ENOUGH! Putting Some Frequent HCR Myths To A Much Needed Rest

[berni_mccoy]

There are far too many myths being propagated around here for the quality of this site. The fever of doom and gloom that this HCR bill will be the end of society as we know it is not just something being perpetrated from Glenn Beck. It's being repeated around here. So, without further adieu...

Myth: There are no cost controls in the current HCR Bill

Fact: There are many cost controls in the bill.

Here's how the cost control works in the current bill. By ensuring everyone enrolls in health insurance, not just the sick, but the healthy, and combining that with a first-time ever enforcement of the MLR of 85% on a national level, the cost of health care will be controlled significantly. It won't affect large group policy premiums that much as these are already the most cost-effective plans available and only purchased by large companies who have been the only groups to be able to negotiate better premium rates. But who it does impact positively are individuals and small businesses who will now be able to purchase policies through the Exchange. In that exchange are not just private policies, but also the policies offered to every Federal Employee. Furthermore, the Exchanges must have a state controlled non-profit plan available. Both the Federal Employee Plans and the non-profits will put premium price control pressure and minimum benefit standards on private plans. In fact, the CBO reported that the impact on individuals would be a rate decline of up to 10% for individuals and 4% for small group policies ( http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf ). Note that these reductions are for the reference plan (assuming similar benefits and actuarial values for existing plans). Premiums will go up for plans that provide more benefits in the individual market.

Myth: Poor people won't be able to afford it.

Fact: The poor will receive subsidies to cover both premiums and out-of-pocket costs

To find out specifics for any given situation, I suggest people use the reform premium calculator here: http://healthreform.kff.org/SubsidyCalculator.aspx

This will tell anyone how much they will pay and how much the federal gov't will pay. "I only make $10 / hr" is an often quoted figure here. The times I've seen it cited, it's often at 35 hr / week. In a 50 week year, that's at most $17,500 / year. Putting that in under the reconciliation plan, and you'd get a yearly premium of $793 for a single adult ($66 / month). If that income were for a family, even a single parent with a child, that family would qualify for Medicaid.

In fact, according to the CBO report (http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf ) more than 57% of the population will receive subsidies.

Myth: I'm not poor enough to qualify for Medicaid and still can't afford Insurance after the subsidies. I'm going to be bankrupted or go to debtor's prison!

Fact: The poor who still can't afford insurance after subsidies will be exempted from the mandate

Furthermore, states are supported by the Federal Government under the new plan to extend Medicaid for those who fall into the gap. States are allowed to enroll people who fall in the gaps if they meet the state eligibility requirements. (see Sec 1331 of the Senate version of the bill summary here: http://dpc.senate.gov/healthreformbill/healthbill49.pdf

Myth: People with pre-existing conditions (PEC) won't benefit from the bill until 2014!

Fact: People with pre-existing conditions can get help this year.

Children with pre-existing conditions cannot be refused by any insurance plan immediately. Adults with pre-existing conditions will be elligible for a high-risk pool that provides federal plans to them until 2014. The high-risk pool goes into effect no later than 90 days after signing. Premium rates of the high-risk pool are capped and subsidies apply as they would to exchange plans. To see a comparison of the House and Senate high-risk pool plans, see: http://www.kff.org/healthreform/upload/8040.pdf

Myth: There are no immediate benefits under the HCR Bill

Fact: There are several benefits of the HCR Bill that take place this year, not the least of which is the high-risk pool plan discussed above

Here they are again:

1) Eliminating lifetime limits, and cap annual limits, on health-care benefits. In other words, if you get an aggressive cancer and your treatment costs an extraordinary amount, your insurer can't suddenly remind you that subparagraph 15 limited your yearly expenses to $30,000, and they're not responsible for anything above that.

2) No more rescissions.

3) Some interim help for people who have preexisting conditions, though the bill does not instantly ban discrimination on preexisting conditions.

4) Requiring insurers to cover preventive care and immunizations.

5) Allowing young adults to stay on their parent's insurance plan until age 26.

6) Developing uniform coverage documents so people can compare different insurance policies in an apples-to-apples fashion.

7) Forcing insurers to spend 80 percent of all premium dollars on medical care (75 percent in the individual market), thus capping the money that can go toward administration, profits, etc.

8) Creating an appeals process and consumer advocate for insurance customers.

9) Developing a temporary re-insurance program to help early retirees (folks over 55) afford coverage.

10) Creating an internet portal to help people shop for and compare coverage.

11) Miscellaneous administrative simplification stuff.

12) Banning discrimination based on salary (i.e., where a company that's not self-insured makes only some full-time workers eligible for coverage.

But don't just take my word for it. Mediamatters is a trusted watchdog organization here. They've destroyed this talking point as it's been used by Fox and Rove (here: http://mediamatters.org/research/201003090020 and here: http://mediamatters.org/iphone/research/201003110008 )

Myth: The Bill doesn't cover everyone. Millions are left uninsured.

Fact: The millions uninsured are primarily those who refuse to comply with the mandate and illegal immigrants
The CBO published a report on the Senate bill with regard to how many will gain coverage; it also discussed who will remain uncovered. Those who remain uncovered are primarily those who refuse to comply with the mandate and illegal immigrants. (see http://www.washingtonpost.com/wp-dyn/content/article/2010/01/01/AR2010010101837.html ).

Even so, illegal immigrants can already qualify for Medicaid and they will do so moving forward. The bill does not change this.

FINAL FACT: The Bill Isn't Perfect

We all know this. It's not everything we hoped for. That doesn't make it bad. In fact, it will do tremendous good by extending health care to 32 million more Americans, controlling costs on rising premiums, providing subsidies for the poor, closing the donut hole in prescription drugs for Medicare and ending the evil practices of the insurance industry such as rescission and pre-existing conditions. As Bernie Sanders stated in response to Big Ed's question: "Yes, absolutely, there is enough good in this bill to pass it.". Every Democrat should vote for and support this bill.

[frazzled]

1. Excellent summary

Is the bill paradise or nirvana? Of course not. But your facts are straight on ... and this represents an enormous leap forward for millions of Americans.

[NYC_SKP]

2. K and R. But those opposed to this will not be swayed by facts and research.

The small contingent of people opposed to the bill who are not closet conservatives, trolls, or angry over the primaries, seem to exhibit similar characteristics, including a willingness to let our economy collapse in the perceived furtherance of an idealistic and selfish agenda.

These same people would be happy to have a dictatorship led by an individual who shares their beliefs, they are neither friends of Democrats in general nor Democracy in particular.

And they are fools.

:patriot:

[Larkspur]

3. And Media Matters says..

...the bill does not instantly ban discrimination on preexisting conditions.

[berni_mccoy]

4. I never said that wasn't the case. Read my post please.

[panader0]

5. K&R and bookmarked

Your post should be required reading.

[Winterblues]

6. Once they pass this big guvment takeover they gunna take our guns...

:shrug: Thanks for some solid information..:thumbsup:

[OHdem10]

7. I am holding my nose and supporting this Republican Bill. Thank

you for your effort here. Good job.

Here is a question not a myth.

Every quarter the Insurance Companies must submit their financials
to Wall Street. It is expected that their profits and earnings
will increase. How do their improve their earnings and profits?
By denying coverage and increasing fees. This is how Insurance
works.

If they do not have increased profits and earnings they get
hit by the Raters( Moody, etc). No company can take many hits
from the Ratings Companies.

What I am asking is --how can the Insurance Companies meet Wall
Street demands and not stick it to the customers.

Even in Massachussetts the Premiums have started going up.

This is the fallacy of this plan.

I am trying to be a good soldier here. Reality hits me in the face.

[Doremus]

56. Please explain how your post squares with the rule about spending 85% of premiums on health care.

Thanks.

[riderinthestorm]

81. The insurance companies just raise the premium.

85% of what? THEIR premium that they set. So they may have a stipulation in there to spend that percentage but there's no real cap on how high they can set that premium as I understand it.

Furthermore, there's a lot of people talking that there actually IS a cap in the bill but from what I've read there are ways to get around it through loopholes but bottom line will be 1. can people afford that premium? and 2. can anyone afford to get health care if they've paid so much of their income in the form of that premium?

Co-pays, deductibles, 80/20 plans and more have bankrupted a significant percentage of Americans WITH health insurance.

I'm not convinced this bill helps anyone avoid bankruptcy through the medical costs that will still exist and be codified into this bill. Especially if you are mandated to have it - you are required to give that much to the insurance companies leaving you with so much less every month.

[damonm]

103. Not so fast.

The premiums that they set AND that pass review from BOTH the state they're doing business in AND the office of HHS.
And once they have raised these premiums, $.80-$.85 of every dollar of it must be spent on medical care.
And "a lot of people talking" can be WAY wrong. Read the bill for yourself.

[riderinthestorm]

108. The sections I've read about the caps that are right now undergoing lots of revision

So it's changing, just as the review board provisions for how much the insurance companies can charge are changing even today. That's why I indicated that "a lot of people are talking" is what's currently going on in for some of this bill especially about the parts I had in my post.

How much enforcement will happen on the rates also isn't at all clear from my read. California theoretically has enforcement provisions for example, but they are toothless as the offices aren't fully funded.

Imho 80% payout doesn't work though to prevent bankruptcy if you have a catastrophic illness. Let's just say that said insurance company pays out 80% on a million dollar stem cell transplant for the average lymphoma or leukemia patient. You're (I'm) still bankrupt and that's just THAT procedure. That doesn't take care of the co-pays for the visits leading up to that, the prescriptions, the deductible etc. etc.

I get that you are implying that NOW the insurance companies are going to be spending "more" of their monies on actual medical care (80 - 85%) but that doesn't really help if/when they are just basically charging the rest of us "more" to cover that, and we can't afford it anyway.

[Doremus]

110. That isn't what you said.

You warned that premiums were going to go UP UP UP, uncontrolled.

I reminded you about the 85% rule.

Now you're babbling nonsensically about insurance company spending and bankruptcy.


I hate it when people can't say "oh yeah, forgot about that, sorry."

[kestrel91316]

86. If it's a "republican" bill, do please enlighten us as to why repukes across the board

are in such violent opposition to it that they are all bordering on hemorrhagic strokes. And then explain why the medical insurers are also frothing at the mouth over it.

Those things ALONE tell me it's something I should get behind, if for no other reason than to piss them off.

[KaryninMiami]

8. Excellent summary- thanks much for doing this !

[jtrockville]

9. Not all of the benefits listed as "immediate" are "immediate".

The "young adults" provision doesn't take effect until 6 months after signing. My buddy has a child who turned 21 this month and is caught in that "donut hole". She is relieved to know that she will only need to fill the gap for a few months, but she wishes this benefit was indeed "immediate".

[berni_mccoy]

10. Fair enough. For the sake of argument, let's say within the first year then.

6 months is not a long time for legislation to kick in. It can be a long time for individuals who are suffering. I understand that point quite well.

And note, that I'm not making the "immediate" claim. It's the talking point used by opposers. I said benefits that would come within the first year.

[jtrockville]

33. Yes, you did clarify "within the first year".

Which, for the situation my buddy is in, is still a great relief. "Immediate" would be better but she can live with the "6 months". Initially I told her that I though most of the provisions didn't kick for many years (it's hard to get the facts when so many R's are spewing myths), so we researched it together and found the "6 month" kick-in for the "age 26" provision.

There is indeed some good stuff in the first year.

[panader0]

12. I thought the young adult thing was up to age 27?

[T Wolf]

14. This "benefit" only applies to NEW PLANS as defined in the bill. Thus, unless my employer cancels

my coverage and starts up with a new plan (could be from the same insurer), I will NOT be able to move my daughter back onto my plan.

I am still on my existing plan and will be stuck with it unless my boss changes it.

[berni_mccoy]

25. Please take time to inform yourself. It covers ALL EXISTING Plans

Sec. 2301. Insurance Reforms. Extends the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26 to all existing health insurance plans starting six months after enactment

from: http://www.politico.com/livepulse/0310/BREAKING__Reconciliation_bill_posted_.html

[BurtWorm]

11. Thanks.

You've made me feel better about supporting a shitty bill just so Republicans are more harmed politically than Democrats.

[LWolf]

13. Fact: Insurance is not care. nt

[berni_mccoy]

16. Fact: it is in the U.S.

Try buying your medical care without it and see how much it costs.

[Donnachaidh]

23. it costs the same as what the doctors bill the insurance companies

Geez, the spin coming off this bullshit is smoking! Better put in a purchase order for some new tires... :rofl:

*Duhhh yeah -- you can't get healthcare in this country with out insurance .. Duuhhhhh" Beaky Buzzard?

[berni_mccoy]

27. Let me tell you how much it costs

Insulin for one person: 300 / month without insurance
Diabetes supplies for one person: at least 750 / month without insurance
Visits to specialists for type-1 diabets: thousands of dollars per visit per person.

Occasional hospital trip due to illness-related blood-glucose problems: thousands of dollars per visit.

We have two children with type-1 in our family. We could not afford health care without health insurance.

This is true for millions of Americans living with chronic diseases.

The fact that you find HCR a laughing matter says everything it needs to about you as a person.

[laughingliberal]

52. The loophole allowing conditional annual caps will take care of that. nt

[Orangepeel]

71. No it doesn't, actually. Insurance companies are very effective at bargaining

and hospitals routinely end up charging the uninsured more

[Marr]

24. It most certainly is *not* care.

The insurance companies drive up medical costs a lot and have every incentive to refuse payment. Everyone I know pays a lot of money into health insurance and gets little or, more often, literally nothing back. They pay for their visits out of pocket, which are increasingly rare because they're also paying for useless insurance.

Somewhere along the line this argument was morphed from, "how do we provide health care to everyone?" to "how do make sure everyone has a private health insurance provider?", and the answers to those two questions lie in opposite directions.

Insurance is not health care, sorry. And this bill institutionalizes the problem industry; welds it into place as the official centerpiece of health care in this country. It's a giant step in the wrong direction, even if you can point to a few items where individuals may see some slight improvement over the abhorrent situation we have at present.

[Political Heretic]

70. Um no it isn't. Try buying your care with it as a working class family and see if you can afford it

[LWolf]

84. No, it's not.

I have insurance. I don't get care.

Why? Because there is no money left for the co-pays and deductibles that actual care would cost AFTER paying the premiums.


Therefore, no care. I pay out, but get no care in return.

FACT.

[readmoreoften]

105. Fact: that answer just shows that insurance is an obstacle to health care.

There is an unneeded broker skimming 20-30% off the top. Get rid of them, get rid of a large part of the problem.

[T Wolf]

18. Fact. Insurance is the opposite and antithesis of care. This is the basic fact that many,

including "our" party and its leaders, fail to grasp.

They are trying to shore up (at our expense), a corrupt, abusive, and illogical system. As long as they continue down that road, not much good and a hell of a lot of bad will result.

But for those who buy into the faith-based administration arguments, we'll just wait to see how things are working out a year from now. Any pools on the net effect?

[LWolf]

85. Agreed. nt

[SandWalker1984]

15. Fact: Exchanges are a Joke! Fact: you left out all the loopholes built into the bill.

The state where I live has an exchange for those self employed that cannot get into a group plan. It took the insurance corporations less than 3 years to manipulate the state legislature and therefore rates until people such as myself could NO LONGER AFFORD the exchange rates for health care insurance. The last quote I had for "affordable" insurance was $17,600 a year for 2 of us, with deductibles of $5000 EACH.

This bill, from what I've read so far, is full of loopholes for the health care industry to get around all the pretty little "facts" you're quoting. When the industry's lobbyists help write the bill (where was the sunshine???), loopholes are what you get.


One of the biggest loopholes was provided by Ensign:

The Ensign Healthcare Loophole
posted by Greg Kaufmann
The Nation
January 8, 2010

Taken at face value, Senator John Ensign's amendment which was included in the final Senate healthcare bill sounds pretty decent: by meeting "wellness" standards people can receive discounts on their employer-based healthcare premiums. Stop smoking--pay less. Hit a certain weight--pay less. Meet a cholesterol target--you get the idea.

Dems probably should have stopped and realized since the amendment was offered by Ensign it probably wasn't motivated by "wellness" at heart.

In fact, it allows premiums to be raised from current levels, and then "discounts" would reduce the premiums to current rates. People who don't meet the insurance companies' targets could pay up to 30 percent more for coverage, roughly $4000 based on the average cost of family coverage. The amount could increase to 50 percent which is over $6,600 for a family.

There is also the problem that this is biased against people with a genetic predisposition to high blood sugar, hypertension, high cholesterol, being overweight and a host of other often hereditary conditions. It's also biased against a lower-income person working two to three jobs to pay the bills, who has to stop and chow down some fast food between jobs rather than get to the gym where he or she can't afford a membership anyway. It's even biased against communities that don't have grocery stores where they can find fresh fruits and vegetables.

So what does this all mean? Remember a central promise of healthcare reform--even the watered down version--how people with preexisting conditions weren't supposed to be denied coverage or forced to pay more for their insurance? That all sounded pretty good, right? Well, guess again.

"Incentives quickly become penalties for those who cannot meet the target," said Sue Nelson, vice president for federal advocacy at the American Heart Association (AHA). The AHA has led a coalition of more than 200 health and consumer organizations who oppose this Senate provision, including the National Organization for Women, American Cancer Society, the American Diabetes Association, and many mental health groups. "A wellness program could consist solely of a premium surcharge based on a blood cholesterol count over 200. are significant potential unintended consequences such as burdening sicker employees and their families with significant increases in healthcare costs thereby making coverage unaffordable for those who need it the most."

Read the full article at:

http://www.thenation.com/blogs/notion/514042/the_ensign...



LOOPHOLES.....

[berni_mccoy]

20. Fact: You can say anything is a loophole without proving it

The argument that incentives will be turned into penalties sounds good. Until you factor in how profits will be regulated by the OPM and the exchange administrator. Furthermore, the Federal plans and non-profits in the policies will ensure that if an Insurance company tries to leverage these so-called "loopholes", they will begin to lose competitively with the non-profit and Federal plans.

[Political Heretic]

72. Sigh...of course you are correct.

[JPZenger]

17. This needs to be widely redistributed ... quickly

[Political Heretic]

73. Yes, God hurry and get the bullshit spin out there! Too many people are seeing through the facade!

Go go go!

[Fumesucker]

19. The bill is a kludge..

http://en.wiktionary.org/wiki/kludge

1. (electronics engineering) an improvised device, usually crudely constructed. Typically used to test the validity of a principle before doing a finished design.

2. (general) any construction or practice, typically inelegant, designed to solve a problem temporarily or expediently.

3. (computing) an amalgamated mass of totally unrelated parts forming a distressing whole

[Javaman]

45. The etymology is interesteing...

One explanation I heard was that the term came from the Navy. It's the sound something (they don't need or want) makes when dumped over side.

[Fumesucker]

46. No, that old story is about a Kushmaker..

This is one version, I've heard better ones..


So this man decides he has done nothing with his life and makes up his mind to join the Navy. He goes to the Navy recruit center to try and get a job. The only problem is that he doesn't have any skills when it comes to this sort of thing.

"So, what sort of skills can you bring to the table when it comes to the Navy?"

"Well, not many. But I can build a kushmaker."

"What the hell is a kushmaker?"

"I can show you but i'm going to need 100 men, 100 tons of steel and 100 tons of wood. Put me out on a boat in the ocean with these supplies and give me a week to make my masterpiece. Then I can present it to you."

The navy recruiter is skeptical, but intrigued.

"Okay, I will grant your wish."

"Perfect."

So the man and his supplies and his 100 men are put on a ship and put out in the middle of the ocean for one week. After this week, the Navy recruiter comes to the ship, banging on the hull.

"I wanna see the kushmaker! I wanna see the kushmaker!"

"No, no. It isn't done yet. Give me another two days."

So the navy recruiter comes back in two days and asks again.

"I wanna see the kushmaker! I wanna see the kushmaker!"

"It still isn't done yet! Come back in 5 hours!"

So the Navy recruiter hangs around on the ship. He's starting to get impatient. After 5 hours he gets fed up and bangs on the hull's door.

"Come on! 5 hours, let's see this shit!"

So the man throws open the doors of the hull to reveal a huge clusterfuck of wood and steel, thrown together completely randomly. It is fucking huge and ugly.

"What the hell is this shit?!" Yells the Navy recruiter.

"I'll show you."

So the man snaps his fingers and all 100 men assemble and begin to push and pull the huge clump of shit towards the edge of the boat. They throw it off the edge and into the water.

KUUUUUUSSSSSSHHHHHHHHHHHHHHHHHHH!

[MineralMan]

21. Thanks for an excellent post! Off to the Greatest Page with it!

[Name removed]

22. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Name removed]

41. Deleted message

Message removed by moderator. Click here to review the message board rules.

[gmoney]

26. But what about the Marxism?

:sarcasm:

Nice summary.

[mzmolly]

28. Excellent summary

Berni. :yourock:

[tandot]

29. Great summary. Thanks, berni_mccoy!

[Ikonoklast]

30. Thanks you, berni, for keeping after this.

This bill is far from perfect, but it will help a great many that need health care now and is a foundation to build further reforms on.

[berni_mccoy]

59. Many people here would be sad to hear

that I'm never giving up. I'm going to keep on posting the facts while they continue to post the anti-HCR propaganda.

[kestrel91316]

88. Berni, you rock. I know it's flawed. I know I probably won't benefit from it.

But I choose to look at the BIG picture and see the many people who WILL be helped.

Because it's never been all about me.

[Child_Of_Isis]

31. I don't think the concern is with the bill

as much as with the insurance companies. A lot of people do not trust them. They have attorneys out the whazoo (paid for by premiums) and will find every loophole they can.

And again, insurance does not equal healthcare. How many of us have heard the dreaded "your insurance doesn't cover this".

[Scurrilous]

32. K & R

:thumbsup:

[Vinnie From Indy]

34. Fact: Insurance companies have no intention of playing fair

Without a PO, insurance companies love this bill. All ofthe above reasons that are listed to like this bill are ALL built on the assumption that insurance companies will not come up with dozens of ways to work around, circumvent or just plain refuse to obey these provisions. As far as I can tell, there is nothing in the bill that will prevent them from behaving they way they do now. They will simply find alternative means and methods to trade lives for profit.

[Political Heretic]

74. The people shilling this bill are the same people shilling the self-corrective power of free-markets

It's exactly as absurd.

[Hello_Kitty]

35. Pres. Obama just said to go out and make phone calls and knock on doors to support HCR

berni, get off the computer and stop spamming DU. Put your walking shoes on, go down to your local OFA or Dem office, get a list, and get moving on selling this thing to the voters.

[berni_mccoy]

36. Don't worry, I've done my share of leg-work on this

Discussed health care with my reps. All but one are supporting it (and that would be Sen. Gregg, a republican who would never support it. I still talked with his aide though).

And I'm still doing what I can to pressure other reps as well.

[Hello_Kitty]

42. Big whoop. Calling your Reps is easy. Talking to voters isn't.

Go request a list of independent voters in your area and see what they think of this bill. If they are consistent with what polling shows of approval of this bill, you are going to encounter a lot of resistance. You will need to persuade them. Good luck.

[Political Heretic]

75. That would require actual...you know... work and commitment.

And before the obvious question comes up.... yep, I've been on the street.

[Hello_Kitty]

93. Same here. I'm canvassing for local candidates tomorrow afternoon.

It's mostly Dems I'm talking to and hearing a lot of complaints about HCR.

[Better Believe It]

37. A factual response to misleading "facts".

Not a Myth: There are no cost controls in the current HCR Bill

Fact: There is nothing in the bill that would keep insurance companies from raising their rates just as they currently do.


Vaunted Health Insurance Rate Review Authority Kicked Out of Reconciliation Bill
By: David Dayen
March 17, 2010

In a completely obvious maneuver, the Senate parliamentarian has kicked out the Health Insurance Rate Authority from the reconciliation set of fixes. The national rate reviewer would have had the ability to cancel premium increases across the country, in association with state regulators. But it has no primary budgetary impact, so out it goes.

http://news.firedoglake.com/2010/03/17/vaunted-health-i... /

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

Feinstein Insurance Reform Kicked Out Of Health Care Bill
By Ryan Grim
March 17, 2010

The Senate parliamentarian told Dianne Feinstein (D-Calif.) on Wednesday afternoon that her proposal to create a National Insurance Rate Authority runs afoul of reconciliation rules, Feinstein told HuffPost after the conversation.

"I'm crushed it's out," she said. But she added that she would bring it up with him one more time to try to make the case that it would be a legitimate use of reconciliation. "I'm going to make one last effort with the parliamentarian," she said.

It'll be a difficult effort. Reconciliation rules require that legislation must have a direct and substantial effect on the budget to qualify for the majority-vote procedure. Merely an incidental budget effect is not enough. Feinstein's rate authority would save the government money by reducing private insurance premiums, which would then reduce the amount of subsidies needed -- but such an effect is apparently too indirect for the parliamentarian to give it the thumbs-up.

Feinstein introduced her measure as a stand-alone bill in reaction to radical premium increases in California. Obama embraced the idea, including it in his proposed changes to the bill passed by the Senate.

Congressional observers such as health care blogger Jon Walker have speculated from the beginning that the rate authority proposal would be ruled out of order under reconciliation.

http://www.huffingtonpost.com/2010/03/17/feinstein-insurance-refor_n_503225.html


Myth: People with pre-existing conditions (PEC) won't benefit from the bill until 2014!

Fact: People with pre-existing conditions won't benefit from the bill even after 2014!

The bill allows insurance companies to keep denying coverage to sick children like they do presently for 6 months after enactment. The bill also gives the insurance companies an additional 4 years of denying adults coverage or dropping them due to previous conditions before they have to stop that immoral practice. Once the regulations take effect, insurance companies will face a paltry $100/day fine if they violate the rule. With fines that low it is quite likely insurance companies will choose to pay the fines as opposed to the more expensive medical care they should provide. It only makes sense for them to do so. After all, they aren't in the healthcare business. Insurance companies are in the profit business. If given a choice between increasing their profits or not, is it reasonable or prudent to expect the insurance companies to lower their profits and cover those who need expensive treatments out of the goodness of their hearts?


Myth: The Bill doesn't cover everyone. Millions are left uninsured.

Fact: Ten million or more Americans will remain completely outside of our healthcare system once this bill becomes law.


Myth: The Bill Isn't Perfect.

Fact: It almost is!

It is almost perfect if you represent the health insurance industry or big Pharma! What more could they expect from their bought and paid for political representatives? That's why the bill should be called the Health Insurance Industry and Big Pharma Protection Act. A little truth in advertising wouldn't hurt.


Does the bill provide for any competition in the insurance industry or will the monopolies that exist in most markets remain intact?

No. The law provides for no competition in the insurance industry and the current system of insurance market monopoly remains fully intact.

Has there been any commitment made by anyone in the White House or Congress even to a timeline about reviewing this legislative package and improving it? All the people advocating passage say the bill will be improved later. What is their plan for improving it and what are the improvements that they will make?

No. There is no timeline at all and no plan of any kind has been laid out regarding improving this bill in the future.

You can read more questions and answers about the health insurance industry bill at the following blog:

http://tpmcafe.talkingpointsmemo.com/talk/blogs/o/l/oleeb/2010/03/a-few-questions-about-the-heal.php?ref=recdc

[laughingliberal]

53. +1000 nt

[Political Heretic]

76. Thanks for taking the time to put forth factual information rather than political talking points.

[laughingliberal]

38. Let's put a much needed rest to some talking points:

Cost Controls

The average MLR 20 years ago was well over 90%. When a proposal to set it at that level was made President Obama's director of OMB, Peter Orszag, stepped it to stop it saying it would amount to a nationalization of the system. The MLR is now set at 85%.

Couple of things about that:

The Senate bill would impose a “medical loss ratio” of 80% to 85%, depending on the market segment, meaning insurers would have to spend 80 to 85 cents of each dollar they collect from plan members to provide health care. Carl McDonald, a health care analyst with Oppenheimer & Co., an investment bank, wrote in a note to clients Monday that the number was “workable” for insurers, especially if they can label certain items that count as corporate expenses for accounting purposes as health care for purposes of meeting the spending minimum.

Further how does this prevent the insurance industry from increasing its profits and paying the 6.7 billion industry tax by raising premium rates. The 6.7 billion tax should be another exclusion listed under what is not “medical care.” The American people should not be punished for the sins of the insurance industry. Providing the insurance industry with an incentive by allowing it to arbitrarily raise premium prices because it will receive 15 or 20 percent of a larger premium amount does not effectively address the continued rising cost of premiums, e.g. health insurance. This needs to be fixed. We NEED a PUBLIC OPTION!

http://www.progresspolitics.com/2009/12/medical-loss-ratios-and-health-care-reform-this-needs-to-be-fixed/

The second point above is interesting. Not only can they raise rated to cover the tax imposed on them but the fines which will be imposed for denying preexisting conditions would, also, count as expenses. They're so cute!



and


From an interview with Wendall Potter by Lawrence O'Donnell:

O'DONNELL: "Is there anyone currently employed in the U.S. government - at the IRS, or in the HHS - who knows how to enforce this; how to go into an insurance company and figure out what their real medical loss ratio is?"

POTTER: "No, I don't think so. At least I haven't come across them. One of the things I have learned over the last six months is that there is very, very little understanding in Washington about how commercial health insurance companies work, including on Capitol Hill. The exceptions are Sen. Rockefeller and his team..."

There is currently no one who is up to the job of detecting the fraud. CA has had an MLR requirement and found it difficult to detect abuse or enforce.

I will also note, here, that there are non-profit divisions of insurance companies operating in some states now and the premiums average the same as the for-profits. They are not held to any higher MLR.

Help for the Poor

There will be subsidies for premiums for the poor. I've seen nothing to suggest there is any help with out of pocket expenses, at all. I would appreciate a source if you've found something different. The actuarial value for the bronze plans is 60%. Deductibles for individuals are $2000, families $4000. Out of pocket annual maximum for an individual is just over $5000, family $11,900.

Additionally, there will be other costs passed on to the patient due to the loophole which allows annual caps on coverage for certain conditions. Any expenses the patient must pay out of pocket for conditions where the caps have been reached will not count towards meeting their out of pocket maximums for the year.

Rescissions:

Rescissions are still allowed in cases of 'fraud' which is the precise reason given for rescissions now. Despite some rather protracted discussions here, I've found no evidence in the bill that there is any change to how the insurance companies will define 'fraud.'

Millions who will remain uncovered:

Many who will remain uncovered are those over 50 who fall just outside the 400% of FPL. Many people in this group see premiums which run 25% or more of their income. They will have waivers if the premium is over 17% of their income but they will be left without coverage. Note the 3X multiplier allowed for age will not bring premiums for this group down and they are the group the industry seeks to avoid covering. Undocumented people and those over 50 with incomes over 400% of FPL will be the bulk of those left uncovered.

The attempts to paint those who will be left without coverage as those who choose to go without is disingenuous. Most will be older Americans who will not qualify for the help and who will face the same outrageous premiums they do now.

[Marr]

63. +1

[Political Heretic]

78. And thank YOU for taking the time to put up factual information as well.

[MadHound]

39. Let's look at that again shall we?

First, in the latest bill, cost controls have been pretty much scuttled. <http://www.miamiherald.com/2010/03/18/1536309/insurance-rate-regulation-dropped.html>

Oops, next.

Second, yes, poor people will get subsidized. The problem is, and has been, that the middle and working class are going to get hammered. Nice to know that when I've paid my last dollar, lost my house and home, all due to a mandated monopoly, I will finally get subsidized premiums:eyes:

Third, yes, the pre-existing insurance ban won't kick in until 2014, and yes, until then those with pre-existing conditions can join a high risk pool plan. But given that price controls are so much Swiss cheese, how much will that plan cost? Oh, yeah, here, have an arm and a leg.

Finally, yes, the bill isn't perfect. Most people weren't expecting perfection. However we were expecting a bill that wouldn't do any more harm. Sadly, that's what this bill is going to do, make things worse that they already are. It is going to destroy the middle and working class, and impose a double burden on union members.

We wanted improvement, not perfection. What we're getting instead is, simply, destruction for millions of Americans.

[laughingliberal]

44. +1 nt

[kiva]

48. +2 n/t

[berni_mccoy]

49. One part of cost control does not mean the bill doesn't control costs.

It also doesn't mean they won't pass it. It means they won't pass Finestein's changes via reconciliation.

However, I see your gang is here pumping up this falsehood. Note in my OP I did not factor this element of cost control into the discussion because I knew it was already out of the current bill.

[MadHound]

60. Didn't figure this factor into the discussion because it proves your assertion wrong

That's what your real deal is. You're shamelessly lying and spinning, doing everything you can to get this monstrosity of a bill passed, why? Do you have insurance industry stock, what? Why are you so willing to see the middle working class destroyed in this country?

Notice you didn't, couldn't touch any of my other assertions, hmmm, says a lot right there.

[KittyWampus]

50. Half-truths again as usual.

[berni_mccoy]

51. That's all HCR opposition has at this point.

[MadHound]

62. Go read the bill yourself, prove me wrong

Sadly all that I think you'll do is continue to post bullshit since the facts simply aren't on your side.

[Marr]

64. +1

I don't see the proponents countering your points at all.

[Matariki]

79. No rebuttal - just personal attack. Speaks volumes.

[Political Heretic]

80. And thank YOU for taking the time to put up factual information, also!

[karynnj]

40. Great summary with an incredible number of good links

Thanks

[uponit7771]

43. FUCK FACTS!!! /sarcasm

[berni_mccoy]

47. Unfortunately, many do around here.

[Kind of Blue]

54. This is a work of Beauty. Thank you, berni_mccoy!

KnR

[happy_liberal]

55. What if I qualify for medicaid but don't want medicaid

Will a person be forced to sell their home and assets to get medicaid?

[berni_mccoy]

61. I don't understand your question?

If you qualify for medicaid no one is going to make you sell anything.

[kestrel91316]

91. IIRC you can't get Medi-Cal or Medicaid if you have ANY assets whatsoever.

I own a struggling small business that theoretically has highly depreciated "assets" needing a lot of repair and replacement, lol. That effectively shuts me out, and even with subsidies I probably can't afford coverage and care.

My ONLY hope is an improved economy so I reach the point where I can get by with subsidies. But that doesn't stop me from supporting this bill. If it helps my clients, then indirectly it helps me.

[Lorien]

57. ENOUGH of the pro insurance industry profits propaganda!

Truly, this is getting absurd. Did you fight as hard for single payer or the public option? I thought not.

[thotzRthingz]

95. U GO Lorien!

[inna]

58. Thanks for a rational and well thought-out post.

[Hekate]

65. TY Berni. I'm sending this to my Kucinich-fan hubby. KnRnB.

:toast:

Hekate

[Marr]

90. Be sure to send him the responses that he hasn't been able to counter, too. n/t

[berni_mccoy]

98. There are no responses to counter. At least factual responses.

The only counter responses that are in this thread are anti-HCR propaganda with no facts. The best you can do is come up with links to FDL, Grover Norquist's new soap box and home to teabaggers and freepers. There hasn't been one fact posted in response that counters anything in the OP.

[bvar22]

66. "insurers can game healthcare bill"

"Though Senate bill cuts 'pre-existing conditions,' it still allows insurance companies to create 'pre-existing' categories to raise rates

The Democrats' healthcare overhaul, billed as a monumental game-changer for Americans' health insurance coverage, provides numerous loopholes for health insurance companies which will allow them to raise rates to protect profit margins, a health insurance whistleblower says."

http://rawstory.com/2010/01/whisteblower-reveals-health-insurers-game-insurance-bill/

Read more about how the Health Insurance Industry plans to Game the "Regulations" at the link.

Hell, the Lobbyists and Lawyers for the Health Insurance Industry WROTE he damned things.
The Army of Lawyers & Lobbyists NOW bombarding Congress to PASS Mandates without a Public Option WILL immediately change "targets" TO the much vaunted loopholed, trap doored, ambiguously worded "regulations".
They won't even take a day off to celebrate their Victory.
Just like the "Public Option", these precious "regulations" won't stand a chance against this horde of predators.

The Democratic Party does NOT have a good track record of being "regulators" over the last 30 years.
In fact, the "Centrist" Democratic Party ARE "De-Regulators.
The "regulations" can easily be "de-regulated", especially AFTER the Blood Bath in 2010/2012.

That IS the "Uniquely American Solution".

This "Health Insurance Reform Bill" is being brought to you by thew same people who brought you the Great Wall Street Banker Bailout.
"Thank GAWD it passed!"

[johnaries]

67. Excellent post! If I may add...

MYTH: this is Insurance Reform only. It does nothing for Health Care directly.

FACT: It provides funding to A. make records more accessible and efficient, thereby lowering costs, B. help more doctors and providers afford education to increase the number of providers, C. focus on preventive care thereby avoiding much higher-cost treatments, D. create more Community Health Centers which can provide free &/or low cost services.

K&R

[derby378]

68. FACT: Cost controls are going bye-bye

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7952057&mesg_id=7952057

[Egnever]

87. Only one of them

the MLR caps still remain as do the provisions for non profits and a host of others.

[thotzRthingz]

94. AYUP, insurance rate regulation has just been KILLED...

http://www.miamiherald.com/2010/03/18/1536309/insurance-rate-regulation-dropped.html

[WeekendWarrior]

69. THANK YOU. nt

[kestrel91316]

77. Excellent post and summary. Of course it's not perfect. But flaws will

become apparent soon enough, and then we will get to work fixing them.

NGU.

[kestrel91316]

82. Freeper heads are exploding because this bill will ensure coverage for

one heck of a lot of black and brown people. The fact that it will help a bunch of white people, too, they don't care about. It's alll about keeping poor minorities POOR.

[berni_mccoy]

99. As are the anti-HCR DUers.

[Egnever]

83. Diabetes sucks

Got a 5 year old with it myself. We have been what you would call job locked pretty much since diagnosis. This bill aint perfect but for anyone with a chronic condition it is a massive improvement over what is going on now.

Two with type one....Eek one is hard enough cant imagine trying to take care of two.

Thanks for the post Berni

K&R

[Sebastian Doyle]

89. Good fucking lord

I got this far into the OP.....

"Here's how the cost control works in the current bill. By ensuring everyone enrolls in health insurance...."

...and had to stop reading and throw up. :puke:


The fucking fascist unconstiutional mandate is your idea of a "cost control"??

Bullshit. And when the mandates are declared unconstitutional, OR when millions refuse to pay them, THEN what happens to your talking points?

[thotzRthingz]

92. ummm, let's start with your first MYTH / FACT ... and see what you think?

18 March 2010: Insurance-rate regulation dropped from latest health bill
http://www.miamiherald.com/2010/03/18/1536309/insurance-rate-regulation-dropped.html

[walldude]

96. Cost controls were dropped today...

I can't wait to see what else they do in the 4 years they have to gut this already crappy bill.

You know I see people like you leading the pro bill charge and saying that anyone who disagrees with you is denying the FACTS. I have news for you, no one is denying anything, some of your facts are right on and some have changed today. The difference between your pro position and my against is you actually believe that they will "improve" this bill, while I'm done with having the football pulled out from under me. And today they started to prove me right. Next to go is pre-existing conditions coverage. Watch and see.

[berni_mccoy]

97. Please stop spreading this falsehood.

Cost controls were not dropped. One aspect of the bill that helps to control costs was prohibited from being passed via Reconciliation. First, that doesn't mean all cost-control measures were removed. Secondly, it doesn't mean they can't pass it as a separate amendment once the first bill is passed in both the House and Senate.

[Vinca]

100. Dianne Feinstein's amendment to create a board to oversee

rates was dumped by the parliamentarian.

http://www.huffingtonpost.com/2010/03/17/feinstein-insurance-refor_n_503225.html

[walldude]

101. Yeah I see that but your answer is still "they will fix it later"

I'm not sure what makes you think they will.

[berni_mccoy]

102. That is incorrect. My answer is that there are sufficient cost control mechanisms remaining

Would Finestein's addition be better? Yes.

Will it ruin cost-control in the bill? No.

The analysis provided covers cost-control of the bill *before* Finestein's amendment. But you knew that already.

[Name removed]

104. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Born_A_Truman]

106. K&R

[NJmaverick]

107. K&R for the truth

[eridani]

109. 15 states ALREADY have tried regulation by MLR

It is not a cost control at all. It is a total abysmal FAILURE.