Tuesday, August 4, 2009

HR 3200: Title I

Here's a quick summary (bulleted points) of the highlights of the first title of the bill.

*Sorry for some of the goofy margins and returns on this. I wrote it in wordpad while reading the bill and the format did not translate well into blogger.*

Pages 1-72:
First 14* pages definition of terms.

Title I (pages 1-72): Protections and Standards for Qualified Health Benefits Plans (QHBP)
Section 102: "Protecting the Choice to keep Current Coverage" (page 16).
Includes restrictions on premium increases during the "grandfather" period (page 17).

Subtitle B: Standards Guaranteeing Access to Affordable Coverage
Section 111: "Prohibiting Pre-Existing Condition Exclusion" (page 19).
People cannot be dropped for non-payment of premiums unless a specific course of consumer protection has been provided (page 20).
Individuals and families will all be charged a uniform rate (page 21).
Eighteen months after the date of the enactment of the legislation, a commission will provide Congress and applicable agencies a report on the study of factors affecting coverage (page 22): "To ensure that the law does not provide incentives for small and mid-size businesses to self-insure or create averse selection in the risk pools of large insurers and self-insured employers" (page 23).

Section 114: "Nondiscrimination in benefits: parity in mental health and substance abuse benefits" (page 23).

Section 115: Ensuring adequacy of provider networks; transparency in cost for in-network
and out-of-network benefits.
Premiums are to "be used for services" (page 25). *I need to study about the term "medical
loss ratio"; not sure what that means.

Subtitle C: Standards Guaranteeing Access to Essential Benefits (sets the bar for coverage for private insurers)
Choice of coverage (page 25)
Accordance with general medical standards (page 27)
No annual or lifetime limit on coverage
Is equivalent to average prevailing employer provided coverage

Minimum services to be covered:
Hospitalization (27)
Outpatient hospital, outpatient clinic, and emergency services (27)
Professional services of physicians and other health professionals (28) (they get
paid; it's not voluntary all of a sudden)
Services, equipment and supplies incident to the delivery of care (28)
Prescription drugs (28)
Rehabilitative and habilitative services (28)
Mental health and substance disorder services (28)
Preventive services (28)
Well baby and well child care including oral health, vision, hearing etc. for children under
21 years of age

People who are using private insurance cannot pay more than $5,000/year out of pocket for
an individual; $10,000 per family

Section 123: Health benefits advisory committee (oversight)
Term limits for committee members (3 years)
Duties (pages 32-35)

Section 124: 45 day maximum for committee to review recommendations (keep 'em moving,

18 months after enactment of legislation, initial standards for coverage will be set but will be
reviewed periodically (36).

Subtitle D: Additional Consumer Protections

Section 131: Requiring fair marketing practices by health insurers
Claims and appeals processes (37)
External review process (38)

Section 133: Requiring information transparency and plan disclosure (38) (no more fine print; no more quick changes to coverage, etc)

Subtitle E: Governance
Examination and Audits
Work with state regulatory agencies to terminate non-compliant plans (45)
Coordinating communication between state attorneys general (45) and all other overseeing

Subtitle F: Miscellaneous

Section 152: Prohibiting discrimination in health care (50)
Section 153: Whistle-blower protection (51)
Section 154: Collective bargaining shall not be restrained (53) (unions?)

Subtitle G: Early Investments

Competition (54)
Section 162: Ending health care rescission abuse (55) (fraud is the *only* exception for losing
Third party review of rescission

Section 1173A: Standardize electronic administrative transactions
Including: Letting patient know the cost at point of service (58) (no sudden bills out of the blue)
Protection of data (62)

Section 164: Reinsurance program for retirees (65)

More tomorrow as time permits: we are painting at the new house tomorrow so I may not be able to update until the evening.


Christian Prophet August 4, 2009 at 8:36 PM  

What is your congressperson's vulnerability? His family? Diluge his family with your protest. His friends? Diluge his friends with your protest. His financial supporters? Diluge his financial supporters with your protest. Make it not a protest based on economics, but a moral crusade. See:

Chris August 4, 2009 at 8:59 PM  

You've done enough.......paint away!

smallbytesbythecapital August 4, 2009 at 10:08 PM  

It's pretty sad when we understand the bill better than the Republicans and Blue Dogs. Oy.

skyewriter August 4, 2009 at 11:17 PM  

Christian Prophet:
Where do I make an economic argument in this purely descriptive, brief summary of the first 72 pages of 1019? I choose to conduct myself as a citizen by leaving a *civic* official's personal life to themselves. I don't need to intimidate people, their loved ones, or their friends. In terms of writing them and contacting them, if you read this blog ever, you would know I am all for legal and ethical communication with our elected officials.

My primary responsibility as a US citizen is to use my rights to keep myself informed with facts, not propaganda, and try to correct obfuscation by those who would seek to make health care a political issue and not a human one. You call it morals. I call it ethics. Human rights. And since *god* isn't here personally, it's up to humans to protect those rights for each other.

But apparently, your mission is from a "higher" (and invisible) authority. What would Jesus do? Harass people? You suggested it, not me. If you suggest the Biblical flood with your repetitive use of d*E*luge, I respect your right as an American to protest. But please take it somewhere else.

Chris: I'm on it. See above...

D: Thanks for stopping by! It's been a while. Like ARRA, I don't think anyone on the right side of the aisle has even cracked the cover on these 1019 pages of legislation.

August 4, 2009 11:08 PM

themom August 5, 2009 at 9:44 AM  

thank you for the post. The spin ahs begun from the other side as we know. If we stay informed and pass this on - there is hope.

James August 5, 2009 at 9:51 AM  

Thanks for the link to the bill skyewriter. I also liked your summary. Have fun painting and we will be here when you check in. Take care.

Chris August 5, 2009 at 10:46 AM  

OH, and I did download the bill to read.......when I get a few hours to myself....LOL!!!!!

skyewriter August 5, 2009 at 7:53 PM  

You are welcome, themom and James.

Chris. I am glad were able to download it; it took me a while yesterday (I actually was afraid my laptop was going to seize up it took so long).

Happy reading!

Sidhe August 6, 2009 at 1:37 PM  

Timmy and I are working on getting through this thing...it has become our evening ritual to actually resesarch real stuff and then discuss (of course, it's more fun for me because I'm always right:-)).

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