I first wrote this post in 2011 but believe it still applies today.
In order for the healthcare reform to be successful there are two changes that need to be made that presently aren’t in the healthcare bill. The first change is revoking the antitrust exemption that the health insurance companies now have. The second change is putting the regulation of health insurance companies at the federal level. This is the only way to get competition across state lines. I believe this is possible based on the Constitution that the federal government regulates interstate commerce and most if not all of the health insurance companies sell insurance in more than one state. It would be much easier to understand the Senate healthcare proposal if it was written in everyday language. Anybody with a high school degree should be able to read and understand the proposal. The way it is written now takes a lot of time and effort to understand exactly what the proposal is the defining. One example is that I had to assume that the reference to Secretary in the proposal was to the secretary of the Department of Health and Human Services. I find it interesting that this proposal sets a requirement for presenting a summary of benefits and coverage in both style and language. It’s too bad that the Senators who wrote this proposal did not follow their own requirements that they are establishing for the insurance companies. If they had it would’ve been much easier to understand the healthcare reform proposal.
The Senate healthcare proposal states that there will be no lifetime or unreasonable annual limits. It then goes on to say that this proposal “shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per in the beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under federal or state law”. My interpretation of this last sentence is that the state laws can override the federal health care rules.
The Senate healthcare proposal states that a group or individual plan cannot be canceled except for acts or practices that constitute fraud or makes intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. My interpretation of this statement is that if you lie on your application or you submit fraudulent claims your coverage can be canceled. You cannot be canceled for getting sick.
The Senate healthcare proposal has a requirement for the coverage of preventive health services. It states that a group health plan or health insurer issuing group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for preventive services. The types of preventive services that must be the provided are defined by federal agencies.
The Senate healthcare proposal states that dependent coverage for children shall continue until the dependent (who is not married) turns 26 years of age. It goes on to say that the insurer does not have to make coverage available for a child of a child receiving dependent coverage.
The Senate healthcare proposal defines that essential health benefits shall include at least the following categories: (a) Ambulatory patient services, (b) Emergency services, (c) Hospitalization, (d) Maternity and newborn care, (e) Mental health and substance use disorder services, including behavioral health treatment, (f) Prescription drugs, (g) Rehabilitative and habilitative services and devices, (h) Laboratory services, (i) Preventive and wellness services and chronic disease management, and (j) Pediatric services, including oral and vision care.
The Senate healthcare proposal states that in defining the essential health benefits the Secretary shall: (a) ensure that such essential health benefits reflect an appropriate balance among the categories described in such subsection, so that benefits are not unduly weighted toward any category; (b) not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life; (c) take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups; and (d) ensure that health benefits established as essential not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life.