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If Congress Won't Read It, I Will

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I decided last week that I am going to read the entire proposed health care bill, HR 3200, also known as America’s Affordable Health Choices Act of 2009. It has been hotly debated lately on a national level, and I wanted to know firsthand what was contained therein that could inspire such passion on both sides.

I have never been one to allow others to form my opinions for me, and I have a feeling that this particular topic is one that will be discussed for some time. I want to be able to speak knowledgably about this issue. There is no better place to garner this information than directly from the source itself.

My guess is that it will take me a few weeks to work my way through the bill, since it is essentially 1100 pages of legalese. That being said, I am committed to finishing this quest. I do know that this is not the final version, as it must progress through committees before getting to any vote. That being said, there is so much discussion about this that I wanted to learn as much as I could.

I am presently neither in favor of this bill nor am I fully opposed to it, although that will probably change as I read further. I intend to do my best to present the facts in a neutral manner.

A LITTLE ABOUT ME: Before I start, I thought it would be a good idea to give you some background information about myself. I am a Christian homeschooling father of four, and I am generally conservative in my political beliefs. That being said, I am also one of the many millions of people with a pre-existing condition that makes it impossible for me to get normal individual insurance coverage. Hence, we pay about $1300/month for insurance, since I am self-employed. Additionally, my wife and I paid approximately $30,000 to give birth to our last two children, and those were natural childbirths (i.e. no epidural, etc.). Clearly, I am in favor of anything that will reduce our health care costs, as long as it makes sense. As you can see, my opinions probably don’t line up with either side at this point. I am not an attorney – I’m just a regular guy who is interested in seeing what is proposed.

I can’t really apologize for the fact that this post is over 2,000 words long – the source document is huge, after all.

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I finished reading the first large section (Title I) a few days ago. Here are my notes and observations for that portion:

MOST POTENTIALLY CONTROVERSIAL TABLE OF CONTENTS SECTIONS:
My reading of the table of contents revealed the following sections that seem ripe for political disagreements. We will return to review these as I work my way through the bill.

Sec. 246. No Federal payment for undocumented aliens.

Sec. 401. Tax on individuals without acceptable health care coverage.

Sec. 441. Surcharge on high income individuals.

SOMETHING I LEARNED

I learned via my research that an insurance company’s “medical loss ratio” is the percentage of premiums actually used to pay for medical services. The Act calls for the highest-possible ratio. If plans don’t meet this, they must rebate any overage to their enrollees. While I suppose it seems appealing to get a dividend of sorts from my insurance company, this feature also seems to inhibit companies from being profitable.

OTHER NOTES FROM TITLE I

SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS. This is the first section that I liked, at least in principle. In a nutshell, this section states that “A qualified health benefits plan may not impose any pre-existing condition exclusion…”. Clearly, I like this, since I haven’t been able to get “real” insurance since 1993.

Sec. 113, (a) (1) – Limited age variation permitted – no more than a 2:1 ratio. This means that they can’t charge anyone more than double what the lowest rates are. Admittedly, this seems more fair than the present rules would indicate, although I am pretty sure that the Texas Health Insurance Risk Pool (my insurance) has the same limit in place.

SEC. 121. COVERAGE OF ESSENTIAL BENEFITS PACKAGE.

(c) No Restrictions on Coverage Unrelated to Clinical Appropriateness- A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.

MY NOTE: Since this would tend to indicate that the public health option cannot restrict care unless there is a medical reason to do so (and I welcome other interpretations here), it seems to me that this particular section could cause a lot of problems and arguments. Why? Well, simply put, most abortions would be covered, if I am reading this correctly. I am personally pro-life, but I have discussed this with a couple of pro-choice friends. Frankly, it seems that none of us want to fund abortions via our tax dollars.

SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.

Under part (a):

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

MY NOTE: This seems reasonable to me. I know people who have run up against their limit from ONE big illness/hospitalization. I doubt that the average insurance shopper knows to look at this limit in their current policy. To me, having a limit in place for health care is like saying that your home’s hazard insurance will cover you as long as nothing really bad happens, like a fire.

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.

MY NOTE: Again, this seems very reasonable.

Under part (b):

Minimum Services To Be Covered- The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services, including emergency department services.

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

(9) Maternity care.

(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

MY NOTE: I was pleasantly surprised to see maternity care covered under the essential plan. In my own family, this item would have saved us countless thousands of dollars. My wife pointed out that the list didn’t include birth control pills, which I suppose could result in a new baby boom.

SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.

This will automatically includes Surgeon General, and up to 17 people appointed by the President, along with 9 people appointed by the Comptroller General.

MY NOTE: Why is the President (no matter which party) given this much control over this committee? If the President is able to appoint 17 of the 27 members, it seems like an inordinate amount of control. Perhaps this should be spread out a bit more.

SEC. 141. HEALTH CHOICES ADMINISTRATION; HEALTH CHOICES COMMISSIONER.
(a) In General- There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the `Administration’).

NOTE: Is it really necessary to set up an entirely new agency? This seems like the type of thing that could be maintained and subsumed under another department that already exists, such as Health and Human Services, in my opinion.

(2) FLEXIBILITY IN PLAN ENROLLMENT AUTHORIZED- Beginning with Y3, the Commissioner shall establish a process to allow an affordability credit to be used for enrollees in enhanced or premium plans. In the case of an affordable credit eligible individual who enrolls in an enhanced or premium plan, the individual shall be responsible for any difference between the premium for such plan and the affordable credit amount otherwise applicable if the individual had enrolled in a basic plan.

NOTE: I understand the principle at play here, but I don’t understand why the affordability credits can be used to defray the cost of “premium” plans. It would seem more fair to simply provide the basic plan to those who can’t afford it, rather than allowing them to choose the most expensive plan and pay very little for this.

(B) FOR UNAFFORDABLE EMPLOYER COVERAGE- Beginning in Y2, in the case of full-time employees for which the cost of the employee premium for coverage under a group health plan would exceed 11 percent of current family income (determined by the Commissioner on the basis of verifiable documentation and without regard to section 245), paragraph (1) shall not apply.

NOTE: I certainly hope the costs are supremely low if this is the definition that they intend to use. I would love for my own insurance cost to be under 11% of my income. The section also refers to modified adjusted gross income, which would make it an even lower figure. This seems like a low threshold for what constitutes “unaffordable”, but I must admit that this would benefit me directly.

Sec. 1137A. (D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card.

NOTE: This section is actually modifying the Social Security Act, which is why the numbering is different. This could result in some interesting debates with regard to individual privacy. Does this information go to the newly-created Health Choices Administration, or is it simply meant to make payment and approvals faster?

SEC. 164. REINSURANCE PROGRAM FOR RETIREES. (d) Retiree Reserve Trust Fund- (B) FUNDING- There are hereby appropriated to the Trust Fund, out of any moneys in the Treasury not otherwise appropriated, an amount requested by the Secretary as necessary to carry out this section, except that the total of all such amounts requested shall not exceed $10,000,000,000.

NOTE: This section is intended to provide reimbursement for employers who provide health care for their retirees. This particular figure ($10 Billion) seems to have been thrown out without a lot of supporting research for setting the limit there. I would love to see some reference to a study or any documentation on this figure.

Overall, it seems as though the Health Choices Commissioner (new position created by the Act if it is passed) is given a LOT of power to determine things under this bill. This will be a Presidential appointee. In one section, it states that the duties include “ADDITIONAL FUNCTIONS- Such additional functions as may be specified in this division.” Later, the bill gives the Commissioner the power to provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms. This seems like an exceptional amount of power to me to vest in one person.

If you have any questions or want to disagree with me, I welcome that. Just make sure that you bring your documentation. I brought mine, after all.
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TYPOS/MISTAKES

I realize that this version hasn’t been finalized in any way, but I did find a few errors, for what it’s worth. I suppose I included these items just to prove that I am reading every word of this thing:

Subtitle B, Sec. 221, part (a) – should read “compromising”, not “comprimising”

Sec. 114 (b) – the provisions of section 2705 (other than subsections (a)(1), (a)(2), and (c)) of section 2705 of the Public Health Service Act – REPEATED PHRASE

Under Sec. 123 (d) Publication- The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.

In the next section, Sec. 124. (a) (4) Add “and the posting on the Internet website of the Department of Health and Human Services ” to make these sections consistent.

Sec. 154 – SHOULD SAY “or” instead of “of”.

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