First of all, I don't think I would be too much mistaken in saying most members of Congress don't read this shit. Actually, Chairman of the House Judiciary Committee and Attorney John Conyers (D-Michigan)said, "I love these members, they get up and say, read the bill. What good is reading the bill if it's a thousand pages and you don't have two days and two lawyers to find out what it means after you read the bill?" You are a lawyer, you doddering old buffoon. If the Chairman of the House Judiciary Committee, who is a fucking lawyer, can't understand the bill, what are the chances that anyone else in Congress can? 168 Representatives and 57 Senators have law degrees, but according to Mr. Conyers, even lawyers need lawyers to help them understand this shit.
So, I'm going to tell you, as I understand it, what this thing is shaping up to look like as I continue reading and learning about it, and I'm going to try not to be biased and paranoid.
If you guys would like to look at it, go ahead: http://www.opencongress.org/bill/111-h3200/text
How do I even begin to explain this? It's one of the most difficult things I've had to read and follow along with, and I'm a fan of 17th Century political philosophy.
First thing's first I guess, the bill establishes what is called the "Health Benefits Advisory Committee." The Surgeon General will be the chair of the committee and there are around 28 members. Some members are private citizens and some are government officials. It is their job to figure out what benefits should be covered, apart from the essential benefits listed in the bill.
In order for health insurance coverage to be deemed "qualified," it has to comply with a minimum set of benefits and preconditions that will be set by the "Health Choices Commissioner" based on the recommendations of the Health Benefits Advisory Committee. There is far too much involved in recounting all of the requirements, but some of the biggies are: no pre-existing conditions exclusion, the ability to renew the plan, plans must offer an "essential benefits package" (tons of shit listed here, read Sec. 122 for a full list), adequate provider network...etc. However, there is a grace period during which insurance policies that are insufficient, according to the government, can make the necessary changes to be in full compliance. So, no matter what, everyone can keep their current health insurance for at least a little while.
If you're enrolled in an individual benefits package on the day before the first day the Act becomes law, your policy is grandfathered in and you can keep your insurance regardless of whether or not the policy is qualified as long as the individual insurance issuer doesn't enroll any new individuals after the first day the Act becomes law, the issuer doesn't increase premiums, terms or conditions. If you have a policy through your employer that isn't qualified, you can stay enrolled for 5 more years, but at the end of the 5th year, if your employer-provided policy is still unqualified, the provider will not be allowed to offer benefits and you will need to find a new provider. If your employer-provided benefits qualified from the beginning or if your the provider your employer uses changes its policies in order to be in compliance, you can keep the package.
If you do not have any insurance as of the day the Act becomes law, you will not be able to get individual private insurance. As of the first day the Act becomes law, individual policies for individuals in the private market, regardless of whether or not they qualify, are no longer allowed.
Where will you get health insurance? Here's where it gets even more confusing, but in order to try and make it a tiny bit less confusing, from here on out, assume that any policy being offered, regardless of who the offering entity is, is a qualified plan.
There are a few places we'll be able to get insurance. There are private providers in the Health Insurance Exchange, the gubment (offered exclusively through the Exchange) and qualified private providers who do not participate in the Exchange. In the case of the last option, qualified private providers may not offer individual benefits policies. If you do not have insurance offered by your employer, you have no choice but to get individual insurance through the Exchange.
What the fuck is the Health Insurance Exchange?
There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.(Sec. 201(a))
Now, what the fuck is the Health Choices Administration and who the fuck is the Commissioner?
(a) In General- There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration.
(b) Commissioner-
(1) IN GENERAL- The Administration shall be headed by a Health Choices Commissioner (in this division referred to as the ‘Commissioner’) who shall be appointed by the President, by and with the advice and consent of the Senate.
Now, there are certain types of people and employers who are qualified to get individual or group insurance through the Exchange. While the requirements for individuals listed in Y1 do not change in subsequent years, the eligibility requirements for employers are staggered over three years.
During the first year (Y1, or 2013) the Act is in place, individuals who are not covered as full-time employees through a qualified group plan offered by their employer, for which their employer pays the required amount towards the premium (72.5% of the premium for the lowest premium plan for individuals, and 65% of the premium of the lowest premium plan for a family), are eligible to get individual or family coverage through the Exchange. However, individuals who match that description but are covered by Medicare, Medicaid, the VA, or who are members of the Armed Forces (including their dependents), are not qualified to get coverage through the Exchange. Confused yet? Employers who are eligible to get coverage for their employees through the Exchange during the first year are employers with 10 or fewer employees.
During Y2 Individual requirements stay the same. However, employers eligible for the Exchange are employers with 20 or fewer employees.
During Y3 individual requirements stay the same. For employers in Y3 and beyond, any employer that employs 21 or more employees becomes eligible at the Commissioners discretion.
What I've found in this bill, unless I'm just reading it completely wrong, is that in order for an employer who offers coverage to employees through an Exchange-participating plan to remain eligible to continue offering such coverage, they have to meet different contribution requirements. Instead of the 72.5% of the lowest offered premium amount for individuals and 65% for families, they pay an amount, "equal to the average premium for the 3 basic plans in the area for the plan year with the lowest premium levels." So they're paying 100% of the average of the three lowest plans, instead of 72.5% or 65% of the single lowest plan. Honestly, it is hard to tell which of those amounts will be less. This next section sheds a little light on it.
In addition to offering qualified plans, insurance providers interested in being offered through the Exchange must adhere to further qualifications. They have to offer three different tiered plans, while providers who do not participate in the exchange just have to offer the bare bones (they can offer more if they want). Exchange-participating plans must report data to the Commissioner that the Commissioner deems necessary to carry out "risk-pooling" and other information that could be used to address "disparities in health and health care." Risk pooling is a really interesting one, and its definition in the bill deserves its own block quote...
The Commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among QHBP (Qualified Health Benefits Provider) offering entities offering Exchange-participating health benefits plans of premiums collected for such plans that takes into account (in a manner specified by the Commissioner) the differences in the risk characteristics of individuals and employers enrolled under the different Exchange-participating health benefits plans offered by such entities so as to minimize the impact of adverse selection of enrollees among the plans offered by such entities.
Um...You dicks put out a 1018 page bill, a fucking period here and there wouldn't have busted the printer ink budget. What the fuck does that even say? In the course of my little health care bill journey, I've learned a bit about risk pooling. Large employers who offer health insurance constitute their own risk pool, small and medium sized employers who offer health insurance are lumped together with other small and medium sized employers to constitute a risk pool and if you buy individual insurance on your own, you're your own risk pool. Every insurance company participates in risk pooling and in the current system, health insurance companies can deny coverage based on pre-existing conditions, thereby weeding out the highest-risk people. If the bill passes, insurers won't be allowed to discriminate based on pre-existing conditions. What the Exchange will do is create a HUGE risk pool, but it will limit the amounts Exchange participating providers can charge in premiums. Providers who don't participate in the exchange are not part of this risk pool. Because the Commissioner will set premium limits on how much Exchange-participating providers can charge, and because providers who do not participate in the Exchange do not have to adhere to these limits, Exchange-participating providers will always be able to charge lower premiums. So, even though employers will have to pay 100% of the average premium for the three lowest premium plans in their coverage area, that amount still may be less than 72.5% of the premiums for individual plans not offered through the exchange (or 65% for families). What happens then? Employers become Exchange-eligible according to the staggered schedule, they dump their non-Exchange coverage, non Exchange-participating providers slowly go out of business, and all we're left with is the Exchange.
That's all for now kiddies. And that's actually just stage one in the plot to ruin this country even more. It seems like it'd be really easy if the government just said, "Hey, we're going to drive health care costs down because we're not going to allow Illegals to come to the hospital and get a chest x-ray because they've got the sniffles. We're also not going to let John Edwards sue Doctors for 9128495 trillion dollars because they accidentally put their thumb in little Timmy's soft spot. Now, since the cost of Doctor's medical malpractice insurance has gone down, and since they are no longer being forced to do unnecessary and ungodly tests on people who will NEVER pay them, they'll be able to charge less for their services! Which means, you have to stop being assholes and start lowering premiums."
Why all the need for private options and health choices commissioners and health choices administrations and health benefits advisory committees and health choices ombudsmen and health choices trust funds and on and on and on until my fucking head explodes? Stop fucking with everything. And now, as my pièce de résistance, I'm going to make a funny pun using an old, cliched acronym...drumrolldrumrolldrumroll...KISS: Keep It Simple Socialists! Ha! I'm sorry.
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