What's really in HR 3200. Can you cite verse and chapter like the best of our Congresscritters can, or do you rely on the summaries and talking points generated by others?
If you want to know what the bill actually says (instead of what a talking head claims it says), follow me below the fold as we discuss the ins and outs of HR 3200.
This is part of an ongoing series on the text of HR 3200.
Part 1
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 25. Under the direction of Health and Human Services the Commissioner will develop rules to determine the best loss ratio.
Page 26. Exchange participating plans must offer a bare amount of coverage. The act is not meant to affect excepted benefits, which are ERISA, which itself is codified in Title 29 section 1191b.
(3) Benefits not subject to requirements if offered as
independent, noncoordinated benefits
(A) Coverage only for a specified disease or illness.
(The definition of excepted referred me to a different section in the bill, which then referred me to the ERISA, which then referred me to Title 29 of the US code--no wonder nobody knows what's going on).
Page 26 also states that no health plan can't impose any restriction (other than the co-pay or deductible) on any services that your doctor might choose to have you do.
Page 27 gets us into the essential benefits packages.
- Must provide payments according to generally accepted standards
- Limit cost-sharing (Cost-sharing is the moneys that the patient has to come up with for any treatment).
- Does not impose lifetime or annual limits
- Has adequate network coverage
Page 28. Covers the minimum services.
- Hospitalization
- Outpatient hospital and clinical (including emergency rooms)
- Dr visits to physicians and other health professionals (what exactly does this mean? Chiropractors? Some insurance plans cover acupuncturists--will this? More info is needed on that I think)
- Medical equipment and supplies
- Medicine
- Rehabilative services (this is a big one--physical therapy is expensive)
- Mental health (another big one--lots of current plans don't cover mental health issues)
- Preventetive services
- Maternity care
- Children care. Includes oral, health, vision, hearing and associated equipment (braces, glasses, etc.) until the child is 21.
We're taking care of our kids with this one. No child will have to suffer because their parents can't afford to take them to the doctor.
23 (1) NO COST-SHARING FOR PREVENTIVE SERV
24 ICES.—There shall be no cost-sharing under the es
25 sential benefits package for preventive items and
1 services (as specified under the benefit standards),
2 including well baby and well child care.
Pg 29 talks about maximum out of pocket expenses each year. This will be adjusted each year based on the Consumer Price Index.
9 (B) APPLICABLE LEVEL.—The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con
15 sumer Price Index (United States city average)
16 applicable to such year.
The cost-sharing levels will be determined, as much as possible anyway, by the actual copayments, not any co-insurance that you might have.
Page 30 (and bottom of page 29)
22 (3) MINIMUM ACTUARIAL VALUE.—
23 (A) IN GENERAL.—The cost-sharing under
24 the essential benefits package shall be designed
25 to provide a level of coverage that is designed
1 to provide benefits that are actuarially equiva
2 lent to approximately 70 percent of the full ac
3 tuarial value of the benefits provided under the
4 reference benefits package described in sub
5 paragraph (B).
My eyes glazed over there--can someone interpret for me? I think this is saying that the cost-sharing measures are designed to cover up to 70% of the actual costs of the program, with the remainder to come from elsewhere (presumably the money set aside for the financing of the program).
I'm quite possibly wrong, as I'm not actually an actuary--I just play one on the internet.
Pages 30-32 establish a Health Benefits Advisory Board, which is a panel of various experts in the field. Their job is to recommend benefits and design the plan levels (essential, enhanced, and premium). This is a good thing--better to have doctors and health professionals doing this than bureaucrats of any stripe. The membership of the Board is as follows:
- The Surgeon General
- 9 members who are not Federal employees or officers and are appointed by the President
- 9 members who are appointed by the Comptroller General (and chosen in the same manner as they are for the Medicare Payment Advisory Committee)
- An even number of members (not more than 8) who are Federal employees and/or officers. Chosen by the President
The Board will convene 60 days after passage of the Act. Each one will serve a term of 3 years, but the terms will be staggered so that you don't have a new board being replaced every 3 years. The goal is to have the Board reflect a wide swath of the industry--providers, patients, doctors, hospitals, insurance reps (yes, that's specifically included), etc., so that one sector doesn't have undue influence.
The board will recommend and update benefit standards, and will have the first recommendations turned in within one year of the passage of HR 3200.
Page 33 describes the levels of plans available. The enhanced plan will have an actuarial (there's that word again!) value of 85%, the premium an actuarial level of 95%.
Page 34 The Board shall receive a Per Diem, as well as travel expenses, but otherwise will not be paid. Membership on the Board does not make you a Federal employee. Any recommendations from the Board will be published in the Federal Register and on the HHS website.
Page 35 Within 45 days after the Board delivers its recommendations the Secretary (of HHS I assume?) will review them and decide which ones to implement.
Page 36. Not later than 18 months from the passage the Secretary will adopt an initial set of benefit standars.
Page 37. Here we start getting into some consumer protections. Any QHBP (Qualified Health Benefit Plan) will have to set up an appeals process based on rules set up by the Commissioner.
Pg 38. The Commissioner will set up an external review process. Any decision made by the review process is binding, other than through the courts.
Pg 39. Plan information needs to be delivered in a timely manner and in "plain language" (that's the exact quote from the bill). I find that highly ironic that the bill has an entire section relating to plain language. The reimbursement process is also to be simplified. All qualified health plans need to follow the same reimbursement procedures (to be determined by the Commissioner)
Pg 40. Any changes in a health plan must be communicated in a timely and reasonable manner. For those with multiple plans the Commissioner will set up rules to coordinate benefits and payments.
Any Medicare experts here? I've got no idea what this entails.
13 A QHBP offering entity shall comply with the re14
quirements of section 1857(f) of the Social Security Act
15 with respect to a qualified health benefits plan it offers
16 in the same manner an Medicare Advantage organization
17 is required to comply with such requirements with respect
18 to a Medicare Advantage plan it offers under part C of
19 Medicare.
Pg 41. Here's where we find out that the government will take the money from your checking account. (Really the bill just states that qualified plans must follow legal procedures for electronic fund transfers.) Pg 41 also establishes a "Health Choices Administration" as a separate government entity headed by The Commissioner (a pretty powerful post looks like).
Pages 42-49 list the duties of the Commissioner, which include:
- Establishing qualified plan standards
- Operating the Health Exchange
- The administration of Affordability Credits.
- Any additional functions that come up
- Regulate health plans from both inside and outside the exchange.
- Conduct audits in coordination with the States (the costs of the audits to be borne by the plans themselves).
- Data collection to be used for review.
- Levy sanctions. This to be done in conjunction with the state insurance regulators, the Secretary of Labor and any other appropriate agency. These sanctions include fines, suspension of enrollment in that plan (presumably to be enrolled into a different plan) until the Commissioner decides otherwise, suspension of payment to exchange plans, and (in conjunction with the State regulators) possible termination of plans that are repeat violators.
- Develop standard definitions of insurance and medical terms.
- Issue orders to make the administration of the plan as efficient as possible.
Page 46
The Commissioner shall consult with at least the following groups/people.
- National Association of Insurance Commissioners
- Sate attorneys general
- State insurance regulators
- Appropriate state agencies for reimbursement of affordability credits
- Other Federal agencies as needed.
- Indian tribes and tribal organizations
Page 47.
The Commissioner will work as closely as possible with Federal and State agencies. The Commissioner is responsible for setting uniform standards across the country. The Commissioner will appoint an Ombudsman from the health care field.
Page 48. The Ombudsman will handle complaints and information requests, provide assistance for those complaints, help individuals appeal decisions, help individuals choose an appropriate plan, help with any disputes regarding affordability credits, submit reports to Congress regarding his activities. This report is not designed to be a platform to fix any problems regarding plan benefits or rate compensation.
Pg 49. If your insurance is not offered through the exchange, or it comes from your employer, these requirements do not supersede the EIRSA
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