Originally posted by Nightflyer28
reply to post by redhatty
Gee, what a surprise. The most paranoid interpretations of the bill being passed around like a giant bong at a Grateful Dead concert.
Howzabout we have the democratic response, now.... And no, I didn't write it, but I sure read it.
Or, if you don't want to link all the way over there, I've set up a new thread instead of sticking it all at the tail end of this one.
What's REALLY in the bill vs what chain-emails SAY is in it
[edit on 8/13/2009 by Nightflyer28]
Originally posted by Jenna
reply to post by Nightflyer28
I guess I'm a bit confused why you started a brand new thread saying basically the exact same things we've already said when we went through it all here.
Originally posted by redhatty
reply to post by Nightflyer28
Nightflyer28, you really should make sure you attribute all that other author's work in your thread. Plagiarism is very much against T&C of ATS.
Please take the time to actually read this thread & see all the work that has been done, with actual quotes of the bill as much as was possible.
Originally posted by Nightflyer28
I'll do that, thanks.
Incidentally, what's your take on the points made in the forum? I just started looking through the points you made here, and you seem to have taken a fairly close look at it.
Have you guys ever thought that Congress may intentionally leave ambiguous language or gaps in the bill to get the legislation passed, only to later come back and pass smaller bills to fill in the gaps?
While I agree low income folks need health care too, simply making hospitals and public clinics "not for profit" would allow much more flexibility for sliding scale payment schedules for those who don't have/qualify for medicaid.
I accepted Medicaid for about 2 months of my practice. Even thought the reimbursement was substantially lower than my stingiest insurance, I figured it would allow me to treat kids that needed it and at least cover my staff costs. How wrong I was. They denied procedures all the time, delayed billing ( I didn’t get paid for up to 8 months post-op) and were a pain in the ass generally. The support was rude and clueless. Now insurance companies suck too, but Medicaid was like dealing with Nazi nurse Wratched. So I dropped out and now just see poor kids for free. No way in the world I will ever deal with a Government controlled care system again. Ever.
STUDY.—The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:
(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.
(B) The similarities and differences between typical insured and self-insured health plans.
(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.
(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent.
(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure
SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
(1) IN GENERAL.—There is established a private-public advisor committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
BENEFIT STANDARDS DEFINED.—In this subtitle, the term ‘‘benefit standards’’ means standards respecting—
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).
(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.
(a) DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regalators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.—
The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
EC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE.
(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(b) IMPLEMENTATION.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.
‘‘(D) enable the real-time (or near realtime) 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;