Accidental Blogger

A general interest blog

Recent posts

about

Health Care Reform -the Cliffs Notes Edition (Sujatha)

The bill passed yesterday that Pres.Obama was ecstatic enough to personally email me about it at 1:03 am. And here I thought that only Hillary Clinton got 3 am calls.
Here is the  section by section summary link  of the HR 3962, the Affordable Health Care For America Act

All's  well and good,even with a restrictive clause on abortion funding in order to get the conservative Blue Dog Democrats to not derail the bill. But little things niggle.
Such as errors in the statement of intent to ensure that insurance companies will be required to pay out at least 85% of the plan money towards treatment of the enrollee.

"Sec. 102. Ensuring value and lower premiums. Amends the Public Health Service Act to require health
insurance issuers in the small and large group market to meet a medical loss ratio of not less than 85%, effective for plan years beginning January 1, 2010. Directs the Secretary to require that plans in the individual market also meet a medical loss ratio of not less than 85% so long as it does not destabilize the existing individual market. If plans exceed that limit, rebates to enrollees are required. In determining the methodology for the medical loss ratio, the Secretary is to design it to ensure adequate participation by issuers, competition in the market, and value for consumers."

A better summary  would have said "If plans do not meet the minimum medical loss ratio, rebates to enrollees are required." This is a section summary, so one would have to read the actual bill for the specific language, which I haven't.

But there is a whole box of goodies, most of which take effect on Jan 1, 2010. No more pre-existing condition based denials, no more rescission, no lifetime caps, immediate provision for a large group of high-risk uninsured till the proposed Health Insurance Exchange (aka Public Option, if I'm not mistaken) comes into existence, etc., etc.

In the spirit of not lettling the perfect be the enemy of the good, we have a bill, warts and all, passed in the House of Representatives. The next milestone will be the Senate Health Care bill and debate- the next blockbuster thriller.
Stay tuned for the epic battle 'Duel in the Sun', starring  Harry Reid, Joe Lieberman, Olympia Snowe, Evan Bayh et al.
(Teaser: Will Bayh block debate, even though he said he wouldn't? Will the GOP and Joe Liarman succeed in thwarting the efforts of Harry Reid  to get the bill out the door? Will it Snowe or won't it?)

Other Links:

Generate a side-by-side comparison of all the different flavors of Health Care Reform proposals.

Ezra Klein's summary of How the Big Bad Insurance Companies work.

Wendell Potter, ex-CIGNA executive's testimony to Congress regarding health insurance company practices.

Posted in ,

18 responses to “Health Care Reform -the Cliffs Notes Edition (Sujatha)”

  1. Ruchira

    Good Cliff notes, Sujatha.
    The bill has passed (squeaked by in the teeth of opposition) and some of the reforms are supposed to go into effect starting next year. I wonder if public support will increase when health reform becomes the law. Or will the tea-partiers refuse to give up? Also, if the new health care / insurance policies begin to show benefit for consumers and Americans appear to like the changes, I am wondering if those loud voices who are opposing them now, calling the overhaul Obama-Care and the Pelosi-Plan, will scramble to get on the band wagon and even try to claim credit.
    But as you said, all that is moot until the “Duel in the Sun” starts playing in the senate chambers. We may be in for a nasty trick ending!

    Like

    Reply
  2. Sujatha

    This isn’t the final final bill- that’s what comes out of the blender after the House and the Senate bill (keep fingers crossed on that passing!) are reconciled in ‘conference’. A curious side note (or not), Dennis Kucinich voted NAY on this bill, since he thinks better no bill than a bad one that doesn’t usher in single-payer.

    Like

    Reply
  3. Ruchira

    Yeah, I know that. Sudhir and I were wondering if we had heard correctly when Kucinich cast his vote. But he is a purist so perhaps it is not so surprising.
    I hope the senate Democrats don’t dilute the bill too much. Particularly I don’t wish to see them letting insurance companies off the hook at the behest of Aetna Lieberman and the the Blue Dogs.
    The testimony of Wendell Potter (Ezra says he has a name like a character in a Frank Capra movie. I think he sounds (and acts) more like someone out of a Sinclair Lewis novel) is a bombshell and leaves nothing to the imagination. Every news show should interview him in prime time. So far I have only seen him appear on MSNBC.

    Like

    Reply
  4. Joe

    As much as I generally want liberals to actually stand up for liberal principles, I don’t respect Kucinich’s vote here. Yes, single-payer would be nice, and would be a major and important improvement. But anything requiring insurers not to deny coverage for pre-existing conditions alone is a hugely important reform that will affect the lives of a lot of people, and you can’t just ignore those people because whatever reform we might get isn’t ideologically pure enough.

    Like

    Reply
  5. narayan

    I turned 65 yesterday. I became eligible for Medicare on Nov 1. I applied for a Medicare Advantage plan through Aetna on Oct 20. I got screwed by Aetna on Oct 30, two days before my policy went into effect. All I can say is, “Wait till you turn 65!” Can socialism be worse?

    Like

    Reply
  6. Sujatha

    ” I got screwed by Aetna on Oct 30, two days before my policy went into effect.”- Would you care to elaborate, Narayan? What happened with the transition to the Medicare Advantage plan?

    Like

    Reply
  7. Ruchira

    Happy belated birthday, Narayan. Aetna or no Aetna, you are now officially entitled to public health care. Hopefully, your experience with Medicare will be smoother than it was with private insurance.
    I agree with Joe. I didn’t much care for Kucinich’s “stand up for principles” histrionics either. This legislation needs all the help it can.

    Like

    Reply
  8. prasad

    Thanks for the notes Sujatha! Speaking for myself, I neither understand nor hope to what precisely the Republicans (over and above individual congressmen posturing for their reelection) get out of anything short of scuttling the process entirely. It seems like once healthcare reform plans – even very anemic ones – pass the long-term trajectory is for more expansive coverage, not less.
    In which context, I think it’s a quite under-appreciated wisdom in Obama that he’s been willing to make all sorts of compromises (eg on public option) to pass the thing. The trick is to pass something, then status quo and the weight of precedent will be on the side of humane health-care. Also, no incremental expansions in the future will have to contend against numbers like 1.5 trillion dollars.

    Like

    Reply
  9. Dean C. Rowan

    With a sigh, Brian Leiter points out this lament. Obama “and his rascal Chief of Staff Rahm Emanuel could have prevented the substandard health care ‘reform’ bill it looks like we are going to get. They didn’t want to prevent it. I think they like it. For us, it’s an open question whether it’s better than nothing at this point.” Damn straight.

    Like

    Reply
  10. Ruchira

    Thanks Dean, for posting that link. I went there from Leiter an hour ago and found myself agreeing with much of what has been said.
    There are now two camps of Democrats – 1) those like my husband, Sujatha and Anna Quindlen who are patient with Obama making incremental changes to the “business as usual” style of governing and 2) those like me, Leiter and the Revere docs who want him to kick butt… right now!
    Rahm Emanuel has been a suspect in my eyes from day one. He is ruthless but not on the right issues. The kind of no-nonsense spokesperson and advisor I would have liked Obama to go to in the matter of health care reform is Dr. Howard Dean. But he is a persona non grata in the spineless Democratic Party.

    Like

    Reply
  11. narayan

    Elaborately, since Sujatha asked – my problem with Aetna (names and setting changed to protect the guilty)
    Imagine …
    You are at the Etna Benz-Yugo dealership. Despite all the careful research you have done you fall for the blandishments of Larry Lizzard, salesman of the year for three years in a row, and sign up for the 2010 Merc SPQR9-Bute – subject to loan approval. Says Larry, “Let me go talk to my manager. I’ll get you a good deal.”
    At home that night you make the announcement to your significant other whose reaction is, “Are you nuts? Get back there and cancel your order. No more conjugality till then!!”
    Early the very next day you are in Lizzard’s cubicle. “Look, for personal reasons I’d rather go with the Yugo Kero-06 in the back lot.” “Nooo problemo!”, says Larry with a worldly-wise smirk, “Let me go talk to my manager”. The Muzak kicks in and you see arms flailing and spittle flying in the manager’s hermetically glassed-in office. “Here’s the deal”, says Larry. “We’ve already sent the loan application to our bank; why don’t we wait to hear from them, and then we’ll change the papers to your satisfaction. Here at Etna Benz-Yugo the customer is always right.”
    Monday, a week later, conjugal rights restored, you are back at Etna Benz-Yugo with the bank’s letter of approval of a loan of $89999.95 from Murphy’s Bank and Trust (WHERE THE CUSTOMER IS OUR FIRST PRIORITY), which came in Saturday’s mail, too late to talk to the bank. Larry is nowhere in sight, so you make your case with Betsy Hazzard, prime contender for this years award. She nods her head for the five minutes it takes to hear you out. “Nooo problemo!”, says Betsy, “Let me go talk to my manager”. Muzak plays. Arms flail. Spittle flies. “Here’s the deal”, says Betsy. “My manager says that the bank cannot change the terms of the loan till the beginning of the month – their rules, not ours. Here at Etna Benz-Yugo the customer is always right! You take delivery of the Yugo, then come the first of the month we’ll put in a revised application for a loan of $9999.95. Once that is approved, your payments will be adjusted – starting the first of the year.” “I know,” she says, eyes rolling, “their rules, not ours.”
    You are aghast. “What? You mean I’ll be driving a Yugo and paying for a Merc till the end of the year?” “Is that a problem for you?” says Betsy. “Let me go talk to my manager.” Muzak, arms, etc. “Here’s what we’ll do. Fill out this application for a refund of all overpayments till the end of the year – one copy to us, two to the bank, and five notarized copies with a detailed letter to the Grievance Resolution Officer of the Commonwealth of Taxxylvania, Bureau of Protection Against Sleazy Commerce and Laws (BPASCAL). You better get started soon – there’s a deadline for this paperwork, no more than ten days after the start of the problem – umm, let me see, that was last Tuesday. Mind you, the state needs sixty days to process your application, so you’re looking at February or March – at worst. But not to worry, everything will be retroactive till today – IF they approve.” There is the obligatory shrug and a doleful look of commiseration. “What can I say? Here at Etna Benz-Yugo the customer is always right. The grievance stuff – I know – that’s just how things work, no red tape at our end. Look, if this is too much of a hassle, why don’t you stick with your original choice. All our customers say that the SPQR-9 Bute is the better car, and as you know, the customer is never wrong”.
    “What if I cancel the whole deal?” you say.
    “That’s your decision of course. But I’d be careful about that. The bank has sent you its first notice of payment already – you know how nasty they can get with late fees, penalties and all.”
    Key words : Consumer rights, Customer wrongs, Kafka, Capitalism, Sleazy, Third World are Us, Cash flow generation, Red Tape, The other guy’s fault, Statute of limitations, Deadlines, Deathlines
    Only in America can you be stuck with paying for something BEFORE you decide NOT to buy it, or else they’ll sod your credit rating. My advice is : don’t lose your job, don’t get sick, don’t get pregnant, and above all, don’t grow old, better still, try not to be born. And if you want the H1N1 vaccine, it is available immediately and free with the purchase of a zero-return $250,000 annuity with Citi Bank – or is that Smythe-Blarney? Where the customer gets the first shot, at any rate.

    Like

    Reply
  12. Dean C. Rowan

    “My advice is…try not to be born.” And I bet nobody’s insurance covers a procedure like retroactive self-inflicted abortion.

    Like

    Reply
  13. Ruchira

    Narayan,
    You made my day. Happy Birthday, again!
    (Should we forward this to the Obama-Pelosi-Emanuel Health Care Inc?)

    Like

    Reply
  14. Ruchira

    And I bet nobody’s insurance covers a procedure like retroactive self-inflicted abortion.
    It would, if you were able to buy insurance, pay the premiums, make no claims and THEN opted for the procedure somewhat along the lines of the premise of this novel by Jack Finney.

    Like

    Reply
  15. Sujatha

    How divine, Narayan! Errr… Ghastly situation, divine writing, I meant. Might I email the whole sad tale to whitehouse.gov for what a mockery is being made of Medicare Advantage plans by Aetna? They might be able to sneak in a single-payer override on the Senate Bill (one can always dream…)
    Ruchira, I’ve changed my mind about Kucinich’s vote. He was likely right about what the insurance companies have in store for us. Maybe the Senate killing this bill wouldn’t be a bad idea, if only it didn’t take another 50 years for something to happen about Health Care Reform in the Congress.

    Like

    Reply
  16. Ruchira

    Sujatha: That then will be a different movie in the senate.
    And yes, it will be a long time before another Congress and White House will come together to tackle health care. And Obama can kiss a second term goodbye.

    Like

    Reply
  17. narayan

    Ruchira & Sujatha :
    Please do! I am not plugged into political channels and can use the official exposure and whatever heavy armament that might accrue. (I bear scars from having reached out to a White House appointed Indian mucky-muck twenty years ago. At the time I got the feeling that I wasn’t rich enough, or Republican enough, or Malayali enough to merit intervention.)
    An hour after I got off the phone with the idiots at Aetna I was in the local office of the Council on Aging (or some such derogatory name). The lady I saw mistook me for an aging furriner, for someone with an appointment, and heard me out. She told me that Aetna was following guvmint rules, that she would help me with the grievance procedure in time, warned me not to dump Aetna, and said it would take me at least ten days to get an appointment to see anyone at that office. What a bunch of wimps! These people call themselves advocates and can’t see the Kafka for the rules they’ve learnt by rote. I anticipate more patronizing explanations of the way things are done in the US of A.

    Like

    Reply
  18. Sujatha

    Done, Narayan. Let’s see if a response (non-automated) arrives. I cut and pasted the main part of your experience in a letter at the WH website.

    Like

    Reply

Leave a reply to prasad Cancel reply