I’m live blogging S 1796; will report findings as I go.

I’m going to “live blog” reading the Senate Finance Committee’s health bill, S 1796.

A quick. 25-minute review of the 11-page table of contents shows that most of the bill provides pork to special interests. Relatively little is about health insurance reform, Medicare reform, Medicaid reform, etc. This should be a whole bunch of bills that should be considered individually, not thrown together in a big mess like this. But this is the way your Congress hides what it’s doing. Please click on the headline of this post.

Back soon.

p. 124, line-13-19; An employer’s health benefits plan qualified if meets certain requirements.
p. 124 line 14-24. Insurance agents (small businesses) get screwed. Buyers can purchase through an exchange directly from insurer or an agent.

Services provided must be pretty much as covered today plus
p. 125, line 15-17. “does not impose any annual or lifetime limit on the coverage of such covered health care items and services.”

But here’s the killer p. 126, L 10-17. “Preventive services, including those serv- ices recommended with a grade of A or B by the United States Preventive Services Task Force and those vaccines recommended for use by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease
Control and Prevention).” I’ve tried to find on the Internet a comprehensive, understandable list of the USPSTF services. No luck. Same for the ACIP vaccination stuff. This looks like it could be abused to favor providers and drug makers and drive premiums sky high.

p. 126 L 24-25 and p. 127 L 1- 2.NO COST SHARING ON PREVENTIVE SERVICES WILL TURN U.S. HEALTH CARE INTO BRIT HEALTH CARE. If people don’t have to pay for preventive services, UK experience shows, they’ll be on docs’ doorsteps daily, weekly and monthly, clogging up the system and causing long waits for people who really need primary and acute care services. This is just stupid.

p. 128. Price Controls never work, but they’re in the bill, p 128, L 4-24 and on p. 129, under “ANNUAL LIMITATION ON DEDUCTIBLES
FOR EMPLOYER-SPONSORED PLANS.‚Äî” In the case of a health
benefits plan offered in the small group market, the deductible under an essential benefits pack- age shall not exceed—
‘‘(i) $2,000 in the case of a plan cov- ering a single individual; and
‘‘(ii) $4,000 in the case of any other plan.

Now that doesn’t make sense. A person making $20,000 a year can barely afford the $2,000 deductible; for someone making $50k and up, it’s not really a big deal. But a $4k deductible would be a big deal a household making $40k or $60k, but not for one making more. Consumers should be allowed to pick their deductibles. Let the markets work on this one. Washington doesn’t know what will work for buyers.

What’s worse is that those limitations on deductibles are qualified in ways that put dollar signs in the eyes of consultants, accountants and lawyers. Who will figure this out for individuals and small businesses?

P. 131, L 5-14. Secretary of HHS will determine annual premium increases. Price Controls. Centralized planning. Politicized rate setting just like Reid and Schumer politicize provisions put in the bill to protect Nevada, NY and NJ at the expense of the rest of the country. Do you trust our Sec. of HHS, the former executive director of a trial lawyers society to set rate increases for your premiums? Get real!

P. 133, L 18- 135 L 4. POWER TO THE HHS SECRETARY. Lobbyists and trade association execs must have $ signs in their eyes, because they’ll have teams assigned to negotiate benefit designs, covered treatments, rates and everything else with HHS, which, as usual, will be highly politicized. Which providers, drug makers and unions will pony up the best campaign contributions for the president and Congressional committee members who will oversee this process? Warning to Members of Congress, you will be on the phone all day every day serving constituents unhappy with the secretary’s decisions. Customer service people at insurers lead such wonderful lives. You’ll love it.

p. 135 L 18-136 L 18. Levels of coverage based on the percentage of “essential services” a plan offers. Bronze 65%, Silver 70%; Gold 80%; Platinum 90%.

p. 136 L 19- 137 L 13: CATASTROPHIC PLAN FOR YOUNG INDIVIDUALS.‚Äîtreated as qualified if individuals are not 26 before beginning of plan year and an individual has incurred cost sharing based on a specified formula. Now can’t you see Mom on the phone with an insurer, broker or Member of Congress screaming bloody murder because she thinks her kid’s being shafted?

Done for the night. This is as bad as I expected. What a mess.

8 a.m. Don’t have much time before appointments. Nobody else seems to be blogging this or writing it up in newspapers, etc. Waiting for Senate leaders to meld S 1796 with the Dodd committee’s more liberal version. I’m expecting that the section I’m reading won’t be changed a whole lot. But it could be changed to accommodate the public option that’s expected to be in the final bill.

P. 138 Line 20 - p 139 L 6. This should be interesting: ‘‘SEC. 2244. APPLICATION OF CERTAIN RULES TO PLANS IN GROUP MARKETS.

SMALL employers’ plans can impose lifetime limits on benefits, but states are required to “prohibit the plan
25 for plan years beginning after 2009 from imposing unrea139
O:\FRA\FRA09275.xml [file 1 of 7] S.L.C.
1 sonable annual or lifetime limits (within the meaning of
2 section 223 of the Internal Revenue Code of 1986) on en3
rollees in the plan. This subsection shall not apply to a
4 grandfathered health benefits plan or to a qualified health
5 benefits plan in the small group market.

p. 139 L 6- 16. Additional Large Group requirements. Large employers will not be allowed to require cost sharing on preventive care and shall be required to cover preventive care even though most of it is a waste of time.

p. 139 L 17. Automatic enrollment. Employers of 200 or more required to automatically enroll new employes in health plans unless they opt out. I presume an employe could opt out if covered under a spouse’s plan or if covered in the individual market. Also an employee could opt out and game the system because fines for being covered at this point are cheaper than the cost of premiums even when employer covers 65% to 72.5% of the premiums? Try explaining this to a new employee.

p 140 L 3-p 145 L 7. ‘‘SEC. 2245. SPECIAL RULES RELATING TO COVERAGE OF
4 ABORTION SERVICES. Insurer or self insured employer allowed to decide whether it will cover abortion services. Abortions with public funding, whatever that is, prohibited. There are qualifiers here. For example, states’ exchanges are required to offer at least one plan that covers and one plan that doesn’t cover abortion services. Also, “‚Äò‚Äò(B) ABORTIONS FOR WHICH PUBLIC
5 FUNDING IS ALLOWED.—The services described
6 in this subparagraph are abortions for which
7 the expenditure of Federal funds appropriated
8 for the Department of Health and Human
9 Services is permitted, based on the law as in effect as of the date that is 6 months before the
11 beginning of the plan year involved.”

S 1796 doesn’t pre-empt states’ abortion laws or change existing Federal laws regarding abortion. It prohibits discrimination against providers that do or don’t provide abortion services. Up holds rights and obligations under Title VII of the Civil Rights Act of 1964. This is the least controversial section of S 1796. Ha! This should get a lot of attention.

p. 146-173. 1 PART II—PREMIUM CREDITS, COST-SHARING
2 SUBSIDIES, AND SMALL BUSINESS CREDITS
3 Subpart A—Premium Credits and Cost-sharing
4 Subsidies
5 SEC. 1205. REFUNDABLE CREDIT PROVIDING PREMIUM AS6
SISTANCE FOR COVERAGE UNDER A QUALI7
FIED HEALTH BENEFITS PLAN.

Read this. Will any small business or employee of a small business be able to apply for the credits and subsidies without the expensive aid of tax accountants, consultants and lawyers? Will it be worth it to apply for the credits and subsidies? And if the law is complicated, wait until you see the implementing regulations and forms that small businesses, individuals, agents and insurers will have to fill out, perhaps annually. And I’m not talking about the next section:

p. 174-178 L 3: SEC. 1207. DISCLOSURES TO CARRY OUT ELIGIBILITY RE2
QUIREMENTS FOR CERTAIN PROGRAMS.  The IRS will be turning private tax info over HHS employees and their contractors. “‚Äò‚Äò(A) IN GENERAL.‚ÄîThe Secretary, upon
13 written request from the Secretary of Health
14 and Human Services, shall disclose to officers,
15 employees, and contractors of the Department
16 of Health and Human Services return informa17
tion of any taxpayer whose income is relevant
18 in determining any credit under section 36B or
19 any cost-sharing subsidy under section 2247 of
20 the Social Security Act or eligibility for partici21
pation in a State medicaid program under title
22 XIX of such Act, a State’s children’s health in23
surance program under title XXI of such Act,
24 or a basic health program under section 2228
25 of such”

 

 

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