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Reply #51: I would love to think it is in the bill [View All]

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 10:24 PM
Response to Reply #50
51. I would love to think it is in the bill
Edited on Thu Nov-12-09 10:56 PM by laughingliberal
Here is what I find in the bill related to limiting premiums to a percentage of income. It is for individuals at up to 400% of federal poverty levels. It is done by providing affordability credits. There is nothing which prevents the insurer from charging more. The government will provide a subsidy to make up the difference. If you can find anything requiring the insurance cartels to base our premium on our income, I'd be happy to read it but I've read the bill and the only restriction on their pricing is the limitation of the 2:1 ratio for age and the medical loss ratios. Here is the relevant section of the bill: ::


(a) In General- The affordability premium credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in an amount equal to the amount (if any) by which the reference premium amount specified in subsection (c), exceeds the affordable premium amount specified in subsection (b) for the individual, except that in no case shall the affordable premium credit exceed the premium for the plan.
(b) Affordable Premium Amount-
(1) IN GENERAL- The affordable premium amount specified in this subsection for an individual for the annual premium in a plan year shall be equal to the product of--
(A) the premium percentage limit specified in paragraph (2) for the individual based upon the individual's modified adjusted gross income for the plan year; and
(B) the individual's modified adjusted gross income for such plan year.
(2) PREMIUM PERCENTAGE LIMITS BASED ON TABLE- The Commissioner shall establish premium percentage limits so that for individuals whose modified adjusted gross income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier.
(c) Reference Premium Amount- The reference premium amount specified in this subsection for a plan year for an individual in a premium rating area is equal to the average premium for the 3 basic plans in the area for the plan year with the lowest premium levels. In computing such amount the Commissioner may exclude plans with extremely limited enrollments.
(d) Table of Premium Percentage Limits, Actuarial Value Percentages, and Out-of-pocket Limits for Y1 Based on Income Tier-
(1) IN GENERAL- For purposes of this subtitle, subject to paragraph (3) and section 346, the table specified in this subsection is as follows:
The initial premium percentage is-- The final premium percentage is-- The actuarial value percentage is-- The out-of-pocket limit for Y1 is--
133% through 150% 1.5% 3.0% 97% $500
150% through 200% 3.0% 5.5% 93% $1,000
200% through 250% 5.5% 8.0% 85% $2,000
250% through 300% 8.0% 10.0% 78% $4,000
300% through 350% 10.0% 11.0% 72% $4,500
350% through 400% 11.0% 12.0% 70% $5,000
(2) SPECIAL RULES- For purposes of applying the table under paragraph (1):
(A) FOR LOWEST LEVEL OF INCOME- In the case of an individual with income that does not exceed 133 percent of FPL, the individual shall be considered to have income that is 133 percent of FPL.
(B) APPLICATION OF HIGHER ACTUARIAL VALUE PERCENTAGE AT TIER TRANSITION POINTS- If two actuarial value percentages may be determined with respect to an individual, the actuarial value percentage shall be the higher of such percentages.
(3) INDEXING- For years after Y1, the Commissioner shall adjust the initial and final premium percentages to maintain the ratio of governmental to enrollee shares of premiums over time, for each income tier identified in the table in paragraph (1).

(a) In General- The affordability cost-sharing credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in the form of the cost-sharing reduction described in subsection (b) provided under this section for the income tier in which the individual is classified based on the individual's modified adjusted gross income.
(b) Cost-sharing Reductions- The Commissioner shall specify a reduction in cost-sharing amounts and the annual limitation on cost-sharing specified in section 222(c)(2)(B) under a basic plan for each income tier specified in the table under section 343(d), with respect to a year, in a manner so that, as estimated by the Commissioner--
(1) the actuarial value of the coverage with such reduced cost-sharing amounts (and the reduced annual cost-sharing limit) is equal to the actuarial value percentage (specified in the table under section 343(d) for the income tier involved) of the full actuarial value if there were no cost-sharing imposed under the plan; and
(2) the annual limitation on cost-sharing specified in section 222(c)(2)(B) is reduced to a level that does not exceed the maximum out-of-pocket limit specified in subsection (c).
(c) Maximum Out-of-pocket Limit-
(1) IN GENERAL- Subject to paragraph (2), the maximum out-of-pocket limit specified in this subsection for an individual within an income tier--
(A) for individual coverage--
(i) for Y1 is the out-of-pocket limit for Y1 specified in subsection (c) in the table under section 343(d) for the income tier involved; or
(ii) for a subsequent year is such out-of-pocket limit for the previous year under this subparagraph increased (rounded to the nearest $10) for each subsequent year by the percentage increase in the enrollment-weighted average of premium increases for basic plans applicable to such year; or
(B) for family coverage is twice the maximum out-of-pocket limit under subparagraph (A) for the year involved.
(2) ADJUSTMENT- The Commissioner shall adjust the maximum out-of-pocket limits under paragraph (1) to ensure that such limits meet the actuarial value percentage specified in the table under section 343(d) for the income tier involved.
(d) Determination and Payment of Cost-sharing Affordability Credit- In the case of an affordable credit eligible individual in a tier enrolled in an Exchange-participating health benefits plan offered by a QHBP offering entity, the Commissioner shall provide for payment to the offering entity of an amount equivalent to the increased actuarial value of the benefits under the plan provided under section 303(c)(2)(B) resulting from the reduction in cost-sharing described in subsections (b) and (c).

(a) In General- In applying this subtitle for an affordability credit for an individual for a plan year, the individual's income shall be the income (as defined in section 342(c)) for the individual for the most recent taxable year (as determined in accordance with rules of the Commissioner). The Federal poverty level applied shall be such level in effect as of the date of the application.
(b) Program Integrity; Income Verification Procedures-
(1) PROGRAM INTEGRITY- The Commissioner shall take such steps as may be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle.
(A) IN GENERAL- Upon an initial application of an individual for an affordability credit under this subtitle (or in applying section 342(b)) or upon an application for a change in the affordability credit based upon a significant change in modified adjusted gross income described in subsection (c)(1)--
(i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application; and
(ii) the Commissioner shall use the information so disclosed to verify such information.
(B) ALTERNATIVE PROCEDURES- The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.
(c) Special Rules-
(1) CHANGES IN INCOME AS A PERCENT OF FPL- In the case that an individual's income (expressed as a percentage of the Federal poverty level for a family of the size involved) for a plan year is expected (in a manner specified by the Commissioner) to be significantly different from the income (as so expressed) used under subsection (a), the Commissioner shall establish rules requiring an individual to report, consistent with the mechanism established under paragraph (2), significant changes in such income (including a significant change in family composition) to the Commissioner and requiring the substitution of such income for the income otherwise applicable.
(2) REPORTING OF SIGNIFICANT CHANGES IN INCOME- The Commissioner shall establish rules under which an individual determined to be an affordable credit eligible individual would be required to inform the Commissioner when there is a significant change in the modified adjusted gross income of the individual (expressed as a percentage of the FPL for a family of the size involved) and of the information regarding such change. Such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change, the verifiable information required to document such a change, and the process for submission of such information. If the Commissioner receives new information from an individual regarding the modified adjusted gross income of the individual, the Commissioner shall provide for a redetermination of the individual's eligibility to be an affordable credit eligible individual.
(3) TRANSITION FOR CHIP- In the case of a child described in section 302(d)(4), the Commissioner shall establish rules under which the modified adjusted gross income of the child is deemed to be no greater than the family income of the child as most recently determined before Y1 by the State under title XXI of the Social Security Act.
(A) IN GENERAL- The Secretary of Health and Human Services shall conduct a study to examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. If the Secretary determines that an adjustment is feasible, the study should include a methodology to make such an adjustment. Not later than the first day of Y1, the Secretary shall submit to Congress a report on such study and shall include such recommendations as the Secretary determines appropriate.
(i) IN GENERAL- The Secretary shall ensure that the study under subparagraph (A) covers the territories of the United States and that special attention is paid to the disparity that exists among poverty levels and the cost of living in such territories and to the impact of such disparity on efforts to expand health coverage and ensure health care.
(ii) TERRITORIES DEFINED- In this subparagraph, the term `territories of the United States' includes the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and any other territory or possession of the United States.
(d) Penalties for Misrepresentation- In the case of an individual who intentionally misrepresents modified adjusted gross income or the individual fails (without regard to intent) to disclose to the Commissioner a significant change in modified adjusted gross income under subsection (c) in a manner that results in the individual becoming an affordable credit eligible individual when the individual is not or in the amount of the affordability credit exceeding the correct amount--
(1) the individual is liable for repayment of the amount of the improper affordability credit; and
(2) in the case of such an intentional misrepresentation or other egregious circumstances specified by the Commissioner, the Commissioner may impose an additional penalty.

edited to add link
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  -When Social Security passed in 1935, it wasn't perfect ProSense  Nov-12-09 10:55 AM   #0 
  - Dang.  jobycom   Nov-12-09 10:57 AM   #1 
  - Beautiful.  Tommy_Carcetti   Nov-12-09 10:58 AM   #2 
  - Good history lesson. Huge shifts/Immediate Breaks don't often happen in US. "Checks and Balances"  emulatorloo   Nov-12-09 10:59 AM   #3 
  - Bury the facts. n/t  ProSense   Nov-12-09 11:23 AM   #11 
  - It still is not perfect. Hell it is barely solvent at this point.  leeroysphitz   Nov-12-09 11:00 AM   #4 
  - no comparison  optimator   Nov-12-09 11:01 AM   # 
  - "SS isn't a private corporation" Neither is SCHIP  ProSense   Nov-12-09 11:03 AM   #7 
  - SS didn't mandate payments to private corporations. & it was transparently straightforward.  Hannah Bell   Nov-12-09 04:20 PM   #43 
  - But it originally did NOT require people to invest their money with private, predatory corporations  T Wolf   Nov-12-09 11:01 AM   #5 
  - So the insurance companies that people have to pay right now to get coverage are not private?  ProSense   Nov-12-09 11:05 AM   #10 
     - You are willing to accept the "next to nothing" just for a "win"  MNDemNY   Nov-12-09 11:34 AM   #17 
        - There is a lot more in the bill that is good than some DU'ers want to admit.  emulatorloo   Nov-12-09 02:05 PM   #27 
           - Will you support this bill with the Stupak language intact?  MNDemNY   Nov-12-09 04:16 PM   #42 
              - Stupak won't be in any bill sent to the Oval Office.  MilesColtrane   Nov-12-09 11:54 PM   #54 
  - That was before the corporations owned the country  liberal_at_heart   Nov-12-09 11:02 AM   #6 
  - Social Security is a bill that only helps the corporations  Winterblues   Nov-12-09 11:05 AM   #8 
  - Did it mandate that we purchase our retirement benefits from a privately owned cartel?  Toucano   Nov-12-09 11:05 AM   #9 
  - But it did not set back womens' rights 50 years, now did it?  MNDemNY   Nov-12-09 11:26 AM   #12 
  - Does it upset you that much that people are disappointed with the bill?  PVnRT   Nov-12-09 11:28 AM   #13 
  - She and her co-horts are only interested in a "win" for the administration.  MNDemNY   Nov-12-09 11:32 AM   #16 
  - Not at all. I'm really happy it passed.  ProSense   Nov-12-09 11:35 AM   #18 
     - so happy are you willing to let the Stupak amendment become law???  MNDemNY   Nov-12-09 11:43 AM   #22 
  - It is not that this bill is not "perfect".  MNDemNY   Nov-12-09 11:31 AM   #14 
  - What was different--you had real Democrats with spines who  OHdem10   Nov-12-09 11:32 AM   #15 
  - No, but when it was passed it had sufficient benefits and no critical defects  Political Heretic   Nov-12-09 11:37 AM   #19 
  - Quit making exuses.  Shagbark Hickory   Nov-12-09 11:39 AM   #20 
  - Pure nonsensical spin  ProSense   Nov-12-09 11:43 AM   #23 
  - That summary badly glosses over what really happened.  Xithras   Nov-12-09 11:39 AM   #21 
  - "The original 1935 bill was so poorly written...."  ProSense   Nov-12-09 11:44 AM   #24 
  - And you're ignoring mine.  Xithras   Nov-12-09 11:54 AM   #25 
     - You're contradicting yourself  ProSense   Nov-12-09 11:59 AM   #26 
        - There is no contradiction in my statement.  Xithras   Nov-12-09 02:22 PM   #28 
           - "If todays bill fails, introduce a new one tomorrow." What?  ProSense   Nov-12-09 02:57 PM   #30 
              - As I said, a failure of leadership.  Xithras   Nov-12-09 03:17 PM   #31 
                 - " a failure of leadership"  ProSense   Nov-12-09 03:21 PM   #32 
                    - Most people? Hardly.  Xithras   Nov-12-09 03:31 PM   #35 
                       - "Polls here on DU "  ProSense   Nov-12-09 03:33 PM   #37 
  - That's why the health care bill in Congress, if it passes, will work.  backscatter712   Nov-12-09 03:26 PM   #34 
  - "Administration should have engaged in a far more comprehensive...aid to the poor and unemployed"  ProSense   Nov-12-09 02:23 PM   #29 
  - K&R  SIMPLYB1980   Nov-12-09 03:23 PM   #33 
  - A few differences  laughingliberal   Nov-12-09 03:32 PM   #36 
  - "if the HCR is not a success pretty early after implementation it is unlikely to get 'fixed.'"  ProSense   Nov-12-09 03:47 PM   #39 
     - I suppose it may be a rousing success right out the barn door  laughingliberal   Nov-12-09 06:20 PM   #45 
        - Actually, this isn't quite accurate  ProSense   Nov-12-09 06:40 PM   #46 
           - The way I read the bill people at over 400% of the poverty level do not qualify for subsidies  laughingliberal   Nov-12-09 06:50 PM   #47 
              - It has nothing to do with subsidies.  ProSense   Nov-12-09 06:55 PM   #48 
                 - I don't see where the insurer has any obligation to cap my premium.  laughingliberal   Nov-12-09 07:06 PM   #49 
                    - It's in the bill.  ProSense   Nov-12-09 07:08 PM   #50 
                       - I would love to think it is in the bill  laughingliberal   Nov-12-09 10:24 PM   #51 
                          - The credits don't have anything to do with the cap. They are separate issues. n/t  ProSense   Nov-12-09 10:27 PM   #52 
                             - Then find me the section that states the insurance company has to limit my premium to a percentage  laughingliberal   Nov-12-09 10:38 PM   #53 
  - Not a fair comparison, Social Security was a new program  dugaresa   Nov-12-09 03:42 PM   #38 
     - The public option is a new system. n/t  ProSense   Nov-12-09 03:48 PM   #40 
        - however i am currently covered under a bad employer based option  dugaresa   Nov-12-09 04:02 PM   #41 
           - Larger employers will be given access.  ProSense   Nov-12-09 05:37 PM   #44 

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