On Sep 1, 2009, at 4:48 PM, Charles Bennett wrote:
So what? Nobody's claiming the public option (aka Medicare for
whoever wants it) would be better than the best private plans.
That's
why it's an *option*. It's for people who can't afford or can't get
access to adequate coverage under the private plans. The point is
that it's pretty good, as measured by Medicare satisfaction rates,
which are generally high.
If you like your current plan, as Congressfolk usually do, keep it.
No worries.
It's not quite like that. You can keep your plan *IF* and only *IF*
you have it on day 1 of the new law and there are no changes in "terms
and conditions"
After that, you have no choice. you plan must *conform* to the
government standards
In any case ALL policies must conform within 5 years.
So you can keep your plan sort of..
Well, yes, your private plan will have to conform to new regulations.
Like the insurance companies won't be able to drop you for having a
pre-existing condition. It looks like Section 1, Division A, Title I,
Subtitles A - D cover the standards. These appear to be (I'm largely
just quoting the bill):
* Participating in the national health insurance marketplace
* Permitting you to keep your current coverage. Read that one twice,
Chuck, it's section 102.
* Prohibiting pre-existing condition exclusions
* Prohibiting denying you the ability to renew your current coverage.
That's worth reading twice, too. Section 112.
* Rules regarding insurance rating
* Prohibition of discrimination and requirement of parity in mental
health and substance abuse disorder benefits
... blah blah blah
* Requires fair grievance and appeals mechanisms
... blah
* Requires timely payment of claims
... etc.
Sounds horrible. Some of these are even there *explicitly* to ensure
that you *can* keep your current insurance, even in situations where
today you could lose it by, say, getting sick. You realize, Chuck,
that the "grandfathering" you mention below, doesn't refer to you, the
insurance holder? It refers to the insurance *company*. The private
insurance company is permitted to keep screwing you for up to five
years if you're already a policyholder at the time the law goes into
effect.
What's so wrong with all that?
-Patrick
As long as you don't change jobs, and the plan stays charges the same
rates etc..
Here is the meat of the matter. The devil *IS* in the details.
From page 16 of H.R. 3200 for those of you keeping score.
3 (a) GRANDFATHERED HEALTH INSURANCE COV
4 ERAGE DEFINED.—Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov
6 erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
On the first day of Y1 of the plan, everyone that wants to can keep
their plan..
but.. No NEW enrollees..
Nww folks MUST join a conforming plan. So THEY don't have the option
of anything Obama doesn't approve of, and no one in the future with an
employer plan does.
(excepting congress of course)
The kicker is that if you plan raises it rates for ANY risk group then
it LOSES it grandfathered status.
If you change jobs, and switch to a new plan, you are out of you old
plan and MUST now select a "conforming" plan at your new employer.
If you fall into a high risk category and they raise YOUR rates, you
are out
so what right? Well guess what.
(From Page 828 of H.R. 3200)
11 ‘‘SEC. 4375. HEALTH INSURANCE.
12 ‘‘(a) IMPOSITION OF FEE.—There is hereby imposed
13 on each specified health insurance policy for each policy
14 year a fee equal to the fair share per capita amount deter
15 mined under section 9511(c)(1) multiplied by the average
16 number of lives covered under the policy.
17 ‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub
18 section (a) shall be paid by the issuer of the policy.
OIC.. the insurance company has to pay it.. So it has pressure to
raise rates but if they change anything, you lose you grandfathered
status.
W.C. Fields once said " I keep a bottle in my desk in case I see a
snake, which I also keep in my desk"
What do they get for this fee? They get a government plan they are
supposed to compete with.
Wouldn't you like to have a business where your competitors have to
pay you? How long do you think they would last if YOU get to set the
fee?
From the PRO bill website.
<http://covertheuninsured.org/legislative_bill/hr-3200-dingell>
"Treatment of existing insurance coverage (“grandfathered coverage”)
Individual coverage. Individuals previously already enrolled in
insurance bought through the individual (non-group) market prior to
enactment could keep that coverage. Dependents could be added to it.
Such coverage would not have to meet the new insurance and benefit
requirements of the bill so long as the insurer did not change the
terms or conditions of the policy or vary the percentage increase in
the premium for its enrollees without changing the premium for all
enrollees in the same group at the same rate.
Employment-Based Health Plans. Individuals enrolled in employment-
based plans could keep their existing coverage and that coverage would
not have to comply with the insurance or benefit requirements of the
bill for a 5-year grace period (beginning 2013). Upon expiration of
the grace period, the employment based plan would have to meet the
bill’s applicable requirements, including those relating to the
benefit package offered to employees. The plan would be considered
acceptable coverage during the 5-year grace period for purposes of
meeting the employer and individual mandates."
So under the most charitable reading of the bill the government "lets"
me keep my current package for a 5 year grace period after 2013.
ASSUMING that there are NO changes made to it.
right.. anyone here ever have a health plan stay EXACTLY the same for
a couple of years in a row? No fee increases, no changes in "Terms
and Conditions" no changes in co-pay? Me either.
Pretty much everyone sees some sort of rate hike every year or some
sort of "changes in terms or conditions"
This is why average people are asking their critters if they have
actually *read* the bill and why pissed off people are showing up at
town halls.
Its not even "mostly" astroturf, it's people that read this and think
"oh, hell no.."
"upon expiration of the grace period, the employment based plan would
have to meet the bill’s applicable requirements" means that "if you
like what you have you can keep it" is no better than 1/2 true and not
true at all after grace period.
1/2 truths = lot's of people showing up to "talk" to their
congressmen.
=c=
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