Looks like Health Insurance Co's have already found LOOPHOLES

[jtrockville]

Is anyone surprised?

From yesterday's NYT:
http://www.nytimes.com/2010/03/29/health/policy/29health.html

Coverage Now for Sick Children? Check Fine Print
By ROBERT PEAR
Published: March 28, 2010

...snip...

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: "The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost."

Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.

"The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform," said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.

...snip...

[Cronus Protagonist]

1. Well, enough of the velvet glove. Time for the IRON FIST

Medicare for all.

[DRoseDARs]

46. Personally, I'd prefer we use Evan's Spiked Tentacles of Forced Intrusion...

"Wait, what?"

[Matt Shapiro]

57. Exactly right

This is what insurance companies do. They will find loopholes in the rest of this patchwork plan as well. Their purpose is profit, and they get much more of that by NOT providing health care.

There is only one solution.

Expanded and improved MEDICARE for EVERYONE in this country!

(Including abortion coverage -- after all, women are people too -- and it will actually cost less, since pre-natal, birth, and post-natal care are far more expensive than abortion.)

[glinda]

58. We need to start pushing for that. Insurance Companies don't care and will not care.

[Tom Rinaldo]

The Scorpian and the Frog n/t

[emulatorloo]

2. I have no doubt Department of Health and Human Services will issue a clarification

for these jerks.

[jtrockville]

4. I suspect it will take more than one clarification.

If my suspicions are right, Health Insurance companies will read the "fine print" on every single sentence of the law. And who can fault them? They have an obligation to their shareholders to do so.

Why do we bet our life that a company will behave in our best interest? (Especially when they are obliged to do the opposite?)

[Cal Carpenter]

9. "...Especially when they are obliged to do the opposite?..."

Ding ding ding.

That's what is so frustrating about discussions about anything having to do with a kinder,gentler, more 'regulated' corporate system. In reality, the interests of the investors and the public are rarely aligned - certainly not the fundamental economic interests. It is the responsibility of the corporation to serve its investors. That is what it is there for. 'People power' can't compete with that - not in the market, not in the voting booth.

If we want certain institutions/industries to serve the public, they cannot be based in the capitalist market. Health care is now even MORE embedded in that market than it was before this 'HCR' bill. Look what's happening to education? And people here defend charter schools. We need to stop undermining the things that should exist for the public good!

[zbiker]

52. i guess i am confused

congress simply spouted constantly that pre existing conditions could not be used as an excuse to deny coverage, they said nothing about forcing companies to sell to to anyone, did america not get that ??, look at it like this, if you are a candy bar salesman, and congress says everyone in america must buy candy bars. does this obligate you to sell a candy bar to everyone that comes thru the front door, even if they have no bottom jaw in which to chew with ??, no, it just means that if you have a person you have sold a candy bar to in the past suddenly has his/her jaw fall off you cannot refuse to sell them Candy bars anymore. you must continue to sell that person candy bars until they die of diabetes.
i am still very confused why we seem to think this was such a great victory, there is so many things wrong with this bill that it may well doom our party as a whole.....

[MousePlayingDaffodil]

7. The problem is . . .

. . . regulatory "clarification" by HHS won't suffice, legally, if the language of the statute is found by a review court not to authorize "guaranteed issue" for minors before 2014.

[laughingliberal]

10. Good luck with that

From an article in the New York Times:

A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.

http://www.nytimes.com/2010/03/29/health/policy/29health.html?hp

This will take an amendment to the law to clarify. Then, what will the amendment be? Will there be a law guaranteeing issue for families with children who have preexisting conditions or a law guaranteeing issue for the child? This is a mess but the law does not guarantee issue for anyone until 2014 as it stands now.

[Xithras]

27. And then the insurance companies will take them to court..

Because "clarifications" don't carry the force of law, and can't be used to extend law. A judge will need to determine what the text of the law actually requires.

[Yo_Mama]

55. They Can't Clarify What Doesn't Exist

Sorry, but the part of the law that sets the special date for minors starting in September 2010 IS VERY CLEAR. That amendment only refers to Section 2704, which amends 42 U.S.C 300gg, which covers exclusions for pre-existing conditions. It's an entirely different section that covers enrollment - 300gg-11.

Okay, because the timing is one clause of the bill, and because it refers to Section 2704 only, and because there are other sections of the law that amend 300gg-11, THE INSURANCE COMPANIES ARE RIGHT. It's not ambiguous.

And furthermore, staffers on both House and Senate committees already pointed this out. It's not like it was an oversight.

If you don't like this, lobby Congress. Because President Obama can't fix it, and he can't have anyone write regs to fix it. Congress makes the law, the Executive executes it.

I'm not very fond of insurance companies, and I don't work for them. But they are right on this one, and if this ever goes to court they will win in 20 minutes.

Not, btw, that this would ever have helped anyone if they could raise the rates as high as they needed to, which is what would happen. Without large group insurance and combined rates, the ability to enroll does not mean the ability to afford.

[Romulox]

3. Feature not a bug. This was a bailout for the insurance industry. nt

[jtrockville]

5. Indeed. Sometimes I forget...

The needs of a "bodied person" should never trump the needs of a "corporate person". I'd add the sarcasm tag, but since it really is the way things are, I'm not sure it's appropriate.

[Echo In Light]

6. Shocker!

[Poll_Blind]

8. Serious but rhetorical question: Can the Democrats legislatively plug the holes, will they even TRY?

Time will tell. Remember how many of those who voted for the Patriot Act said they did it while "holding their nose" and that they'd legislatively "tighten it up".

And how that (mostly, to be fair) didn't happen?

I have very grave concerns about the same thing in regards to this situation.

PB

[pnwmom]

17. Could the Rethugs vote against a narrow bill that restored the ban

against preexisting conditions for CHILDREN? Especially if it was timed a couple months or so before the election?

[Leopolds Ghost]

21. Insurance lobbyists wrote the bill... LITERALLY. Wash Monthly did articles about it

Back in the day. DLCers like Health lobbyist Tom Daschle (first choice for HHS Sec, remember?) crowing a few years back about how this time, the insurance company was writing the bill, at the think tank stage, to avoid the mistakes of the past. And the first thing the insurance lobbyists demanded was a guarantee that the uninsured would be required to purchase their product in return for the industry agreeing to pass the costs of regulation along to the new "customers" and spare the existing, employed baby boomers.

[seafan]

11. Just two days since the bill was signed. Did we honestly expect anything different?

This is the punishment we will receive when Big Insurance is allowed to remain in control.


Why the people of this country must be subjected to this monstrous treatment, I just cannot fathom.


Medicare for All.



More discussion here.

[Lorien]

19. Amen. nt

[jtrockville]

20. (from your link) David Dayen says "you're crazy"

...snip...

If you don’t think this will happen for virtually every insurance regulation in the bill, you’re crazy. And on some of these less high-profile than the children’s exclusion, insurers will win.

The challenges facing the Affordable Care Act have really only just begun.

Maybe this will help grow support for the only real solution: Medicare for All.

[seafan]

28. 'If you don’t think this will happen for virtually every insurance regulation in the bill...' (Yep!)

Medicare for All is the only solution to this madness.


Nothing short of that will cut it.

[jtrockville]

30. Just leaves me to wonder one thing...

I wonder why Dayen thinks insurers might lose this battle?

After all, they've been denying care to children with pre-existing conditions (or anyone else for any other reason) for quite some time now - yet many people still are reluctant to remove our dependence on the health insurance industry.

[seafan]

31. I don't think he does.

Dayen's point seems to be that Big Insurance will ride this steamroller over the public until something or someone stops them.


Some major fallout is on the horizon with this insurance reform bill.

Why these Democrats cannot find it in themselves to Do. The. Right. Thing. here is just mind-numbing.




Medicare for All, as many who have fought (unsuccessfully) to be heard have known, is the only solution.

[jody]

12. "Is anyone surprised?" IMO no politically astute person is surprised.

[DURHAM D]

13. Exact;ly - the bill was written by insurance company lobbyists.

Nothing has changed.

[EFerrari]

14. They found them like my mom used to "find" the Easter eggs she hid for us.

lol

[OneTenthofOnePercent]

15. HAHA... I like that.

[Leopolds Ghost]

22. ooooh that's pretty! :-)

[Lorien]

18. Not surprised in the least. But so many here are still too busy hopping up and down

down squealing "WE WON!!!!! WE WON!!!!" to notice all of the fine print.

[Lydia Leftcoast]

49. Surprised, no, I just feel like Cassandra once again

(For those of you not up on your Greek mythology, Cassandra was a seer who was 100% accurate but was under a curse so that no one ever believed her.)

[pnwmom]

16. Then we simply write a narrow bill to fill that loophole, schedule the vote

for a couple months before the election -- and then dare the Republicans to filibuster and/or vote against a bill that bans preexisting conditions for children.

[Llewlladdwr]

24. Is that really a good idea?

Do you really want to still be talking about how badly the democrats failed to get this right the first time just a couple of months before the election?

[pnwmom]

53. We would have no choice -- might as well make the best of it.

Besides, it's more a matter of how willing and eager the insurance industry is to show bad faith no matter what. It isn't uncommon AT ALL to have to amend laws to fix loopholes that turn up after the fact.

[Greyhound]

35. That's so cute.

Remember, the insurance industry has more money, more and better attorneys, and far more to lose than "the government". 2,000+ pages of loopholes and ambiguity, this law is not only a boon to the health care denial industry, it is going to make hundreds or thousands of legal careers, as it was intended to from the start.

[laughingliberal]

42. Yes, they are going to have to amend the bill to fix this

The law is damned clear and does not have any provisions for guaranteed issue for anyone before 2014. And, how shall we amend it? Will we require guaranteed issue for those families who have children with preexisting conditions or just require guarantee issue of a policy for the child alone?

Then, in 2014, we can see if we can see them amend the bill to close all the loopholes in the benefits we were sold on which will come to light as more people are affected. This is just the first to show its ugly head.

[kentuck]

23. Who is surprised??

Not I.

[dflprincess]

29. Apparently, not even those who have defended this scam

or else they'd be on this thread trying to explain how these loopholes were all mistakes and will be "fixed" later.

[Skittles]

37. DON'T YOU UNDERSTAND, IT IS A CHESS GAME

GET WITH THE PROGRAM, PRINCESS!!!

[leeroysphitz]

25. Yeah. Sorry to say it but WE TOLD YOU SO. n/t

[amborin]

26. K&R

[Cleita]

32. Why wouldn't they? Their lobbyists and publicists practically wrote the

bill. Did not anyone see this coming when Congress dumped the public option in favor of the corporate friendly exchanges? We don't have health care reform yet, but I don't believe this Congress will or can do anything about it. It's time to start working to get something that is really universal at a state level.

[mzmolly]

33. Remove companies that do not comply from the list of subsidized

insurers.

[ecstatic]

34. those companies who try to skirt around the law should be exposed,fined, punished

The intent of the law is clear. I expected resistance but they will have to comply to do business in this country.

[MousePlayingDaffodil]

38. I'm afraid that a reviewing court . . .

. . . will first attempt to discern Congress's "intent" from the statutory language that was actually enacted. That is pretty much a paint-by-numbers principle of statutory interpretation.

Not having reviewed the statutory language at issue here, I'm loathe to offer an opinion, but the news stories appear to suggest that one provision of the new law rather clearly provides for a "guaranteed issue" requirement for every one beginning in 2014. At the same time, another provision of the law apparently uses different language when addressing the subject of coverage of "pre-existing conditions" for minors prior to 2014. If such is indeed the case, then I'm afraid that this would weigh heavily against the law being construed as imposing a "guaranteed issue" requirement for minors prior to 2014.

[Skittles]

36. this is the part the cheerleaders do not fucking get

and these companies are being given PLENTY of time to fuck the people, just like the credit card companies were given time

[ProSense]

39. No matter how much the insurance companies try to get around it,

the pratice of denying coverage for pre-existing conditions is banned

MR. GIBBS: No, the law is clear, Ed, that insurance companies cannot deny coverage to a child based on a preexisting condition. Under the act, the plan includes -- plans that include coverage for children cannot deny coverage based on a preexisting condition. To ensure that there is no ambiguity on this, the Secretary of Health and Human Services, Kathleen Sebelius, is preparing to issue regulations next month making sure that the term “preexisting” applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.

link

[MousePlayingDaffodil]

41. Well, I'm afraid that a reviewing court . . .

. . . is going to require more than the representaions of the President's press secretary.

And as for HHS issuing "clarifying" regulations, an administrative agency cannot by regulation impose a "guaranteed issue" requirement if the language of the authorizing statute itself is clear that no such requirement was created by Congress.

Now, if the court were to determine that the statutory language in question was ambiguous, such that congressional intent as to this matter could not be discerned, then in such circumstances HHS would be authorized, in exercising its reasonable discretion, to promulgate such regulations.

[Individualist]

40. Not at all surprised. This was intended as a windfall for insurance companies.

[AnArmyVeteran]

43. Let's just make selfishness a crime.

But our prisons would be filled with tea baggers, conservatives, republicans, corporate sociopaths, and every right wing radio and television host. The irony would be that these same thugs love prisons and the corporations which run them, so being inmates in corporate prisons would probably give them all orgasms.

Speaking of orgasms: Do you know what the definition of 'Tea Bagging' is? According to most dictionaries it is defined as 'dipping one's testicles into the mouths of another's mouth'. Now I know why conservative extremists love to go to those tea parties so they can 'tea bag' with each other. But since most of the tea party participants are men that means they are closeted homos. And I thought their parties were for liberty, freedom and patriotism, when in reality they are just big orgies.

[Zhade]

44. We warned people. They ignored us. Again.

This is only the start.

[walldude]

45. Funny when I posted about this on the day the bill passed I was

denounced as passing off right wing talking points, accused of being a hater, and called a liar.


This bill has more loopholes than the tax code. I could barely get through the bill and I still have no idea what's in it. Every section has something or other to do with other sections, you have to jump back and forth from place to place to figure out what it says, and it's all written in legalese which is damn near impossible for a layman to decipher.

While I'm proud that the Dems finally grew a pair, this bill still sucks.

[Donnachaidh]

48. When I brought this up I was called SELFISH because I was angry

Unbelievable, isn't it.

We have our own little brownshirt squad, making sure the message isn't dirtied up with real situations, huh?

[walldude]

51. Yeah.. I stopped posting stuff about the bill for a few days...

I was not going to rain on the parade, and while I hate the bill I was glad to see the excitement surrounding it's passage. If we can get that wound up over Single Payer, Wars, DADT, and other things we may yet come out of this presidency with hope...

[Donnachaidh]

47. Expect to see more and more of this -- that's what you get when you make deals with

PARASITES.

The insurance industry is the CANCER in the health industry - it needs to be surgically removed and KILLED.

[jody]

50. I'm surprised that anyone is surprised! n/t

[JackRiddler]

54. Let's see to it that the failures of the new system drive a push for a real reform...

and do not turn into the triumph of the right-wing yahoos.

This must be the beginning.

[SoCalDem]

56. Found them? They probably helped write them IN..

The more complicated a bill is, the more loopholes there are..