House Health Care Bill Contains Language About Rationing

I'm currently reading the health care bill Pelosi unveiled last week and just stumbled on this little gem on pages 25-26.

House health care bill
(h) FUNDING; TERMINATION OF AUTHORITY.—
(1) IN GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.

(2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

The section this comes from is about high-risk pools which is for people who have pre-existing conditions and have been denied coverage or offered coverage with higher premiums and/or limitations on coverage for their pre-existing condition. This is talking about rationing care for those people if the expenses of all them go over the amount they've set aside to pay those claims. Isn't that what all the supporters keep saying isn't going to happen? It's right there in black and white that they will ration care if they run out of funds and that's just for those with pre-existing conditions. Makes me worry about what else I'm going to find in this 1990 page monstrosity.

[edit on 1-11-2009 by Jenna]

Did you ever think about the Insurance Companies that deny you the service and totally reject your bills. Isn't it considered rationing. This is happening more often than I can expect from the Government doing it. UPS is a great example. you shut it down today, over night the private postal companies will raise their prices to more than double. If you don't have any experience, please don't just post things to misguide people.

could you cite the proposed Bill makeup of this 'High Risk Pool'

your wording in your OP suggests these high-risks are just pre-existing conditions...

would High-Risk be people that have afflictions like kidney or liver diseases?
lung cancers, breast cancers, prostrate cancers ?




one could call the 'limited' use of radical surgery for this multitude of individuals a form of 'rationing'
~or~
it could be rationalized as 'Triage', i.e. taking the worst-first
but not enough to tax the health system beyond its means.

bottom line-- it's just not possible to fix-correct-cure all those unfortunates in a single year.
Any program can only do so much in a positive/productive way,
otherwise the program will be destined to fail 100% of everyone !

thanks,

[edit on 1-11-2009 by St Udio]

reply to post by St Udio


According to the bill:

(c) ELIGIBILITY.—For purposes of this section, the term ‘‘eligible individual’’ means an individual—
(1) who—
(A) is not eligible for—
(i) benefits under title XVIII, XIX, or XXI of the Social Security Act; or
(ii) coverage under an employment based health plan (not including coverage under a COBRA continuation provision, as defined in section 107(d)(1)); and
(B) who—
(i) is an eligible individual under section 2741(b) of the Public Health Service Act; or
(ii) is medically eligible for the program by virtue of being an individual described in subsection (d) at any time during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section;
(2) who is the spouse or dependent of an individual who is described in paragraph (1); or
(3) who has not had health insurance coverage or coverage under an employment-based health plan for at least the 6-month period immediately preceding the date of the individual’s application for high-risk pool coverage under this section.

And here's the aforementioned subsection (d):

(d) MEDICALLY ELIGIBLE REQUIREMENTS.—For purposes of subsection (c)(1)(B)(ii), an individual described in this subsection is an individual—
(1) who, during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section applied for individual health insurance coverage and—
(A) was denied such coverage because of a preexisting condition or health status; or
(B) was offered such coverage—
(i) under terms that limit the coverage for such a preexisting condition; or
(ii) at a premium rate that is above the premium rate for high risk pool coverage under this section; or
(2) who has an eligible medical condition as defined by the Secretary.

The bill doesn't list individual afflictions or diseases that would be considered high-risk. I mentioned pre-existing conditions in the OP because that is specifically mentioned in the bill and covers quite a lot of things.

reply to post by charlie0


So posting the text of the bill is misleading people? I knew something like that would get tossed out there eventually.

reply to post by Jenna


Hey Jenna I read that part now. I agree, it is rationing in the rare case that the high risk pool requires more support although I doubt "high risk" will be as common as to need the above. It doesnt matter what system of healthcare you have, whether it is private or public, there will be some part of it that will in a way support rationing in some circumstance. It is inevitable. Although this part of the bill isnt the type of "rationing" they do with every patient, its only on those certain rare cases.

The private health insurance corporations already ration healthcare on a daily basis with regular patients who have low risk conditions often enough. I dont understand why people accuse almost anything in this healthcare bill as rationing but then demand that their own rationed corporate healthcare be left alone.

reply to post by Southern Guardian


I'm highly dissatisfied with my own health care, so I'm not advocating that mine be left alone. On the contrary I'd love for it to be fixed. My point with the OP was that supporters are always saying there isn't rationing in the health care bills when it very clearly is.