Posted by: reddiva | October 22, 2009

Just Another Socialized Health Care Bill


We’ve been going through the final form of the Baucus bill – the one Harry Reid will use most of when he presents the bill he wants, or rather the bill Obama wants, the American people to live and/or die with.

We start this installment at page 22 under the sub-heading “SUBTITLE C—MAKING COVERAGE AFFORDABLE.”

This is a bit unusual.  Some of the additions to the bill are in the footnotes of this section.  I’ll underline the part in the Chairman’s Mark that has the footnote attached; the change will appear in bold blue as always.

Chairman’s Mark

Definition of Four Benefit Categories. Four benefit categories would be available: bronze, silver, gold and platinum. No policies could be issued in the individual or small group market (other than grandfathered plans) that did not meet the actuarial standards described below. All health insurance plans in the individual and small group market would be required, at a minimum, to offer coverage in the silver and gold categories.

All plans must provide preventive (16) and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental (17) and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services (18) that at least meet minimum standards set by Federal and state laws. In addition, plans could charge no cost-sharing (e.g., deductibles, copayments) for preventive care services, except in cases where value-based insurance design is used. Plans could also not include lifetime limits on coverage or annual limits on any benefits. Any insurer that rates on tobacco use must also provide coverage for comprehensive tobacco cessation programs including counseling and pharmacotherapy (prescription and non-prescription). The provisions in this paragraph would all be within the actuarial value of the appropriate benefit level.

[The footnotes:]

(16) Preventive services include those recommended by the U.S. Preventive Services Task Force and immunizations recommended by the Advisory Committee on Immunization Practices (ACIP).

(17) Pediatric dental benefits in the non-group and small group markets (in and outside an exchange) may be separately offered and priced from other required health benefits. Coverage for these benefits may be provided by state-licensed stand-alone dental-only carriers that meet requirements of section 2791(c)(2)(A) of the Public Health Services Act. Stand-alone dental-only together with a qualified health plan that provides all of the other required benefits would satisfy the required benefit standard. Tax credits and cost sharing assistance for the required pediatric dental health benefits would be designed to ensure they do not total more than they would have otherwise been under this Mark.

(18) Mental health and substance abuse services include behavioral health treatment and must be in compliance with the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008” (P.L. 110-343).

[Back to the text:]

The Secretary of HHS would be required to define and update the categories of covered treatments, items and services within benefit classes no less than annually through a transparent and public process that allows for public input, including a public comment period. The Secretary cannot define a package that is more extensive than the typical employer plan as certified by the Centers for Medicare and Medicaid Services, Office of the Actuary. Some flexibility in plan design is allowed but the Secretary must ensure that plan design does not encourage adverse selection. The Secretary would be required to update or modify these definitions to account for changes in medical evidence or scientific advancement or to address any gaps in access or changes in the evidence base.

[…]

Insurers participating in the state exchanges would be required to provide payment for services furnishes to enrollees of the insurer by any electing federally-qualified health center at levels no less than such center would receive under Section 1902(bb) of the Social Security Act for such services.

Definition of Levels.

[…]

And for those between 300-400 percent of the Federal poverty level, within the same actuarial value, the benefit will include an out-of-pocket limit equal to two-thirds of the HSA current law limit.

Small employers purchasing coverage through the exchange would be required to offer a plan with a deductible that does not exceed $2,000 for individuals and $4,000 for families, unless offering contributions through a health reimbursement account or some other mechanism that would offset a deductible above these limits. This deductible limit would not affect the actuarial value of the plan, including Bronze plans and does not apply to “young invincible” plans.

Stand-alone Dental Plans. Stand-alone dental plans must be allowed to offer the required pediatric dental benefits directly and to offer coverage through the Exchange and must comply with any relevant consumer protections required for participation in the Exchange.

Required pediatric dental benefits in the non-group and small group markets (in and outside an Exchange) may each be separately offered and priced from other required health benefits. Coverage for these required pediatric dental benefits may be provided by any state-licensed stand-alone dental-only carrier that meets the requirements of section 2791(c)(2)(A) of the Public Health Service Act. Stand-alone dental-only coverage together with a qualified health plan that provides all of the other required benefits satisfies the required benefits standards. Tax credits and cost-sharing assistance for the required pediatric dental would be designed to ensure they do not total more than they would have otherwise been if they were combined.

[The next change comes at the top of page 25 under the paragraph “COBRA Continuation Coverage Premium Reduction.]

Chairman’s Mark

Premium Credit. The Chairman‘s Mark would provide a refundable tax credit for eligible individuals and families who purchase health insurance through the state exchanges. The premium tax credit will subsidize the purchase of certain health insurance plans through the state exchanges and will be refundable and payable in advance directly to the insurer. The tax credit would be available for individuals (single or joint filers) with modified gross incomes (MGI) Modified Adjusted Gross Incomes (MAGI) up to 300 percent of the Federal poverty level (FPL). MAGI would be defined as an individual‘s (or couple‘s) adjusted gross income (AGI) without regard to sections 911 (regarding the exclusion from gross income for citizen or residents living abroad), 931 (regarding the exclusion for residents of specified possessions), and 933 (regarding the exclusion for residents of Puerto Rico), plus any tax-exempt interest received during the tax year, plus any income of dependents listed on the return. MGI would be defined as an individual‘s (or couple‘s) total income without regard to sections 911 (regarding the exclusion from gross income for citizen or residents living abroad), 931 (regarding the exclusion for residents of specified possessions), and 933 (regarding the exclusion for residents of Puerto Rico), plus any tax-exempt interest received during the tax year, plus the modified gross income of dependents listed on the return. In addition, under the modification, deductions from gross income that are allowed in determining adjusted gross income, such as the deduction for contributions to an individual retirement arrangement, would be disregarded.

Under the Mark, an eligible individual would enroll in a plan offered through a state exchange and would report his or her MAGI to the exchange. States are permitted to enter into contracts with state Medicaid agencies to make eligibility determinations for the credit. Based on the information provided to the state exchange, the individual would receive a premium credit based on income according to the schedule outlined below. The Treasury would pay the premium credit amount to the insurance plan in which the individual is enrolled. The individual would then pay to the plan in which he or she enrolled the dollar difference between the premium credit amount and the premium charged for the plan. Individuals who fail to pay all or part of the remaining premium amount would be given a mandatory three-month grace period prior to an involuntary termination of their participation in the plan. For employed individuals who purchase health insurance through a state exchange, the premium payments would be made through payroll deductions. Initial eligibility for the tax credit would be based on the individual‘s MAGI for the most recent tax year ending prior to the enrollment period. Individuals (or couples) who experience a change in marital status or other household circumstance, or experience a decrease in income of more than 20 percent, or receive unemployment insurance may update eligibility information or can request a redetermination of their tax credit eligibility.

[In other words, same sex-partners.

The next section discusses the tax credits, and the only changes are that they lowered the tax credit from 13% of income to 12% of income.  They are also going to penalize any person or entity who accesses the “The Exchange” if they use the information for anything other than its intended use.  In addition, they’ve added tax credit protection for the small businesses who hire “seasonal workers.”  Charitable organizations are exempt from the tax credits.

At the top of page 32 in the section dealing with the prohibition of abortion as part of a minimum benefits package, one sentence was deleted from the Chairman’s Mark.  Don’t get excited – Federal funds will still be appropriated for abortion.]

This provision provides that abortion cannot be a mandated benefit as part of a minimum benefits package except in those cases for which Federal funds appropriated for the Department of Health and Human Services are permitted. A qualified health plan would not be prohibited, however, from providing coverage for abortions beyond those for which Federal funds appropriated for the Department of Health and Human Services are permitted. Federal funds continue to be prohibited from being used to pay for abortions unless the pregnancy is due to rape, incest, or if the life of the mother is in danger.

[The open enrollment period in the individual market has been changed to March 1, 2013 to May 31, 2013.  The part you’ve heard about where they lowered the penalty is true, and they have removed the threat of jail time.  But they lowered the percentage required before the penalty would kick in to 8% (from 10%) of the AGI.  Sweet of them, huh?]

Excise Tax. The consequence for not maintaining insurance would be an excise tax of $750 per adult in the household. This per adult penalty would be phased in as follows: For 2013, $0; $200 for 2014; $400 for 2015; $600 in 2016 and $750 in 2017. If a taxpayer‘s MAGI is between 100-300 percent of FPL, the excise tax for failing to obtain coverage for an individual in a taxpayer unit (either as a taxpayer or an individual claimed as a dependent) is $750 per year. However, the maximum penalty for the taxpayer unit is $1,500. If a taxpayer‘s MAGI is above 300 percent of FPL the penalty for failing to obtain coverage for an individual in a taxpayer unit (either as a taxpayer or as an individual claimed as a dependent) is $950 year. However, the maximum penalty amount a family above 300 percent of FPL would pay is $3,800.

Non-compliance with the individual responsibility to have health coverage shall incur no criminal penalty; and neither civil penalty nor interest shall accrue for failure to pay such assessment in a timely manner. Collection shall be limited to withholding of federal payments due.

[The long and short of this “new” bill is that it’s the “old bill” with a couple of insignificant changes and one that really helps the people – the removal of the jail threat.  I am still as opposed to this entire health care proposal as I was before.  If we don’t do something NOW to convince the people we elected to represent us that this constitutes more big government interference into our lives, we will find ourselves living the health-care nightmares of other countries with socialized healthcare.  Our chances of that at this rate are two – slim and none!]

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