So they can lose it by being d*cks.
This says that 90% of employers expect to lose grandfathered status by 2014
http://www.valiant.com/authors/health-c ... us-survey/
So that's one aspect of your problem. As for self-funded not covering your autism needs, I don't have the solution. They (HHS) recently expanded the list of things that self-fundeds must adhere to. Mental health regualtions are still excluded. But if the others could change through regulatory action, maybe that could. But maybe I'm wrong and it's not changeable, I didnt look it up in PPACA.
09 Jul 2011, 7:26 am
I've seen the paper that states 90% of plans will lose grandfathered status by 2014
that's a bunch of bs
99% of companies will be grandfathered in 2020 guaranteed, including the company I work for. Companies slashed their benefit packages in order to "lock in" a low-end plan and grandfather it. Millions of Americans saw a reduction in their benefits in 2009 and 2010 because of the PPACA
You will notice that according to the grandfathering rules, companies can still raise premium contributions on their employees 1000% and still stay grandfathered: wow this legislation has some teeth!
So to recap:
1. The PPACA sets up insurance exchanges that pretty much no one can use
2. The PPACA allows virtually any company to avoid its mandates and provisions
3. The PPACA does nothing to contain health care costs
4. The PPACA forces people to buy health insurance they probably can't afford
5. Implementation of the PPACA has led to a massive reduction in benefits for millions of Americans
6. The PPACA has led to massive premium hikes for most Americans
But this is what we get when we let a shill for the insurance companies legislate on our behalf
Jacoby
Veteran
Joined: 10 Dec 2007
Age: 33
Gender: Male
Posts: 14,284
Location: Permanently banned by power tripping mods lol this forum is trash
09 Jul 2011, 10:29 am
The worst part about this supposed reform was Obama and congressional democrats having the gall to say over and over again that the insurance companies were the ones benefit the most from it. They must really think we're stupid. Only the insurance companies and those who foolishly believe this is "better than nothing" support this monstrosity.
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