During the course of this debate on health care reform it's become increasingly clear to me that very few people have actually read this bill. Certainly not the deathers, nor their corporate media shills. Sadly many of the supporters of the bill have no idea of what it actually says, and find themselves unable to really explain things.
Unfortunately, I find myself in the latter category as well. I haven't read the full text. I've read parts of it, I've read summaries by people I trust, so I think I know what's in it--but do I really? Follow me below the fold to learn the answer
Turns out, I didn't know what it is. So, I propose a series of diaries, going through the bill page by page. I'll do my best to summarize to the best of my (limited, but enthusiastic) knowledge. If I don't know the answer I'll try to find it, or turn to our community of experts to help out. Discussion is encouraged--we need to fully familiarize ourselves with this bill, so we can defend it if need be.
For the purposes of this discussion the bill we'll be discussing is HR 3200 as introduced to the House on July 14, 2009. If there have been ammendments that have changed it significantly, those will be covered during the discussion.
You can find a copy of HR 3200 at Open Congress. It's handy with links to comments (some of them frighteningly cruel), as well as handy links to other bills.
You can go to THOMAS (the library of Congress site), where you can find a copy of the bill with hypertext links to every other section. Very handy. There you can also find every other bill brought to the floor of Congress through their Home Page. THOMAS
Also at THOMAS is a pdf format of the bill which is great if you want to refer to page numbers instead of sections.
I apologize in advance for the quirky formatting of the block quotes. When I copy from the text of the bill I'm also copying the line numbers of the page, which makes it a little odd. If it's in blockquotes it's straight from the text of the bill, otherwise it's my own interpretation.
Now, on to the bill itself.
Page 1
The Introduction. The short, but powerful, summary of the intent of this bill.
H. R. 3200
To provide affordable, quality health care for all Americans and reduce
the growth in health care spending, and for other purposes.
That lays it out right there.
Pages 2-7 are the table of contents
Pages 8 through 14 cover various definitions of terms. Most of these definitions refer to other parts of the bill for further clarification. A couple of interesting points brought up here though. From page 9, lines four through six.
4 (5) DEPENDENT.—The term ‘‘dependent’’ has
5 the meaning given such term by the Commissioner
6 and includes a spouse.
The first is that there will be a Commissioner, aka Health Choices Commissioner. This Commissioner is established earlier on page 8:
8 (3) COMMISSIONER.—The term ‘‘Commis
9 sioner’’ means the Health Choices Commissioner es
10 tablished under section 141.
How far down does this power reach? Will there be local commissioners to decide individual cases? Would this mean that in some states same sex partners will be covered as dependent spouses, but not in other states? Why is this left up to the director, and not made law? I'd hate to have the status of a dependent changed at the whim of a Commissioner.
Page 14 also lays out the abbreviations in time line. Here is where we find out that HR3200 will not start until 2013
10 (25) Y1, Y2, ETC.—The terms ‘‘Y1’’ , ‘‘Y2’’,
11 ‘‘Y3’’, ‘‘Y4’’, ‘‘Y5’’, and similar subsequently num
12 bered terms, mean 2013 and subsequent years, re
13 spectively.
Page 15 is where we start getting into the real policy. The purpose of Section 1 is to establish standards that guarantee a certain level of health care.
Immediately we see that this minimum coverage includes all health insurance plans from day one of Y1 (aka 2013). That's good. To address the concerns of those who don't want to lose their current health insurance we have Sec 102 (on page 16)
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:
- The effective coverage has to be before the first day of Y1
- The insurer can not change any conditions or coverage after the first day of Y1. These include cost-sharing (copays, deductibles) as well as benefits.
- Insurers can't target certain policy holders for rate increases unless it increases rates for all policy holders in the Risk Group.
Number one is a pretty obvious point I'd think. Can't be a grandfathered plan if it goes into effect after 3200 becomes law. Number 2 is good as well, though of course it says nothing about changing rates and premiums before Day 1 of Y1. Number three is also good. Means they can't charge more for you just because you're diagnosed with some sort of disease.
On page 17 there's some discussion of a grace period. This section states that employers have five years to bring their health plans up to par.
8 (b) GRACE PERIOD FOR CURRENT EMPLOYMENT
9 BASED HEALTH PLANS.—
10 (1) GRACE PERIOD.—
11 (A) IN GENERAL.—The Commissioner
12 shall establish a grace period whereby, for plan
13 years beginning after the end of the 5-year pe
14 riod beginning with Y1, an employment-based
15 health plan in operation as of the day before
16 the first day of Y1 must meet the same require
17 ments as apply to a qualified health benefits
18 plan under section 101, including the essential
19 benefit package requirement under section 121.
However, we have this language, from page 18, which seems to invalidate the grace period.
13 In no case shall an employment-based health
14 plan in which the coverage consists only of one
15 or more of the coverage or benefits described in
16 clauses (i) through (iii) be treated as acceptable
17 coverage under this division
Page 19 tells us that individual insurance after D1 Y1 can only be purchased through the exchange. Page 19 also gives us one of the most important parts of this bill. This alone will help hundreds of thousands of people get coverage that they need.
20 A qualified health benefits plan may not impose any
21 pre-existing condition exclusion
Page 20 tells us that this applies to individual insurance, group insurance, and employee offered insurance, no matter how it's offered. (Private insurance, employer, public exchange)
Recissions are also prohibited except for fraud, which isn't clearly defined. Granted you can't make it all black and white but this needs tightening up.
Page 21 talks about costs of premiums. Premiums can't vary within plans except for a few cases.
- By age groups (set by the Commmissioner), but the ratio of the highest premium to the lowest can't be more than 2 to 1
- By area.
- By family enrollment. Within the same rate plan you can charge a family of four more than a family of two.
Page 22 calls for a study to be conducted by the Commissioner to exam the various groups. 18 months after D1 Y1 the Commissioner shall report to Congress any recommendations and changes to increase coverage. This is a good thing, as we need to be able to adjust rates and plans if needed.
Page 23 calls for non-discrimination in benefits for mental health and benefits. This is also good as many plans deny coverage or delay coverage for those suffering from substance abuse or mental issues.
Page 24 requires health insurance plans that use a provider network to meet the standards set by the Commissioner. A qualified plan has to meet a medical loss ratio as defined by the Commissioner. That's a term that I hadn't heard before, but basically it's the ratio of money from premiums that actually goes towards medical services instead of other things (i.e. CEO bonuses and 400% profits for health insurance companies). If the goal is to drive down costs I imagine that this will have to be a fairly low ratio.
This takes us to page 25, which I think is a good stopping point for our first foray.
A couple of worrisome things. The Commissioner has a great deal of power. How long are they appointed for? Who appoints them. Does the Commisioner fall under the jurisdiction of the Secretary of Health and Human Services? Are they appointed by the President? Will there be a committee in Congress that reviews the decisions made by the Commissioner?
I also think that the fraud issue really needs to be cleared up. Recission is a pernicious practice and unless fraud rules are clearly outlined insurance companies will try and claim anything as fraud.
The grace period issue needs to be addressed as well. If you're employed with health care that's not being met by your employer, what are you going to do for five years?
Any further clarifications would be most welcome as I'm certainly not an expert.
Some useful resources:
Factcheck for a balanced look at the bill.
Petition to House Members to not waffle on the public option
Take the Pledge
ActBlue contribution page for those who took the pledge
ActBlue
FDL blog. Lots more useful information as well as a town hall tracker
FireDogLake
Democracy For America
House of Representatives Contact List. Find your Rep and let them know how you feel. If someone else does something you approve of let them know.
House Member List
Senators Contact List
Senate List
Let President Obama know what you think
Whitehouse.gov