HEALTH CARE REFORM: Chapter 1

First of all, I would like to the point out the title of this blog. What I post here is my personal opinion.

My personal opinion is that there has been a lot of serious misinformation going around regarding health care reform. That irritates me. If we're going to make a lot of noise, let's make noise about the facts. There are debatable things up for discussion. But there are also heinous lies being irresponsibly fed to people. And people believe them.

I am not a health care provider. I am not an insurance agent. I am not even a policy wonk. I am a 21 year old intern and student. But I have enough time to read these health care bills (something not a lot of people have done) and analyze them. I am not an expert. But I have an opinion, and hopefully it is somewhat informed.

For today, I present the first 71 pages (less, really, considering the table of contents) of one bill. HR 3200: America's Affordable Health Choices Act of 2009 is the House bill, and it's over 1,000 pages long.

Division A of the bill is titled "Affordable Health Care Choices."

Today, I'm analyzing Title I: "Protections and Standards for Qualified Health Benefits Plans."

I would like to start out by saying that I never found a clear and satisfying definition of "qualified health benefit plan," or QHBP as it is referred to, although that is probably because it will refer to whatever ends up in the final bill.

In Section 102, we find the language, "grandfathered health insurance coverage." Meaning: the current coverage you have, you can keep. The argument of course is that the public option (which we haven't come to and will probably NOT be in the final bill) would run other insurance companies out of business with an unfair advantage. But let the record show that the bill does not say that you MUST abandon your current coverage (if you are so lucky to have adequate coverage).

Section 111 is one that contains a lot I hope we can agree on: the so-called QHBPs will not have exclusions for pre-existing conditions.

Section 122 establishes what will be in an essential benefits package, i.e. the minimum coverage. It limits cost-sharing, which prompted me to ask, what is the difference between "cost-sharing," "copay" and "coinsurance"? I did not look into these definitions, but I plan to do so at some point.

Section 123 establishes a "Health Benefits Advisory Committee" to recommend benefit standards. The Committee is ADVISORY and will make RECOMMENDATIONS.

Section 132 calls for a fair grievance and appeals mechanism, which I think is necessary.

Section 141 expands government, creating an independent agency in the executive branch, the Health Choices Administration, which will be headed by a Health Choices Commissioner. Section 142 establishes the duties of the Commissioner: QHBP standards, the Health Insurance Exchange, and affordability credits, with a focus on accountability.

Section 144 calls for a QHBP Ombudsman.

Section 152 prohibits discrimination in health care.

Section 162 ends insurance recission abuse. Your coverage, under the language of this bill, could only be rescinded by the insurance company upon clear and convincing evidence of fraud.

Secion 163 deals with administrative simplification, with such goals as enabling the real time or near real time determination of an individual's financial responsibility at point of service and near real time adjudication of claims, requiring timely and transparent claim and denial management processes, including tracking adjudications and appeal processing.

Section 164 is about reinsurance for retirees, which entails employment-based plans for retirees 55 or older not yet eligible for Social Security.

And that's Title I. I can't promise a thorough and complete analysis, but nothing too earth-shattering.

Up next is Title II: "Health Insurance Exchange and Related Provisions." That's where all of the new, really controversial ideas are, so I'm really looking forward to reading through that. Maybe a career in health policy could be in the cards for me?