APP - FINALLY!

Damocles said:
The following post is my opinion on the areas that Feckman listed. Since I have time when I get home to read the huge bill and tell you my opinion I waited until I was home...

The sampling...



This isn't quite a truth, in fact it studies the types of insurance given and how it might effect the large pools created by those in regular insurance. Only companies that were selected to be in the study would receive this type of attention. This also studies insurance companies to see how they are effected, these too would receive this attention.


This is true, IMO, the "advisory" committee is such that it can make choices based on costs as to what kinds of care you get at what time.



This part sets limits for the first tier of coverage. The bill separates care into three levels, "Essential" is the first level and this sets limits for that particular level of care to be adjusted in the future according to the Consumer Price Index. It also sets your copay to 30% of the actuarial tables as coverage is limited to 70%. (I will tell you, this level of coverage bites. When my wife had our first bio-child her costs more than quintupled the limits for a "family" on this plan and that was quite some time ago).


True, but in reality it is no different than a company offering you their selected insurance benefits, you really don't have a "choice". In this case you could choose to pay more for a better level of benefits, from basic "essential" coverage to "premium" coverage.



The section guarantees that health care will be provided equally regardless of any extemporaneous qualities of the person. It does, however, exempt this rule from other sections of the bill, which are not evident here. It may not provide insurance to illegals, but I can't really see them taking away care for them.


This is one of the parts I have problems with. Whether it is their intention, this is definitely capable of becoming a national identification card that also links to your financial information. While I see that they are looking for fast paybacks and "near real time" transactions I see it as a huge, and unnecessary, invasion of privacy, no current insurance provider has access to this level of information.



This is actually written to happen in both ways, they'll take the payments directly from your accounts. Another thing I dislike. It does not speak to elective fund transfers in this area on this page, but it would be my hope that they would allow you to choose how you want to pay rather than just suck the funds from your accounts.


This pays reimbursement for coverage of those in a retirement plan if they meet requirements listed by the legislation.

Basically it begins to reimburse the organization for costs related to insurance for those who are retired. People who now have coverage through retirement would see no benefit from this, but the organizations that provide the coverage would, for sure, receive a reimbursement for costs they do not currently receive reimbursement for, I'd say this is true as it starts giving them money for what they would normally pay. Nor does this move them into coverage under any of the government approved insurance coverages it just simply starts reimbursing for what they would normally cover.



I think we've already discussed this. This is also the part that some have listed as the place that forces you to take the government controlled option.


this area specifies four levels of coverage they can offer, all contingent on offering the previous level. If you offer the basic plan you can offer the Enhanced plan, if you offer the Enhanced plan you can offer the Premium plan, and if you offer the Premium plan you can offer a Premium plus plan.

No company could offer a Premium plan only, or an Enhanced plan only, they must offer the Basic plan to be able to offer the next tier up and so forth. Levels of coverage will be set so that you can select the basic plan and know exactly what coverages you will get. "Premium Plus" offers dental and vision coverage as well as medical coverage and only if approved by the Commissioner. As far as I can tell there would be no oral health or vision offered to adults under any of the government plans.


This talks about the levels of coverage for each of the tiers of insurance provided.


That could be one example, if the coverage is indeed inclusive of illegal immigrants. I haven't yet seen that they are covered.

However health care providers are already required to get translators for illegal immigrants I very much doubt that this would change.

It also could include such things as female doctors for muslim women and male doctors for muslim men and other cultural issues that may arise as well as linguistic challenges. It doesn't say that full effort must be made, just that linguistic services will be provided. I don't know what happens if they are in an area without a translator available or if they are very rural and cultural necessities may not be available.



True, outreach programs.



This is a repeat of one I did earlier.


True, you will be automatically enrolled into this under this provision.

It says: "(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid."


True, it specifically says there shall be "no judicial review" of any of the payment rate or methodology.


I see nothing in this that says they could choose to charge more at any time, to be eligible they must agree to accept the government levels as payment in full (of course they'd get the copay up front).



The employee would have a choice to pay for the enhanced, premium, or premium plus... and the only choice for the employer would be either this or the self-covered insurance for which they may end up being part of the "study" that will look through their books and check into levels of coverage...
Click to expand...

Great job Damo! As to which companies are selected to study? I did not read that a "sampling" would be done?
Yesterday a talk radio discussion took place with a local congressman; McDermott WA. He was confronted by a caller who asked "what company wouldn’t take advantage of the government plan?” The government plan is undercutting payroll percentages in some cases by as much as 1/2 of what employers are paying private insurers! This means we could see a huge dumping of employee's into the public system causing a potential economic crisis that will make our latest dance with economic disaster seem like a waltz. McDermott could not come up with a reason why this won't happen...and he's a pro HC democrat!
 
Ice Dancer said:
Great job Damo! As to which companies are selected to study? I did not read that a "sampling" would be done?
Yesterday a talk radio discussion took place with a local congressman; McDermott WA. He was confronted by a caller who asked "what company wouldn’t take advantage of the government plan?” The government plan is undercutting payroll percentages in some cases by as much as 1/2 of what employers are paying private insurers! This means we could see a huge dumping of employee's into the public system causing a potential economic crisis that will make our latest dance with economic disaster seem like a waltz. McDermott could not come up with a reason why this won't happen...and he's a pro HC democrat!
Click to expand...
It says that they'll select some of those who are self-insured and some that aren't to involuntarily participate in a study that will survey the effects of self-insured on the pools created by the insurance companies (and the new government pool). It is specifically done to verify that there isn't any incentive to self-insure, they want to create an incentive to use one of their approved coverages.
 
Damocles said:
It says that they'll select some of those who are self-insured and some that aren't to involuntarily participate in a study that will survey the effects of self-insured on the pools created by the insurance companies (and the new government pool). It is specifically done to verify that there isn't any incentive to self-insure, they want to create an incentive to use one of their approved coverages.
Click to expand...

Their "approved coverages?"
 
Ice Dancer said:
Their "approved coverages?"
Click to expand...
Yes, in order to become approved and part of the list of companies that they'll allow you to select there are specific coverages you must have. First you must have the basic coverage that is 70% paid by the insurance 30% by you with a $5000 deductible for singles and a $10,000 deductible for families. Then they have the "enhanced", the "Premium" and finally (only the private companies have this one) the "Premium Plus". For each of the tiers it is required that you provide the level before it.

The only coverage for dental and eye care for adults is in the "Premium Plus" plan that can be offered only if you offer all three of the other plans.

I do not know what this will do to current eye and dental insurance companies, if anything at all. But if they are included in this "no new customers" requirement that forces you onto their approved coverage lists it will simply make them go the way of the dinosaur.
 
Damocles said:
Yes, in order to become approved and part of the list of companies that they'll allow you to select there are specific coverages you must have. First you must have the basic coverage that is 70% paid by the insurance 30% by you with a $5000 deductible for singles and a $10,000 deductible for families. Then they have the "enhanced", the "Premium" and finally (only the private companies have this one) the "Premium Plus". For each of the tiers it is required that you provide the level before it.

The only coverage for dental and eye care for adults is in the "Premium Plus" plan that can be offered only if you offer all three of the other plans.

I do not know what this will do to current eye and dental insurance companies, if anything at all. But if they are included in this "no new customers" requirement that forces you onto their approved coverage lists it will simply make them go the way of the dinosaur.
Click to expand...

Having seen some of the policies available for dental and eye care, most by carriers other than the usual health carriers, that may not be so bad, particularly when made a part of over all coverage by a reputable carrier.
 
belme1201 said:
Having seen some of the policies available for dental and eye care, most by carriers other than the usual health carriers, that may not be so bad, particularly when made a part of over all coverage by a reputable carrier.
Click to expand...
It would be bad. How many jobs are you willing to sacrifice on this altar? It doesn't matter how bad it gets we can all pretend it is "better" than what we have. This isn't even close to better than what we have, it isn't even as good as the first health insurance plan I had working at a gas station.

We can come up with a better solution than this, let's bridge it by expanding Medicare and adding graduated payments systems to cover the gap until we find that better solution. No need to rush into this craptacular piece of legislation that even my cat wouldn't deign to cover in his sandbox.
 
Damocles said:
It would be bad. How many jobs are you willing to sacrifice on this altar? It doesn't matter how bad it gets we can all pretend it is "better" than what we have. This isn't even close to better than what we have, it isn't even as good as the first health insurance plan I had working at a gas station.

We can come up with a better solution than this, let's bridge it by expanding Medicare and adding graduated payments systems to cover the gap until we find that better solution. No need to rush into this craptacular piece of legislation that even my cat wouldn't deign to cover in his sandbox.
Click to expand...




I agree, Medicare for all with Congressional plans optional. No Donut Hole. No special rules for pharmaceutical companies, insurance companies, banks, or creditors. No limitations on importation of approved drugs. No multi-million dollar salaries or billion dollar stock options added to the cost of healthcare. No advertising that ultimately raises the cost of a drug. No lobbying. No exceptions.
 
PostmodernProphet said:
???...why, you think you would understand it better if I explained it to you a sixth time?......you simply aren't going to accept it from me, you need to hear it from someone you think is "credible"......
Click to expand...

you can't explain it, so you fall back.....

oh the sixth time....geeee....i've told you "six" times that what you think the bill says....i don't see....i have asked you "six" times to explain it to me....now all you have is.......

nothing....you can't explain it any other way, so you mock me for not understanding you....nice try....but that doesn't cut it
 
belme1201 said:
I agree, Medicare for all with Congressional plans optional. No Donut Hole. No special rules for pharmaceutical companies, insurance companies, banks, or creditors. No limitations on importation of approved drugs. No multi-million dollar salaries or billion dollar stock options added to the cost of healthcare. No advertising that ultimately raises the cost of a drug. No lobbying. No exceptions.
Click to expand...
No, just cover the doughnut hole as an interim solution while we find out where the false increase in cost is.
 
Yurt said:
you can't explain it, so you fall back.....

oh the sixth time....geeee....i've told you "six" times that what you think the bill says....i don't see....i have asked you "six" times to explain it to me....now all you have is.......

nothing....you can't explain it any other way, so you mock me for not understanding you....nice try....but that doesn't cut it
Click to expand...

???...does ignoring six explanations "cut it"?.....what about the analogy to the building industry....did you even bother to respond to it?....did you even bother to read it?.....or did you just reject it and say I didn't try....asking me to try again.....
 
You must log in or register to reply here.
Back
Top