APP - Emergency Rooms as Healthcare

PostmodernProphet said:
it's all there in post #289, you can't honestly deny it....
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Retard: There's nothing in this that says private coverage cannot exceed what the government plan offers.

Page 171
21 ‘‘(A) QUALIFIED HEALTH BENEFITS PLAN
22 COVERAGE.—Coverage under a qualified health
23 benefits plan (as defined in section 100(c) of
24 the America’s Affordable Health Choices Act of
25 2009).
1 ‘‘(B) GRANDFATHERED HEALTH INSUR2
ANCE COVERAGE; COVERAGE UNDER GRAND3
FATHERED EMPLOYMENT-BASED HEALTH
4 PLAN.—Coverage under a grandfathered health
5 insurance coverage (as defined in subsection (a)
6 of section 102 of the America’s Affordable
7 Health Choices Act of 2009) or under a current
8 employment-based health plan (within the
9 meaning of subsection (b) of such section).
10 ‘‘(C) MEDICARE.—Coverage under part A
11 of title XVIII of the Social Security Act.
12 ‘‘(D) MEDICAID.—Coverage for medical as13
sistance under title XIX of the Social Security
14 Act.
15 ‘‘(E) MEMBERS OF THE ARMED FORCES
16 AND DEPENDENTS (INCLUDING TRICARE).—
17 Coverage under chapter 55 of title 10, United
18 States Code, including similar coverage fur19
nished under section 1781 of title 38 of such
20 Code.
21 ‘‘(F) VA.—Coverage under the veteran’s
22 health care program under chapter 17 of title
23 38, United States Code, but only if the cov24
erage for the individual involved is determined
25 by the Secretary in coordination with the
8 ‘‘(G) OTHER COVERAGE.—Such other
9 health benefits coverage as the Secretary, in co10
ordination with the Health Choices Commis11
sioner, recognizes for purposes of this sub12
section.
Click to expand...

Nothing in there says anything like what you're saying. All that talks about is grandfathered in plans.
 
Here's what you posted in 236:

Page 15
1 (b) REQUIREMENTS FOR QUALIFIED HEALTH BENE2
FITS PLANS.—On or after the first day of Y1, a health
3 benefits plan shall not be a qualified health benefits plan
4 under this division unless the plan meets the applicable
5 requirements of the following subtitles for the type of plan
6 and plan year involved:
7 (1) Subtitle B (relating to affordable coverage).
8 (2) Subtitle C (relating to essential benefits).
9 (3) Subtitle D (relating to consumer protec
10 tion).

Page 25
15 SEC. 121. COVERAGE OF ESSENTIAL BENEFITS PACKAGE.
16 (a) IN GENERAL.—A qualified health benefits plan
17 shall provide coverage that at least meets the benefit
18 standards adopted under section 124 for the essential ben
19 efits package described in section 122 for the plan year
20 involved


Page 27
19 (b) MINIMUM SERVICES TO BE COVERED.—The
20 items and services described in this subsection are the fol
21 lowing:
22 (1) Hospitalization.
23 (2) Outpatient hospital and outpatient clinic
24 services, including emergency department services.

28
1 (3) Professional services of physicians and other
2 health professionals.
3 (4) Such services, equipment, and supplies inci
4 dent to the services of a physician’s or a health pro
5 fessional’s delivery of care in institutional settings,
6 physician offices, patients’ homes or place of resi
7 dence, or other settings, as appropriate.
8 (5) Prescription drugs.
9 (6) Rehabilitative and habilitative services.
10 (7) Mental health and substance use disorder
11 services.
12 (8) Preventive services, including those services
13 recommended with a grade of A or B by the Task
14 Force on Clinical Preventive Services and those vac
15 cines recommended for use by the Director of the
16 Centers for Disease Control and Prevention.
17 (9) Maternity care.
18 (10) Well baby and well child care and oral
19 health, vision, and hearing services, equipment, and
20 supplies at least for children under 21 years of age.


Page 28
23 (1) NO COST-SHARING FOR PREVENTIVE SERV
24 ICES.—There shall be no cost-sharing under the es
25 sential benefits package for preventive items and

29
1 services (as specified under the benefit standards),
2 including well baby and well child care.
3 (2) ANNUAL LIMITATION.—
4 (A) ANNUAL LIMITATION.—The cost-shar
5 ing incurred under the essential benefits pack
6 age with respect to an individual (or family) for
7 a year does not exceed the applicable level spec
8 ified in subparagraph (B).
9 (B) APPLICABLE LEVEL.—The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con
15 sumer Price Index (United States city average)
16 applicable to such year.
17 (C) USE OF COPAYMENTS.—In establishing
18 cost-sharing levels for basic, enhanced, and pre
19 mium plans under this subsection, the Sec
20 retary shall, to the maximum extent possible,
21 use only copayments and not coinsurance.
22 (3) MINIMUM ACTUARIAL VALUE.—
23 (A) IN GENERAL.—The cost-sharing under
24 the essential benefits package shall be designed
25 to provide a level of coverage that is designed


30
1 to provide benefits that are actuarially equiva2
lent to approximately 70 percent of the full ac3
tuarial value of the benefits provided under the
4 reference benefits package described in sub5
paragraph (B).
Click to expand...

Here's what you left out:

(b) Choice of Coverage-
6
(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
(2) EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of an Exchange-participating health benefits plan, such plan is required under section 203 to provide specified levels of benefits and, in the case of a plan offering a premium-plus level of benefits, provide additional benefits.
(3) CONTINUATION OF OFFERING OF SEPARATE EXCEPTED BENEFITS COVERAGE- Nothing in this division shall be construed as affecting the offering of health benefits in the form of excepted benefits (described in section 102(b)(1)(B)(ii)) if such benefits are offered under a separate policy, contract, or certificate of insurance.
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You left out the entire subsection that says exactly what I've been saying - benefit plans sold outside of the exchange can sell whatever the hell they want. The levels of coverage cover ONLY PLANS SOLD ON THE FUCKING EXCHANGE, you retard.
 
ib1yysguy said:
Retard: There's nothing in this that says private coverage cannot exceed what the government plan offers.



Nothing in there says anything like what you're saying. All that talks about is grandfathered in plans.
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if all it talks about is grandfathered in plans, why is grandfathered in plans only one of seven things listed....as I listed in post #289, if you don't have an approved policy they fine you through the tax code.....an approved policy must be a qualified plan, the requirements for a qualified plan (whether it be the government funded or private funded) are specified....grandfathered plans may not be offered for sale to new customers or modified in any way for the existing customers....there is nothing to offer "exceeding" the government plan....
 
ib1yysguy said:
Here's what you left out:
(b) Choice of Coverage-
6
(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
(2) EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of an Exchange-participating health benefits plan, such plan is required under section 203 to provide specified levels of benefits and, in the case of a plan offering a premium-plus level of benefits, provide additional benefits.
(3) CONTINUATION OF OFFERING OF SEPARATE EXCEPTED BENEFITS COVERAGE- Nothing in this division shall be construed as affecting the offering of health benefits in the form of excepted benefits (described in section 102(b)(1)(B)(ii)) if such benefits are offered under a separate policy, contract, or certificate of insurance.
Click to expand...


You left out the entire subsection that says exactly what I've been saying - benefit plans sold outside of the exchange can sell whatever the hell they want. The levels of coverage cover ONLY PLANS SOLD ON THE FUCKING EXCHANGE, you retard.
Click to expand...

look, that subsection specifically says "such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify".....now to you, that seems to communicate they can sell whatever the hell they want.....to me, it communicates they need to include the essential benefits package....further, depending on how you interpret it, it could be that even the additions are limited to those the QHBP may specify, but certainly they need to offer the essential benefits package specified by the board...

quite frankly, either you are lying or you are an idiot....which is it?.....
 
PostmodernProphet said:
look, that subsection specifically says "such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify".....now to you, that seems to communicate they can sell whatever the hell they want.....to me, it communicates they need to include the essential benefits package....further, depending on how you interpret it, it could be that even the additions are limited to those the QHBP may specify, but certainly they need to offer the essential benefits package specified by the board...

quite frankly, either you are lying or you are an idiot....which is it?.....
Click to expand...

You change your story. I don't think it went unnoticed. This entire time you've been telling us that you'll have no choice but to buy the government plan. Then when you were shown to be a fucking retard, you started saying that the government was making every plan basically the same and they had to sell what the government told them. Then I post language directly from the bill that says all they have to do is meet MINIMUMS (they call it the essential benefits) and they can offer whatever the fuck they want beyond that.

This entire time you've been saying that it isn't talking about minimums. This shows clearly that they require MINIMUM ESSENTIAL BENEFITS and beyond that they can offer whatever level of coverage they fucking want.

You were wrong, wrong wrong. Admit it. You aren't going to be forced to buy the government plan. You will still be able to buy private plans. And the private plans can offer benefits beyond what the government gives you. These are all claims you have made, and they're all false.
 
ib1yysguy said:
You change your story. I don't think it went unnoticed. This entire time you've been telling us that you'll have no choice but to buy the government plan. Then when you were shown to be a fucking retard, you started saying that the government was making every plan basically the same and they had to sell what the government told them. Then I post language directly from the bill that says all they have to do is meet MINIMUMS (they call it the essential benefits) and they can offer whatever the fuck they want beyond that.

This entire time you've been saying that it isn't talking about minimums. This shows clearly that they require MINIMUM ESSENTIAL BENEFITS and beyond that they can offer whatever level of coverage they fucking want.

You were wrong, wrong wrong. Admit it. You aren't going to be forced to buy the government plan. You will still be able to buy private plans. And the private plans can offer benefits beyond what the government gives you. These are all claims you have made, and they're all false.
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I haven't changed anything....if you've been too stupid to understand what I have been saying all along it's your problem, not mine....I've proven you a liar a half dozen times already in this thread alone.....you are nothing more than a partisan hack who has no concern for honesty....I notice you made absolutely no effort to contradict what I said in my preceding post....I will take that as your admission I am correct and you are wrong.....
 
lol

I'll leave it in the capable hands of the other readers. It's pretty obvious to anyone with a brain that your story changes about every 5 minutes.

You got into this with Yurt and you kept saying they weren't taking about minimums. CLEARLY they are talking about minimums. They even say minimums. Not only that, but they explicitly state that private plans can offer more than the minimums, which means whatever bullshit you were pushing about death panels deciding what coverage you get is totally bogus since you can participate or not.

It's a government option. You've said that you'd have to buy the government plan. You don't. You looked retarded. You said all the private plans had to offer the same stuff as the government plans, which would be basically the same as forcing you to buy the government plan. They aren't required to do any such thing. They can offer as much coverage as they want and you can buy it if you don't like the coverage minimums the goverment sets.

You lose. Big time.
 
Fish said:
No, Walmart just has a ton of medicine on a $4/month prescription program. All three of my meds happen to be on the list. I can't believe you haven't heard of this.

Also, if you're near a Publix supermarket: Publix will fill your antibiotic prescription for free (socialism).
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Check the country of origin, usually under the Walmart overlabel, or ask if you're inquisitive.. Most of their generics come from India, some from China. They're approved, but have no fear, they won't go broke at that price for common generics, it's just good business. On brands they're competitive.
 
ib1yysguy said:
You got into this with Yurt and you kept saying they weren't taking about minimums. CLEARLY they are talking about minimums. They even say minimums. .
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your argument is a joke.....so 70%, 85%, and 95% are just the "minimums"?....

and free enterprise gets to play with the 96-99%, so that makes it all right?.....

idiot, how can you even talk about "minimums".....

whatever bullshit you were pushing about death panels
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.....I have never mentioned anything about death panels, let alone "pushed it"....

You've said that you'd have to buy the government plan. You don't.
Click to expand...

if every insurance policy sold has to comply with the requirements the government planned, how else do you describe it....

you answer one simple question successfully and I will call my congressman tomorrow and tell him I have changed my mind...

if the government is intent upon preserving free enterprise in health care, why are we considering a bill that REQUIRES every insurance company to offer everything the government funded policy offers....the same deductible, the same copay structure, the same "essential benefits"?.........

if your answer is simply the plan won't work if we don't, then the proper response is, this is the wrong plan......
 
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ib1yysguy said:
Honest much, Damo?

Private insurance doesn't HAVE to be sold on the exchange. The exchange is the only place where government mandates minimums for coverage.

Okay, proof Damo is a dishonest hack? Damo still can't bring himself to open admit to these very simple facts because they're inconvenient. Just be fucking honest about what's being proposed. If you can't win by arguing about reality, you need to revisit your stance.

The other alternative is that Damo is a fucking dumbass. That's entirely possible. But it's more likely that Damo's just being a dishonest prick.
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Unrealistic, the only place it will be sold is on the exchange because only insurance from the exchange meets their requirement, or self-insuring within the same parameters.

If you buy it from a provider that doesn't meet their requirements you are fined, if they meet the requirements they are on the exchange.

Another alternative is that ib1yysguy just read the blurbs from the democratic defense sites and doesn't realize that the exchange will pretty much be it over a very short period of time.
 
PostmodernProphet said:
your argument is a joke.....so 70%, 85%, and 95% are just the "minimums"?....

and free enterprise gets to play with the 96-99%, so that makes it all right?.....

idiot, how can you even talk about "minimums".....
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The bill doesn't require non-exchange participating plans to cover any specific percentages, or even specific levels of care like basic and premium, etc. That only applies to exchange participating plans. Read below.

PostmodernProphet said:
if every insurance policy sold has to comply with the requirements the government planned, how else do you describe it....
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Every insurance policy sold has to comply with the MINIMUM requirements the government sets. This is called the essential benefits package. Read: For plans not sold on the exchange:

http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:304

(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
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and...

http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:652
SEC. 203. BENEFITS PACKAGE LEVELS.
44
(a) In General- The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.
Click to expand...

It then goes on to describe what the Basic, Enhanced, and Premium and option Premium Plus plans are. But they ONLY QUALIFY TO FUCKING EXCHANGE PARTICIPATING PLANS.

It says right there that the three tier plan offerings only apply to EXCHANGE PARTICIPATING HEALTH BENEFITS PLANS.

So what are the essential benefits that plans outside the exchange will in fact have to adhere to? Essential benefits are laid out in subtitles B, C, and D.

Subtitle B--Standards Guaranteeing Access to Affordable Coverage

These are a bunch of consumer protections.

Subtitle C--Standards Guaranteeing Access to Essential Benefit

Steps they have to take to increase accessibility, which list the various things essential benefits package needs to include like maternity care, prescription drugs, and mental health. This is where the essential benefits are defined.

Subtitle D--Additional Consumer Protection

More consumer protections.

The only thing in there relating to deductibles says that they have to use deductibles and not co-insurance. It doesn't set the rate of deductibles, it doesn't say they have to offer only the minimums described as the ESSENTIAL BENEFITS. It says very specifically they can offer whatever they want as long as they meet the requirements of ESSENTIAL BENEFITS, which doesn't set the reimbursement rates or deductible levels as you have claimed over and over. It's all right there in section 121.
 
Damocles said:
Unrealistic, the only place it will be sold is on the exchange because only insurance from the exchange meets their requirement, or self-insuring within the same parameters.

If you buy it from a provider that doesn't meet their requirements you are fined, if they meet the requirements they are on the exchange.

Another alternative is that ib1yysguy just read the blurbs from the democratic defense sites and doesn't realize that the exchange will pretty much be it over a very short period of time.
Click to expand...

That's not true, Damo. The difference between insurance that qualifies for the exchange and insurance sold outside is precisely the three tiered coverages. Both sets of policies have to adhere to the essential benefits, which are defined in the bill and are globally applicable. The three tiers of coverage only apply to exchange participating plans. So insurance sold outside the exchange DOES meet their requirements. They even define the requirements for insurance to be sold outside of the exchange, you lying sack of spunk. I quote it above.
 
ib1yysguy said:
The bill doesn't require non-exchange participating plans to cover any specific percentages, or even specific levels of care like basic and premium, etc. That only applies to exchange participating plans. Read below.



Every insurance policy sold has to comply with the MINIMUM requirements the government sets. This is called the essential benefits package. Read: For plans not sold on the exchange:

http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:304



and...

http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:652


It then goes on to describe what the Basic, Enhanced, and Premium and option Premium Plus plans are. But they ONLY QUALIFY TO FUCKING EXCHANGE PARTICIPATING PLANS.

It says right there that the three tier plan offerings only apply to EXCHANGE PARTICIPATING HEALTH BENEFITS PLANS.

So what are the essential benefits that plans outside the exchange will in fact have to adhere to? Essential benefits are laid out in subtitles B, C, and D.

Subtitle B--Standards Guaranteeing Access to Affordable Coverage

These are a bunch of consumer protections.

Subtitle C--Standards Guaranteeing Access to Essential Benefit

Steps they have to take to increase accessibility, which list the various things essential benefits package needs to include like maternity care, prescription drugs, and mental health. This is where the essential benefits are defined.

Subtitle D--Additional Consumer Protection

More consumer protections.

The only thing in there relating to deductibles says that they have to use deductibles and not co-insurance. It doesn't set the rate of deductibles, it doesn't say they have to offer only the minimums described as the ESSENTIAL BENEFITS. It says very specifically they can offer whatever they want as long as they meet the requirements of ESSENTIAL BENEFITS, which doesn't set the reimbursement rates or deductible levels as you have claimed over and over. It's all right there in section 121.
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dude, get some help....I'm through repeating myself....you're wrong, you won't admit it....there isn't anything new I say to you....
 
PostmodernProphet said:
/shrugs...there was nothing new in it....the same stuff that's been debunked a half dozen times already.....
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While you may convince yourself that you've already dealt with the parts of the bill that I quoted, you haven't. It's the first time I quoted some of that stuff, and the first time it's been discussed in this thread. The thing about cognitive dissonance is that while you may be fooling yourself, you're not fooling anyone else and you wind up looking retarded. Congratulations.
 
PostmodernProphet said:
/shrugs...there was nothing new in it....the same stuff that's been debunked a half dozen times already.....
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PostmodernProphet said:
bullshit....
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the only bullshit is you trying to peddle your meadowmuffins...you've been shown that it is in fact minimums....yet for some reason you continue to blindly stick to your stance that it is all encompassing....

you're wrong....given the way it is written now. further, obama is now backing off the public option, because he is a wuss and knows if this doesn't pass he is toast....so he caves on what i bet most libs really want....just so he can proclaim some weak ass victory....

you're focusing on the wrong thing and not helping. you haven't been open to any idea other than yours from day one.
 
ib1yysguy said:
That's not true, Damo. The difference between insurance that qualifies for the exchange and insurance sold outside is precisely the three tiered coverages. Both sets of policies have to adhere to the essential benefits, which are defined in the bill and are globally applicable. The three tiers of coverage only apply to exchange participating plans. So insurance sold outside the exchange DOES meet their requirements. They even define the requirements for insurance to be sold outside of the exchange, you lying sack of spunk. I quote it above.
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However, you fail to recognize that it will be illegal for those companies to offer new insurance to anybody. Again, in a very short time the only insurance that could be sold will be on the exchange.

The only off exchange option will be companies that self-insure employees and those have to avail themselves to be in a "study" that will ensure what they are doing isn't cheap enough to create a greater incentive for companies to do it more often.
 
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