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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.
(a) ESTABLISHMENT.—
(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.
(b) DUTIES.—
(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;
Originally posted by Animal
The blog publication titled Shock: Inside the Obama Healthcare Bill written by Robert Wenzel and published at his blog Economic Policy Journal has been making its rounds here on ATS and other sites. It is presented as a critique of the horrors contained in this bill and members of ATS such as WhatTheory in this post claim to have researched the claims made by Mr. Wenzel.
Sadly, upon under taking my own research into the claims made by Mr. Wenzel I have found errors in comprehending the language of the bill and outright lies and misrepresentations of what the bill contains.
This really is not THAT big of a surprise as lies and spin seem to be the main attack against the bill known as HR3200.
What I would like this thread to be is a place where sane minded individuals go through this document, look at the claim made, go to the section or page number presented by Mr. Wenzel and either verify or contest the statement he made in his post.
I am asking for help with this because there are HUNDREDS of claims. None are backed up by anything but section #s or page #s from HR3200. They are easily verified or contested. The following are the first 6 claims made by Mr. Wenzel and contested by me:
“Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!”
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
No where is a mention of an audit. That is purely alarmist propaganda.
I have underlined the particular phrase in question. I do believe that when you examine a companies financial solvency, you are indeed auditing them. You are opening and scrutinizing that companies financial records which is indeed an audit.
Originally posted by ohioriver
I do believe you missed this little provision:::
20 (d) SPECIAL DUTIES RELATED TO MEDICAID AND
21 CHIP.—
22 (1) COVERAGE FOR CERTAIN NEWBORNS.—
23 (A) IN GENERAL.—
In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed— (i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and (ii) to have elected to enroll in Medicaid through the application of paragraph (3).