A Summary Review Of The House Healthcare Bill: This is must reading!

[Better Believe It]

I'm reposting this contribution to the DU discussion on the House healthcare bill that was written by DU'er "ThomCat". It was first posted yesterday in response to a lead post. ThomCat's initial analysis deserves to be read by everyone who wants to achieve a true universal healthcare system in the United States.

ThomCat may want to make some revisions in his analysis after further thought and study, but this is the most informative comment I've seen on the internet so far.

I don't know who ThomCat is, and I have no political or personal connections with him. I've read his DU profile and that's it!

So hat's off to ThomCat for his hard work!

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ThomCat Tue Jul-14-09 04:30 PM

Some good and bad, a summary review.

1. (Bad) Right from the beginning, the stated purpose in Division A (on page 4) is to reduce the growth of cost of health care. Not to reduce the cost, but to slow down how quickly it gets more expensive. How is health care going to be affordable if reducing the cost is not part of the goal?

2. (Good) Includes a Public Option.

3. (Bad) using the term Spouse when referring to partners who are dependents, so Domestic Partners are excluded by this language as long as DOMA is still in force.

4. (Good, sort of) Age based pricing on individual health plans cannot vary by more than 2 to 1. So the cost of a health plan for someone elderly cannot be more than twice as expensive as it is for someone young.

5. (Bad) Rates can still vary by region, with limit on how much they can vary, though the regions are not defined and can/will be defined by the commissioner for this insurance later. This will mean that lobbying is going to determine how much more we get charged in cities compared to suburban or rural areas, and how much more in big cities vs smaller cities. This is a big loophole as far as I am concerned, and could become a big giveaway to insurance companies.

6. (Good and Bad) There is an effort to make mental health care and substance abuse care more available, but there are a lot of caveats, complicated referrals between sections in this bill, so that only a lawyer can figure out if any health plan really has to offer any care, what types, and with what availability or restrictions. It's good that the attempt is here, but clearly a lot of lobbying was done to make this complicated, so this looks like it's probably just a symbolic attempt.

7. (Good, maybe) The commissioner will create standard guidelines for how to determine the Medical Loss Ratio, the rate paid out in medical coverage relative to the amount charged in premiums. This is good because each company won't have their own way of calculating their MLR to best hide their profits. One set of rules apply to everyone. Though, there don't seem to be any teeth for catching them if they don't use this methodology, or for doing anything about it. The commissioner "can" do audits "in response to complaints." That seems to means that if the rule-braking gets too blatant and obvious, and the complaints get too loud to ignore then the commissioner will do an audit, but otherwise anything goes.

8. (Good) Once a standard Medical Loss Ration methodology is set, the commissioner will tell insurance companies what MLR to use, in other words, how much profit they can reasonably make from the premiums they take in. The rest HAS to go towards providing health care. Again, I don't see anything in here for verifying this, or doing anything to companies that take extra profit. It's probably going to be buried in future rules.

9. (Good, maybe) There will be minimum standards for plans. Though, no word on how low the minimum will be, or how variable and confusing the minimum options and choices could be. It's good to have a minimum, but it's better if the minimum is clear, consistent and set at a high enough level to ensure quality care. Nothing here requires that it be clear, consistent or set at a useful level. It looks like this section was heavily influenced so that the minimum can be set very, very low just so they can say there is a minimum down there somewhere, and to weed about the grossest abuses without really effecting most plans at all.

10. (Very Good) "A qualified health benefits plan may not impose any restriction (other than cost sharing) unrelated to clinical appropriateness on the coverage of the health care items and services." This seems to be a very straight forward clause prohibiting plans from arbitrarily refusing to cover certain services if those services are listed as covered, or refusing to cover them for select or certain people. There are other, more explicit non-discrimination clauses in this bill too. So, to the extent that anyone obeys this bill it's wonderful, but to the extent that this bill is toothless and enforced by a toothless new agency (read below) it is symbolic but at least it's there.

11. (Very Good) Qualified plans are prohibited from having annual and lifetime caps on services!

12. (Very Bad) The standard for a Qualifying plan is the "average prevailing employer-sponsored coverage." So if employers start offering less to their employees, the standard for these government qualified plans goes down. They have pegged the quality of Everyone's care to employer provided health care as a way of making it Necessary to preserve employer provided health care.

13. (Very Bad) The Cost Sharing (amount they make you pay in co-pays and deductibles) starts out at $5,000 per year per person for the basic plan and can go up each year linked to the consumer price index. Enhanced plans can not only cost more, they can also have a higher rate of "cost sharing," meaning you pay a greater rate relative to what you get. If you want more than basic, you have to be willing to pay more, and then pay extra for it. How the Fuck is any of this considered Affordable? This section all by itself is going to keep health insurance out of the reach of the Vast Majority of Americans.

14. (Bad) An advisory panel of medical and "Other Experts" will recommend what is to be covered on various levels of plans. 17 members are appointed by the President, only 8 of whom are federal employees. 9 more are appointed by the Comptroller General of the U.S. There are guidelines for trying to avoid stacking the panel with lobbyists, but even so I can easily see at a glance that over half of the panel could be stacked. (Can you say "rewards for largest campaign contributors") This means insurance lobbyists, pharma lobbyists, health care lobbyists, "experts" on corporate payrolls, and a token public advocacy doctors.

15. (Good, maybe) There will be an Ombudsman's office to help people within this new Government Department. But the duties of the Ombudsman seem to be defined mostly as providing information and helping to fill out paperwork, not really acting as an advocate to resolve serious disputes. Nor does the Ombudsman have any authority, because even the Chairman doesn't seem to have much authority. The Chairman is referred to state agencies and directed to "work with them" to get anything done. The Ombudsman would have vastly less influence and authority than even that. Just what we need, toothless advocacy.

16. (Very Bad) Repeatedly, it is stated that nothing in here supersedes state laws. This means that this new government agency will have to negotiate a hodge-podge of 50 sets of rules to implement their influence over insurance, and has to be weaker than the weakest of those 50 sets of rules. This guaranteeing that this new government agency will be toothless and absolutely no threat to the insurance industry. It looks like the lobbyists won.

17. (Good, maybe) There is a whistle-blower protection section in here. But it simply gives whistle-blowers the right to bring legal action under existing laws if they face retaliation, and we know that existing laws are absolutely insufficient and ineffective in protecting whistle-blowers. So it's good that this is in there, but it's useless until the underlying law is updated and improved.

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