HR3200 : Division A : Day One

Now that we’ve all read “Division A” of House Resolution 3200, America’s Affordable Health Choices Act of 2009, let’s look at the bill a little more closely.

Following the purpose of the bill, in section 101, we see the requirements for qualified health benefits plans. These plans will not be considered qualified health benefits plans unless they meet the same requirements that the government created plans. That means they have to meet all of the same standards, make coverage affordable, provide essential benefits, and offer additional consumer protections.

On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:

(1) Subtitle B (relating to affordable coverage).

(2) Subtitle C (relating to essential benefits).

(3) Subtitle D (relating to consumer protection).

Sadly, it does not end there. In the beginning, you will be allowed to keep your current employer-based coverage. Existing plans can be grandfathered in.

Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met

If we stop reading at this point, it doesn’t sound so bad. But what are those “following conditions”? Are there limitations? Why, yes, there are.

(1) Limitation on new enrollment.

(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.

(B) Dependent coverage permitted. — Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) Limitation on changes in terms or conditions.—Subject to paragraph (3) and except as required by law, 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.

(3) Restrictions on premium increases.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

That doesn’t sound so bad does it? Read section (A) again. Existing plans cannot “enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1 (year one). Existing plans cannot change any terms or conditions including benefits after the first day of year one, and they cannot raise rates unless they raise them for everyone in the plan. Yes, the bill states you can keep your existing plan, but with the added “standards”, regulations, prohibition of adding new enrollees, and inability to modify their plans. How many of those current plans will still exists when the “grace period” ends in year five?

Can we be sure that existing plans will still be an option once this bill is signed into law?

President Obama assures us that we can keep our existing coverage. Pay attention at the 3:33 minute mark. In his own words…

Under our proposal, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period. End of story.

Apparently, the story doesn’t end there. As the legendary Paul Harvey would say, here’s the rest of the story.

Again, wait for the 1:11 mark, and you’ll hear the President, in his own words, guarantee us that we will be able to keep our existing insurance.

Linda Douglass wants us to think that people are cherry picking President Obama’s words and piecing them together, then she played two videos where he admits once again that we will be able to keep our existing insurance plans if we like them. Thanks Linda! (Special thanks to Vinny for supplying the Douglass video).

If President Obama is telling the truth about existing health care plans, why did the Energy & Commerce Committee vote on an amendment from Rep. Cliff Stearns (R-FL) on July 28th that stated, “Nothing in this division shall prevent or limit individuals from keeping their current health benefit plan”?

If President Obama was telling the truth, that text should already be included in the bill, and an amendment stating such would not be introduced in committee. As you probably know, “Amendments are proposals to alter or rewrite legislation being considered by Congress. The amending process provides a way to shape bills into a form acceptable to a majority in both the Senate and House of Representatives.” Did you catch that? A proposal to alter or rewrite legislation, not repeat the text within it.

According to this fact sheet at the Congressional Quarterly,

Amendments have many objectives. Members may introduce amendments to dramatize their stands on issues, even if there is little chance that their proposals will be adopted. Some amendments are introduced at the request of the executive branch, a member’s constituents, or special interests. Some become tools for gauging sentiment for or against a bill. Some may be used as “sweeteners” to broaden support for the underlying measure. Others are used to stall action on or to defeat legislation. In the House, where debate is strictly limited, amendments may be used to buy time; a member may offer a pro forma amendment, later withdrawn, solely to gain a few additional minutes to speak on an issue.

The amendment introduced by Rep. Stearns was not a “pro forma” amendment. It was discussed and voted on. For your information, the amendment FAILED in a vote of 32-26. You can see how committee members voted by clicking the image to the left.

So who’s misleading us? Is President Obama lying when he says we will be allowed to keep our existing health benefit plan? If the guarantee that we could keep our existing health benefit plan was written in the bill, the Energy and Commerce Committee would not be wasting their time voting on an amendment that proposed the same guarantee.

Sixteen pages into the bill and we’ve already established that someone is lying to us. You don’t have to have an R or a D after your name to see that.

Let’s move on…

Section 112 informs us of the guaranteed availability and renewability of health insurance coverage, whether it’s government provided or employer-based. It really irks me that on page 20 they keep referring to employer-based plans even though we’ve already learned that those plans are only temporary.

In Section 113, we learn,

The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets.

This study will include types of employers, similarity and difference of health plans offered, the financial solvency and capital reserve levels of employers that self-insure by employer size, the risk of self-insured employers becoming financially insolvent, and the extent to which rules likely to cause and adverse selection.

Stop for a moment. Re-read the previous paragraph. Tax returns report the income an individual or company makes for the year. It does not report the financial solvency of the company or their capital reserve levels. Exactly how is the government “study” going to report this information? It’s an honest question that is not answered within the confines of HR 3200. It sounds to me like the government plans on having the authority to examine the books of any company that self-insures. Is that authority written into the bill? We need to keep reading don’t we?

Section 115 sets another standard for qualified health benefits plans.

A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

Apparently, this “Commissioner” will have the sole authority to decide which provider networks are qualified and which ones are not. Who will be the Commissioner and why are we giving him/her the sole authority to make such decisions? Did you know that Section 116 also gives him/her the authority to set the prices for all qualified plans?

A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

That’s right. All qualified health benefits plans will be required to meet the same “medical loss ratio”, which means any profit above the ratio set by the “Commissioner” will be returned to enrollees in the form of rebates. How many private employer-based health plans would still participate after the first year if they had to return most of their profits at the end of the year (provided we were allowed to keep our current providers in the first place)?

We sure as hell know we won’t get rebates from the government controlled plans, and what private company in their right mind would do business this way? Section 116 sure does a good job of subtly setting the stage for “socialized medicine” doesn’t it?

To Be Continued…
(We’ll start with page 25 next. If you still haven’t finished reading “Division A”, you still have time).

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