on our way to a merge

CNN on what's next

New York Times on the vote and how well the parties are getting along

The Senate Bill search for HR 3590

Here's some direct quotes from :
Patient Protection and Affordable Care Act (Amendment in Senate)

(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for--(1) evidence-based items or services that have in effect a rating of `A' or `B' in the current recommendations of the United States Preventive Services Task Force;.......

      (c) Value-based Insurance Design- The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs."
    Could there be a "public option" or something similar over time?


      (a) In General- Not later than 12 months after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to enrollees a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. In developing such standards, the Secretary shall consult with the National Association of Insurance Commissioners (referred to in this section as the `NAIC'), a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.........


      (a) Clear Accounting for Costs- A health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, submit to the Secretary a report concerning the percentage of total premium revenue that such coverage expends--
      (1) on reimbursement for clinical services provided to enrollees under such coverage;
      (2) for activities that improve health care quality; and
      (3) on all other non-claims costs, including an explanation of the nature of such costs, and excluding State taxes and licensing or regulatory fees.
      The Secretary shall make reports received under this section available to the public on the Internet website of the Department of Health and Human Services....

      (a) In General- Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.


      (a) Administration-
      (1) IN GENERAL- Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health insurance coverage to early retirees (and to the eligible spouses, surviving spouses, and dependents of such retirees) during the period beginning on the date on which such program is established and ending on January 1, 2014......


      (a) Internet Portal to Affordable Coverage Options-
      (1) IMMEDIATE ESTABLISHMENT- Not later than July 1, 2010, the Secretary, in consultation with the States, shall establish a mechanism, including an Internet website, through which a resident of any State may identify affordable health insurance coverage options in that State.
      (2) CONNECTING TO AFFORDABLE COVERAGE- An Internet website established under paragraph (1) shall, to the extent practicable, provide ways for residents of any State to receive information on at least the following coverage options:

    just the beginning of what just passed the Senate today...

    Some direct information on the health care bill

    After seeing countless headlines that give very little actual information and target small details without giving a broader understanding of the health care bill I decided to re-review the bill my self and because I spent some time skimming this 2,000 page bill for a second time I thought I would share that information with anyone who is interested in the actual details contained in the actual bill.  I am going to give you the best simple summary I can.  I am also very interested in discussion as well as information as I have obviously not read every word of the 2,000 page bill if there is something you feel is important that I missed PLEASE share that information and where exactly that information is contained in the bill.

    The first area of interest I had was about mandated coverage.  This section starts on page 322 (I am giving you page numbers and not sections to go look for because there are no links to jump to sections that are hard to see in the large PDF.).  Mandated coverage includes only minimal essential coverage which is to prevent people from waiting to buy coverage until they require care which would be unfair to those who have been faithfully paying into the system, raising costs for everyone.  Since most everyone will need care at some point, you have to take part now since the ability to deny coverage will be removed (there will be no pre-existing condition issues or waiting periods allowed).  The details about the fines for people who do not have insurance are; effective 2013, the fine amount for non coverage will be assessed on your taxes, it will be $750/year assessed monthly (1/12 of total amt per month of non coverage) and is phased in starting with $95 in 2013 going up to $350 in 2015 and a full $750 in 2016.  This is waived for religious reasons if there is an organized sharing of medical cost.  It is also waived for individuals not lawfully present, and waived for those who can not afford insurance= if it costs more than 8% of your income during any particular month or if you are below poverty line.  It is also waived for tribal members and those who are in jail.

    My next area of interest was about the cost of care without a true public option as competition.  There will be mandates such as this:
    "(2) JUSTIFICATION AND DISCLOSURE.—The process established under paragraph (1) shall require health insurance issuers to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase." and it goes on in detail about how this will be carried out and made public.  I also saw in my first read a revocation of the antitrust law exemption for insurance companies, and some rules about not giving bonuses to CEO's (who currently receive hundreds of millions of dollars).  I can not find this part this morning, but I did find this article on the subject

    Now here is the really important part, how we will be protected from insurance companies;
    There will be no life time caps, 
    no pre-existing condition exclusions, 
    no exclusions in a company due to lower income or lesser job status (they can not deny coverage due to income), 
    large employers (over 100 employees) will be required to offer coverage while small businesses will get a tax credit for offering coverage,
    there is administrative simplification including increased communication between providers and use of electronic records, 
    insurance companies get fined for not giving you information ($1,000 per  occurrence   = like one phone call from a subscriber), 
    the rates can not vary more than 3 to 1 for age (a 54 year old will have only 3x the cost of coverage of a 21 year old, no more), 
    coverage will be guaranteed to all - no one can be denied, 
    no changes to existing coverage, 
    there will be smaller out of pocket limits (caps on what can be charged per year), 
    share of costs have caps and limits (insurance companies can't charge co-pays and co-insurance, just co-pays), 
    state founded co-ops would be encouraged and subsidized (this is complicated) but no state will be forced to participate and no individual or employer would be forced to participate in a government plan either, 
    removal of barriers to home services to keep people out of nursing homes, 
    This may seem redundant but I am just going in order with the bill, theses are all separate sections and while in short form they seem redundant, in the bill they are thoroughly addressed.  

    It really was not that hard to skim the bill scrolling through the sections to get the general idea, I encourage you to do the same find specifically where there is an issue you disagree with and share that information with your senator.  Find out what is actually going on and don't believe misinformation and opinions based on past versions of the bill that are no longer relevant.  In health happiness and wellness always ! 

    Here's some updates 
    A linked version of the bill much easier to skim!

    How health lobbyists influenced reform bill

    The bill clears the initial Senate vote

    A local perspective


    Cascade Wellness is blogging again, I will be posting soon!  Please check back for updates or sign up for our mailing list by visiting our home page.  Thank you for visiting !