A Summary Review Of The House Healthcare Bill: This is must reading!

[Better Believe It]

I'm reposting this contribution to the DU discussion on the House healthcare bill that was written by DU'er "ThomCat". It was first posted yesterday in response to a lead post. ThomCat's initial analysis deserves to be read by everyone who wants to achieve a true universal healthcare system in the United States.

ThomCat may want to make some revisions in his analysis after further thought and study, but this is the most informative comment I've seen on the internet so far.

I don't know who ThomCat is, and I have no political or personal connections with him. I've read his DU profile and that's it!

So hat's off to ThomCat for his hard work!

---------------------------------------



ThomCat Tue Jul-14-09 04:30 PM

Some good and bad, a summary review.

1. (Bad) Right from the beginning, the stated purpose in Division A (on page 4) is to reduce the growth of cost of health care. Not to reduce the cost, but to slow down how quickly it gets more expensive. How is health care going to be affordable if reducing the cost is not part of the goal?

2. (Good) Includes a Public Option.

3. (Bad) using the term Spouse when referring to partners who are dependents, so Domestic Partners are excluded by this language as long as DOMA is still in force.

4. (Good, sort of) Age based pricing on individual health plans cannot vary by more than 2 to 1. So the cost of a health plan for someone elderly cannot be more than twice as expensive as it is for someone young.

5. (Bad) Rates can still vary by region, with limit on how much they can vary, though the regions are not defined and can/will be defined by the commissioner for this insurance later. This will mean that lobbying is going to determine how much more we get charged in cities compared to suburban or rural areas, and how much more in big cities vs smaller cities. This is a big loophole as far as I am concerned, and could become a big giveaway to insurance companies.

6. (Good and Bad) There is an effort to make mental health care and substance abuse care more available, but there are a lot of caveats, complicated referrals between sections in this bill, so that only a lawyer can figure out if any health plan really has to offer any care, what types, and with what availability or restrictions. It's good that the attempt is here, but clearly a lot of lobbying was done to make this complicated, so this looks like it's probably just a symbolic attempt.

7. (Good, maybe) The commissioner will create standard guidelines for how to determine the Medical Loss Ratio, the rate paid out in medical coverage relative to the amount charged in premiums. This is good because each company won't have their own way of calculating their MLR to best hide their profits. One set of rules apply to everyone. Though, there don't seem to be any teeth for catching them if they don't use this methodology, or for doing anything about it. The commissioner "can" do audits "in response to complaints." That seems to means that if the rule-braking gets too blatant and obvious, and the complaints get too loud to ignore then the commissioner will do an audit, but otherwise anything goes.

8. (Good) Once a standard Medical Loss Ration methodology is set, the commissioner will tell insurance companies what MLR to use, in other words, how much profit they can reasonably make from the premiums they take in. The rest HAS to go towards providing health care. Again, I don't see anything in here for verifying this, or doing anything to companies that take extra profit. It's probably going to be buried in future rules.

9. (Good, maybe) There will be minimum standards for plans. Though, no word on how low the minimum will be, or how variable and confusing the minimum options and choices could be. It's good to have a minimum, but it's better if the minimum is clear, consistent and set at a high enough level to ensure quality care. Nothing here requires that it be clear, consistent or set at a useful level. It looks like this section was heavily influenced so that the minimum can be set very, very low just so they can say there is a minimum down there somewhere, and to weed about the grossest abuses without really effecting most plans at all.

10. (Very Good) "A qualified health benefits plan may not impose any restriction (other than cost sharing) unrelated to clinical appropriateness on the coverage of the health care items and services." This seems to be a very straight forward clause prohibiting plans from arbitrarily refusing to cover certain services if those services are listed as covered, or refusing to cover them for select or certain people. There are other, more explicit non-discrimination clauses in this bill too. So, to the extent that anyone obeys this bill it's wonderful, but to the extent that this bill is toothless and enforced by a toothless new agency (read below) it is symbolic but at least it's there.

11. (Very Good) Qualified plans are prohibited from having annual and lifetime caps on services!

12. (Very Bad) The standard for a Qualifying plan is the "average prevailing employer-sponsored coverage." So if employers start offering less to their employees, the standard for these government qualified plans goes down. They have pegged the quality of Everyone's care to employer provided health care as a way of making it Necessary to preserve employer provided health care.

13. (Very Bad) The Cost Sharing (amount they make you pay in co-pays and deductibles) starts out at $5,000 per year per person for the basic plan and can go up each year linked to the consumer price index. Enhanced plans can not only cost more, they can also have a higher rate of "cost sharing," meaning you pay a greater rate relative to what you get. If you want more than basic, you have to be willing to pay more, and then pay extra for it. How the Fuck is any of this considered Affordable? This section all by itself is going to keep health insurance out of the reach of the Vast Majority of Americans.

14. (Bad) An advisory panel of medical and "Other Experts" will recommend what is to be covered on various levels of plans. 17 members are appointed by the President, only 8 of whom are federal employees. 9 more are appointed by the Comptroller General of the U.S. There are guidelines for trying to avoid stacking the panel with lobbyists, but even so I can easily see at a glance that over half of the panel could be stacked. (Can you say "rewards for largest campaign contributors") This means insurance lobbyists, pharma lobbyists, health care lobbyists, "experts" on corporate payrolls, and a token public advocacy doctors.

15. (Good, maybe) There will be an Ombudsman's office to help people within this new Government Department. But the duties of the Ombudsman seem to be defined mostly as providing information and helping to fill out paperwork, not really acting as an advocate to resolve serious disputes. Nor does the Ombudsman have any authority, because even the Chairman doesn't seem to have much authority. The Chairman is referred to state agencies and directed to "work with them" to get anything done. The Ombudsman would have vastly less influence and authority than even that. Just what we need, toothless advocacy.

16. (Very Bad) Repeatedly, it is stated that nothing in here supersedes state laws. This means that this new government agency will have to negotiate a hodge-podge of 50 sets of rules to implement their influence over insurance, and has to be weaker than the weakest of those 50 sets of rules. This guaranteeing that this new government agency will be toothless and absolutely no threat to the insurance industry. It looks like the lobbyists won.

17. (Good, maybe) There is a whistle-blower protection section in here. But it simply gives whistle-blowers the right to bring legal action under existing laws if they face retaliation, and we know that existing laws are absolutely insufficient and ineffective in protecting whistle-blowers. So it's good that this is in there, but it's useless until the underlying law is updated and improved.

--------------------------------------

[brentspeak]

1. It's a crap piece of legislation, and this is BEFORE it gets to be watered down

[babylonsister]

2. I'm just SHOCKED you feel that way! nt

[Bluenorthwest]

3. It discriminates against me and my family.

And will likely drive us out of the country to stay together.

[dionysus]

23. the obama health plan, which is way better than what we have, is goign to drive you out of the

country?

puh-leeeeeze
it's well known you can't stand the administration, but at least base yourself in reality please.

[Better Believe It]

32. People shouldn't go to Canada or some other nation out of medical necessity?

Would it be OK with you if we get our drugs in Mexico or Canada if possible?

Well, my wife will now have to work five more years before she can retire and receive Medicare.

We were hoping that she could retire and be eligible for a viable public option next year.

Not going to happen.

The so-called "public option" won't kick in for at least 4 more years! And by the time the Senate gets finished gutting even the weak House bill in conference it might not kick in with a trigger for 8 years or more. The Senate certainly won't "strengthen" the House bill.

And only 9 million people will be on the public option in 2019 according to Congressional aides!

Thanks for nothing.

[dionysus]

36. that's a very large stetch as usual.

have fun with your sour self

[Better Believe It]

38. Yes or No? A simple question not requiring a very large stetch or long complicated answer

Just wondering .... have you ever been out of this country?

I have.

And received prompt and competent treatment for an ear infection in France.

How much did it cost?

Nothing.

And I was just a tourist!

Perhaps you should check out the medical care system in Canada.

[goclark]

41. I was in East Africa in the '70's and had a tooth ache

We were in the middle of no where and finally arrived at the hotel.
There was only one dentist in the town and I was taken to see him on a Saturday afternoon.

My root canal was driving me crazy.

He made the pain stop and gave me medicine to last until I got back to the States.

I was wondering how I was going to have enough to pay him.

When I asked how much, he was offended and said.. " Young Lady, we have Socialized Medicine in this country. You owe me nothing.

[nonsequitur]

46. And where would you go that it's better?

I don't think this sounds so bad and it's not finished yet, it may get better. As long as I can keep the insurance I have now, and my doctors, it's fine with me. I doubt you would want Canada's health care if you moved there. It's not good. It's free, but if you want fast, good care, you better find a doctor and pay for it out of pocket, that's why many Canadians come here for treatment and pay for it themselves. I don't know that much about Australia and the others but I do know Canada's can be your worst nightmare.

[kath]

51. utter bullshit.

enjoy your stay.

[madfloridian]

4. For a family of 4 that would be $20,000 cost sharing per year.

Tell me what is good about that?

[lindisfarne]

6. If the above leads you to believe this, it is a misrepresentation of the House bill. I suggest

reading a better summary of the House bill.

[brentspeak]

9. Care to back up your claim that it's a "misrepresentation" of the House bill?

[lindisfarne]

12. Read the House bill & compare it to what is said in #4. You seem inclined to doubt me so please

read the original so there won't be someone between you and it.

[SpartanDem]

14. A family four would be subsidized up to 88,000 in income

those most would have cost capped at 10,000

This thread has the most through discussion of subsidy structure
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6074075

[lindisfarne]

26. OP at link is wrong in part.Premiums are separate from "cost sharing" expenses. He's conflated the 2

See
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x64708

[dflprincess]

49. Here's the actual wording from the bill

note we're getting another new euphemism instead of "out of pocket" (which makes us all shiver) we now have "cost sharing".

http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

FROM PAGE 8
COST-SHARING.—The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges but does NOT include premiums or any network payment differential for covered services or spending for non-covered services.

PAGE 29:
(A) ANNUAL LIMITATION.—The cost-shar-ing incurred under the essential benefits pack-age with respect to an individual (or family) for a year does not exceed the applicable level spec-ified in subparagraph (B).
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for 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 Con-sumer Price Index (United States city average) applicable to such year.

This bill has nothing to do with reform. We'll still be paying more than people in civilized countries and getting less.

[nonsequitur]

47. I agree that seems steep. Where are you getting those numbers?

Right now we pay around 3200. a month for the 4 of us. We have 3000. deductible and total out of pocket is around 5000. per year. So that's 12,800. a year. My employer pays 50% of our premiums, we pay the rest. So 6400. in premiums plus the deductible and co-pay until we reach the 5000. out of pocket. Prescriptions vary, they stopped covering some that aren't generic which sucks. If there isn't a generic equivalent they should cover it but they don't so we pay 50.00 if it's not a generic. What pisses me off is that some opt out and don't want to pay it when they can afford it. They would simply rather have the extra money and take their chances. I'm hoping this plan will at least make everyone take the insurance. I think the plan needs a little work, but it's not that bad from what I see so far. Single payer isn't going to happen, but I hope Obama makes sure they keep the public option in there and doesn't let the Repukes and blue dogs water it down.

[lunatica]

5. I don't feel better

This is no criticism, except of me for not getting it, but if someone would translate the summary maybe I would understand it.

[lindisfarne]

7. There are better summaries out there. I'd keep looking. n/t

[brentspeak]

10. You apparently haven't found one. Are you still looking?

[lindisfarne]

11. I've seen several on DU. I'm just not willing to spend time looking to find them again. n/t

[Oregone]

8. So, the subsidies only cover premiums, not deductibles/copays? Is that correct?

Is there any aid for deductibles? That $5000 "cost sharing"?!?

This doesn't make any sense.

The average out-of-pocket private expense for health care is ALREADY about $5000 (under it). But that includes premiums and deductibles & co-pays.

Are you telling me they will subsidize premiums which leave another $5000 bucks to be paid? That raises the individual cost of healthcare. Yes, it really does.

Someone tell me Im wrong on this


------

If correct, this shuttles, in the form of a subsidy, a standard premium expense funded by taxpayers to turn into private profits, when the company isn't even required to do anything UNTIL another $5000K is paid out of pocket. So now, private people will at least be spending more, on average, in taxes and more, on average, in out of costs deductibles.

This doesn't make any sense. Am I way off the mark?

[SpartanDem]

16. The 5,000 is the max as an individual you'd pay that if made more than 43,000

less than then is when the subsidies would kick in

[Oregone]

18. You sure thats just not the max out of pocket cap for copays/deductible

And doesn't actually include premiums?

I mean, are you sure a subsidized person wont STILL have a $5000 cost-sharing, once their premiums are taken care of?

[SpartanDem]

22. I was wrong reading the definitions in the bill cost sharing doesn't include premiums

actually BOTH cost sharing and premiums are capped and subsidized based on income in the bill. The premium caps are base on % of income. The cost reductions don't appear to be set yet:
From Sec 243 of the bill:

(b) COST-SHARING REDUCTIONS.—The Commisonsioner shall specify a reduction in cost-sharing amounts
7 and the annual limitation on cost-sharing specified in sec8
tion 122(c)(2)(B) under a basic plan for each income tier
9 specified in the table under section 243(d),


This table define premium limits

In the case of family income
(expressed as a
percent of FPL) within
the following income
tier:
The initial premium
percentage
is—
The final premium
percentage
is—
The actuarial
value percentage
is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%

[lindisfarne]

27. Read the relevant parts of the bill that define these things.Then you'll be certain of what

t the bill says.

[Oregone]

28. Have you? Are you certain?

If so, could you spell it out? You sure even reading it all will make one certain?

Im basically trying to find out how much this will cost someone, worst case scenario. Its not the easiest thing to find in the world.

[SpartanDem]

29. Worst case scenario for an individual

someone making more than 43,000 is cost-sharing is limited to 5,000 and premiums are capped 11% of income

[Oregone]

39. So...

Thats $5000 in addition to the capped, subsidized premiums, right?

[SpartanDem]

42. At that level the premium would be capped only

So if you make 44,000 that 5,000+ 4840(11% of 44,000)= 9,840 maximum annual out of pocket cost

[dflprincess]

50. Your premiums are not capped if you're outside the income limiits in the table

Steny Hoyer told NPR that they really couldn't say what premiums will be because they will be "market driven". He also said that the public option will not under cut private plans because that would prevent people from having a "real" choice between plans (no shit, he said that).

And, keep in mind that an annual premium of $4,840 (as mentioned in the post above) comes out to $403 a month - if you're employer isn't paying part of the premium, how many people are going to be able to afford that as an addition expense?

This plan does nothing to make health insurance affordable and it sure doesn't have anything to do with health care.

[kath]

52. "This plan does nothing to make health insurance affordable and it sure doesn't have anything to do

with health care."
You said it, princess.

This is NOT meaningful reform - it's a huge gift to the fucking blood-sucking insurance companies.

[lindisfarne]

30. I have, but I'm sure you'll get all the details you want by looking at it yourself. You

frequently challenge every point, so just go to the source and get the best answers possible.
I don't accidentally want to misinterpret something in a way which would offend you.

[Oregone]

40. Im not challenging anything. Its an honest question

Lets say for a family with two children making $35,000, what is the most they will privately pay for insurance in a year, worst case scenario for everyone?

[truedelphi]

24. YOu brought up some good points. Tnaks. n/t

[valerief]

13. Average prevailing employer-sponsored coverage

People employed by the US govt get coverage, so that would be considered employer-sponsored coverage, right? So if most of America left their employer coverage for US govt coverage, maybe the average prevailing employer-sponsored coverage would be what the US govt provided!!!!

Thanks for posting this!!!!

[SeeHopeWin]

15. Nice catch, good point....nt

[Better Believe It]

17. Congressional aides say only about 9 million people will be insured by public plan by 2019!

Congressional aides said about 9 million people would be insured by the public plan, with 21 million insured by private companies in the exchange by 2019.

* Another 164 million would be insured through their employers.

http://www.reuters.com/article/governmentFilingsNews/id...

And the House "Public Option" won't kick in until sometime in 2013.

Read pages 117 and 14 of the House healthcare bill at:

http://energycommerce.house.gov/Press_111/20090714/aahc...

[ipaint]

48. Does anyone know

Those who qualify for Medicaid in this healthcare reform bill according to this study number approx 20 million.

http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=40&rgn=1

Currently approx 58 million are served by Medicaid.

http://www.statehealthfacts.org/profileind.jsp?sub=52&rgn=1&cat=4

Will Medicaid be ready for this huge influx of uninsured folks. The number may be even higher by 2013.

[truedelphi]

19. Great work by ThomCat, and the irony is that his analysis of

This legislation, though perhaps spot on, is wordier than the entire health care legislation guaranteeing Single Payer universal Health care in Denmark! (Not ThomCat's fault, of course - but the fault of Congress who in being beholden to Big Corproate interests must keep it so profoundly confusing that it can contain loopholes big enough for a convoy of Corproate Owned SUV's to go through.

[Laelth]

20. Excellent summary. The bill stinks.

Section 16 above is all you need to read.

:dem:

-Laelth

[Jakes Progress]

21. We got our optimists.

And we got our pessimists.

I fall in with the latter. Of course, we will see what works out when they finish, but those betting on a decent health care bill will have some crow to eat or will have to re-invent their idea of "good health care bill" when we do get it.

This is a matter of passing anything just so something will be passed.

When it is over. a small percentage of people will get some coverage. America will still be the most primitive health care industrialized nation. My prediction is that their will be more cynics and fewer cheerleaders on this issue in a few months.

[Better Believe It]

25. Does anyone really believe the Senate will strengthen this bill in conference with the House?

[Doremus]

31. If an accurate description, this plan is CRAP.

In no mood to mince words, sorry.

[JimWis]

33. IMHO - I really don't like the sound of it. It sounds like a lousy

plan to me.

[Stand and Fight]

34. This plan -- as I currently understand it -- is shit.

With a wife who has pre-existing conditions and two small children this plan sounds like one shitty nightmare becomes Democrats are too spineless to ram a REAL plan through Congress.

[Better Believe It]

35. Could you please try to pretty it up a bit? Perhaps some lipstick would help. :)

[Stand and Fight]

44. I've got a feeling this new thing they're putting together is not good...

That is, for the 2010 Congressional elections. If they try to put out some half-baked nonsense that taxes health benefits they are going to lose massive support. Mark my words.

[earcandle]

37. Shit! I think I hit unrecommend by accident! I meant to recommend and now I have no second option..

yuk.

I want to repost this on my website.
May I, please?

[Better Believe It]

45. That's OK. I just don't unrecommend anyone.

[Phx_Dem]

43. Works for me! N/T

[LittleBlue]

53. I was good until #13. The feds can audit my income taxes before I pay $5k for insurance

Sorry, I won't pay. Audit me and get your fine, but $5k or 11% of my income is complete nonsense. That's pre-tax income too, not post-tax. I'd be a middle-class person paying nearly 40% in taxes on my marginal tax rate. In terms of my effective tax rate, you'd be increasing it by 70%. Sorry, that's malarkey.

[Better Believe It]

54. For weekend DU'ers