Okay, so I’m reading HR 3200. I’m stunned. I should have known from the first page, the bill’s title, that it would be a hot mess. The title, in case you’ve not read it, is “HR 3200: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” Hmph. “Reduce the growth” of spending, not reduce spending or cut costs, and any time you see anything that resembles “and for other purposes,” it’s a good idea to keep an eye out for more billions going to the study of how fast it would really take for hell to freeze over. The “for all Americans” part is a bit ominous, too, don’t you think? If the goal is to help the un- and under-insured get insured, why mess with everyone’s health care?
We already have Medicaid for the indigent, and the qualification income bar is so unrealistically low that hardly anyone qualifies for it! How about we change that instead of the entire health care system for everyone in the middle and lower classes? Particularly as the goal is to provide “essential health benefits.” This does not mean that everyone gets the same health care that Congress gets, this means that the basics are covered. God help you if you get seriously sick (because the government won’t).
There are some things in this version of the bill with which I agree and definitely think should be included in some kind of health care reform bill (obviously not one that sets us down the road to single-payer).
So a few things of note:
1. The bill calls the government-run health benefit either “public option” or “health care exchange” (co-op), though actually the “Exchange” will be run by a health care god called the Commissioner who will in turn dictate all terms and conditions of the “public” “option.”
2. The only way you can make your own choice about having employer-based, rather than the government-run, health insurance is if you have it when the bill is enacted. This is the “grandfathered health insurance coverage” (pg 16). So in a way, BO actually got that part right. The part he left out is that if you don’t have insurance when the bill is enacted, you’re screwed (go straight to government-run health care, do not pass go, be sure to pay as you pass go). Also, if you do get “grandfathered” in with your own employer-based insurance, your future dependents cannot be added to that (also page 16), so you’ll either have to pay for two policies, deductibles, etc. or switch yourself to the same coverage as your poor, doomed children.
3. Even if you are “grandfathered” in to your own coverage, you can only retain it for 5 years (pg 17). During this time it will be deemed “acceptable coverage” by the feds. After that, well, off you go, welcome to government-run healthcare. I suspect that this means they are giving themselves five years to set up and establish a government health care system. It’s the government, though, so it’ll probably take ten. BO’s 20-year estimate may not be far off the mark. But that’s what this is about. The options we have today, limited though they may be, will disappear completely once this five-year “grace period” expires and the government takes over and/or dictates all healthcare insurance. It’s all right there, clearly obfuscated for all to read.
4. After those 5 years, employer-based health insurance will not be your primary insurance. Instead, it will become–if it wants to stay in the insurance business and meets the governments gazillion requirement–an “Exchange-participating health benefits plan” (page 19). In other words, it would supplement the crap health care provided by the government. Won’t that be fun? And they sneak in an even more fun provision that the “Exchange” yada yada will be overseen by the Commissioner of the gov’t option. Ha!
5. The people who are saying that abortion will be covered under the government-run health care are correct. If it’s not in the bill as many who’ve read it are saying, means that it will be covered (for more on this check out the Medicaid bill which explicitly excludes coverage for abortion). That’s a kettle of fish yet to be truly examined.
6. The bill provides for a review after 18 months to find out how many people are still enrolled in employer-based health care, so the Commissioner can “make recommendations” for ensuring there are “no incentives” for them to continue to do so (pg. 21-23). In short, they’ll figure out why people are not on the government plan and change the regulations to “correct” that.
7. The Commissioner will be very powerful. And it’ll be his or her job to ensure “adequate enrollment” in the government option by whatever means are necessary, up to and including changing the regulations, taxes, “incentives” for staying out of the government option, and whatever else the Commissioner “deems appropriate.”
8. Dental and optical insurance will be available to children under 21. This is a good thing.
9. You’ll still have co-pays, deductibles, etc., and these will be limited to $5k for an individual and $10k for a family per year (pg. 29). In other words, if something is seriously wrong with you and you need multiple tests, x-rays, follow-up doctor visits, whatever, once you hit that magic “cost-sharing” ceiling, you’re done for that year. Not quite cured yet? Well, sorry, can’t help you until January. See you then . . . if you’re still alive and kicking.
10. By the way, on those co-pays? The Commissioner will try super hard not to be forced to impose co-insurance (i.e. you pay a percentage of the costs once the deductible is expended and up to the stop loss point; I haven’t got to that part of the bill yet, but I’ll come back to this when I do. If they mention it here and don’t establish a stop loss range, that’s very bad news for us.). But really, he or she will work to avoid that “to the maximum extent possible” (pg. 29). Isn’t that heartening? Who knew that government-run health care would mean paying the same damn thing we do now for fewer benefits and the heart-warming pleasure of dealing with the government to get an x-ray approved? Anyone tried to get anything corrected through the government? It’s a red-tape, hurry up and wait, jump through 100 hoops process that usually results in nothing being done at all.
11. And who’ll be in charge of this goodness? Why the Health Benefits Advisory Committee. This will consist of a total of up to 27 people, only one of whom must be a “practicing physician or other health care professional” (pg. 30-33). That makes sense. Why would a health care committee have more than one medical doctor out of 27 people? And it really doesn’t have to be a medical doctor, apparently, just any “other health care professional.” That could mean anything from a nurse to a pharmacist to a dentist to a paramedic.
12. But take heart! No one on the Health Benefits Advisory Committee will be a federal employee because they’ll be paid per diem (pg 34). So what if they are appointed by the president and oversee government-run health care? That doesn’t mean they actually work for the government. Amazing.
13. The Surgeon General will be the chair of this non-government, presidentially-appointed committee (pg 30). So while the committee isn’t (according to the skewed logic of the writers of this bill) employed by the government, its Chair is. Sneaky.
14. If you are denied coverage, you can appeal. To the Commissioner. His or her decision is “binding” (pg 37-38). In short, don’t bother appealing because the same entity that denied your claim will be reviewing it. Geez! But they didn’t toss the entire Constitution out the window; they graciously allow you to place your claim under judicial review if you are not satisfied with the Commissioner’s response. Yippeee! Years of litigation and bs over a denied claim. That really does sound better than dealing with an insurance company, huh? hmph!
15. When the plan changes, you can expect notification in a “reasonable and timely” manner (pg. 40). What that means to the government is anyone’s guess. They think it’s reasonable to buy thousands of perfectly good cars and filling up landfills with crap that can’t be great for the environment (not sure how biodegradable all the parts are, but all that oil, gas, antifreeze, etc. soaking into the earth can’t be good). Nothing like creating enormous piles of trash in the name of the environment. But hey, that’s “reasonable,” even “necessary,” to this messed up government.
16. We get a shiny, brand new government agency! Woot! It’s to be called the very crappy name “Health Choices Administration.” Keep in mind this is the BO administration where terrorist attacks are called “man-made disasters” and American military veterans and grannies in Iowa are “potential national security threats.” Believe “Choices” if you want to, but I really wouldn’t advise it. Keep in mind all those people who are not to be called “enemy combatants” are still rotting in Gitmo. Obama doesn’t really “lie,” he just circumvents the truth. A totally different thing.
17. The president will appoint the Commissioner. Of course. That’s not why I mention it. The interesting little detail here is what is not said (as is always the case with politicians in general and with BO in particular). There is no term limit (there is for the Committee–3 years), so I guess it’s a lifetime appointment. That’s good. Covers all the bases when BO is booted out of office in 2012; he’ll still have his man (or woman) running health care. That’s encouraging.
18. Sitting down? The Commissioner can randomly and / or on the basis of suspicion of “non-compliance” with the national healthcare system audit any and all non-government providers. And (here’s the good part) he or she is authorized to recoup the losses of these random (and until this bill is passed, illegal) “audits” via . . . “qualified health benefits plans” (pg 43). This includes, of course, the government-run health care plan (pg 10), and it also include employer-based plans. That’s a nice way to hike costs and make it prohibitive to have the latter plans, no?
19. If the Commissioner doesn’t like what he or she sees, guess what? All individuals who are covered by the offending health insurance provider will have their benefits suspended (pg 44). That means you. If you try to stay on your employer-provided plan, you can count on an “audit” and having your health care unceremoniously suspended. Just like that. No notice, no nothing. In the middle of radiation treatments? Too bad for you. They will stay suspended until the Commissioner gets around to changing whatever onerous regulations were making your own plan more attractive to you. Then you will have crappy care start back up. WooHoo! So they don’t want anyone not covered . . . except people who don’t go with the government plan. They can be cut off at the wave of the Commissioner’s mighty wand. If he or she really doesn’t like what they see, they can “work with the State” to have the plan abolished. Nice, huh? There goes your plan. Guess it’s “go government” for you. Aren’t you glad you CHOSE that?
20. This may just be me, but it’s drives me nuts that they use “insure” when they mean “ensure.” That’s one of my pet peeves anyway, but in this bill about insurance, it’s even more annoying.
21. Okay, Section 155 is simply hilarious. The United States Congress (this is one of the House versions) has written this bill, right? The Legislative branch, right? Hehe. Sec. 155 says that if any part of it is unconstitutional, the remaining parts will not become null and void. Shouldn’t they know what the Constitution says? I mean really! You’d think someone would take a li’l peek before they start writing laws/bills/etc.
22. If this passes, January 1, 2011 is D-Day (pg 55). Mark your calendars.
23. Sec. 1173a gives the government access to your financial records, including your bank and other assets (this section starts on pg. 57). Not surprising as they will need to determine eligibility, but this SHOULD be freaking out people on the Left who were so against Bush’s “invasion of privacy.” BO won’t be in office forever, and once he goes (2012 at this rate), you can almost bet the ranch that a republican will win the Office (and access to all your private information.). Think I’m kidding? Read the bill yourself. It’s all right there. And no, as I’ve explained above, you are not exempt. No one is. That’s what the bill is about. But don’t you worry, the bill provides that all the information gathered about you cannot be used to “adversely affect any individual.” Whatever that means.
24. No wonder senior citizens are flipping out. Sec. 164 (starts on pg 65) covers the “Reinsurance Program.” This is a “temporary” program, with a fixed budget, that will insure retirees. No idea why or for how long, but this must mean people who are retired and not yet old enough for Medicare. Not really sure. If it’s only temporary, though, chances are that when the current retired population dies off, future retirees will simply continue to be covered by the government plan or some modification of it that hasn’t been written. It’s a “grandfather” clause for the time being, but it paves the way to the potential elimination of Medicare (and maybe even of Medicaid) at some future point. Once everyone is wearing their orange jumpsuit, masks, bags of sand, and other “Harrison Bergeron” trappings and not daring to sing or dance. This is speculation, pure and simple, on my part. But if that’s not the reason for it, why have it at all? Just stick the retirees on the same “public” “option” we’ll all have, love, and cherish? I mean this government-run healthcare will provide some substandard form of insurance to everyone, including the unemployed, so why not retirees, too? As is, it smacks of a transitional measure.
25. “Health Insurance Exchange” finally explained! (pg 72) It’s the “co-op” they mentioned last weekend. Period.
26. There’s a 1-3+ year description (terribly written like the rest of this bill) that qualifies groups (individuals and various size businesses) for the government-run health care plan. They’ve got it all in here, too. Medicaid, Medicare, Veteran’s benefits, and the military and their dependents. So I guess all these plans will be dissolved at some point. Single-payer all the way (as I’d thought and BO has promised–well, on the bright side, he does seem to be keeping one promise, even if it’s not one he actually ran on because when he said it, no one wanted it. Should have been a clue, but I guess it wasn’t. So he ran as a moderate, and now look at him go!).
27. Once you’ve been deemed “eligible,” you cannot be kicked out unless Part A of the Medicare program kicks in, you’re eligible for Medicaid, or . . . well, because the Commissioner says so (pg 79). Comforting, huh? It gets better, the Commissioner can let you “continue treatment” under Part A until he or she decides you can’t anymore (pg 79). So there.
28. To be eligible to play along, private insurance companies will be required to “offer a basic plan,” and if that plan is offered, they may offer “one additional, enhanced plan.” “If and only if” said company offers a compliant “basic” plan AND a compliant “enhanced” plan, they can offer a “premium” plan, too. If they have all this, then they can offer an array of super mega-uber fantastic plans (okay, the bill calls them “premium-plus,” whatever). I’m sure there are “incentives” a’comin that will encourage the offering of only the basic plan, but read on, I shall.
29. The plans unveiled. The basic plan is well, basic. It’s the government’s idea of “basic” and “necessary” and is subject to change based on recommendations by the aforementioned Committee or because the Commissioner had a bad (or good) day. Hmph! This plan is tier-priced, based on income–the more you make, the more you pay. Lovely. At least socialized medicine in most other countries provides shoddy care to its populace for free, but we get to pay for shoddy care. Yay. Only the premium-plus offers dental and optical, if the Commissioner approves, that is (pg 86).
30. The states can still mandate coverage above and beyond the “essential coverage” that will be provided (presumably) for free to anyone who qualifies and cannot pay for the “basic” plan. At the Commissioner’s discretion, that is. And by paying a percentage (to be determined by the all-powerful Commissioner) of the net profits of such a mandate. The feds, in other words, trump the states here. Hey, these guys really don’t read the Constitution, do they? Even I know that’s a lawsuit in the making.
31. The next few pages waffle on about “entities” who offer insurance that must meet the guidelines set by the Commissioner and the Committee. Again, that’s the co-op transitional measure between what we have now and full-blown government-run health care. What else can it be? Even if the private insurers somehow managed to stay in business, they’d have to fall into line with the feds or they wouldn’t be “eligible.” And that means comply in everything from the policy types and coverage offered to the collection of payment, grace periods, etc. (pg 91). My guess is that the incremental allotments are simply going to take all the citizens from private into the government option, or it could be setting up an eventual government take-over of private insurance companies. Like GM. And the banking industry. That’s how it reads to me, anyway. Any way you slice it, the government will be controlling the entire health care industry, and the Commissioner will be godlike in his or her powers. It’s scary.
Okay, that’s enough of this bill for one day. I’m on page 95, and I’m about to read all about “outreach.” Thrilling stuff. Can’t wait to get to the “for other purposes” part. That should be riveting.