You're Gettin' Shucked and Jived by the Senate - Part I

Since we pretty much know what version of the healthcare bill will be voted on December 24, I thought this would be a good time to go through and look at what they are touting as an improvement of healthcare coverage and break down exactly what you will be getting out of it.  Keep in mind that your taxes will go up immediately, while the earliest "benefits" from your increased taxes (or rather, your redistributed taxes) will not go into effect until AT LEAST 2014.

If you've even bothered to look at the bill, then you've done more than what your Senator likely has.  Most likely he hasn't gotten past the fourteen page table of contents, if even that far.

No Limit On Benefits?  Not So Fast...

One of the first sections of the bill you will come to in your reading will be "Subpart II - Improving Coverage".  It begins on page 16.  The first section of interest is Section 2711 which is what addresses the lifetime and annual limits that insurers will be able to place on your benefits.  The limits that your insurer currently has in place helps to keep your premiums low.  Apparently, though, the nitwits in Congress don't seem to care if your premiums go up — they just want you to feel that you have no limits to your benefits paid out by your insurer if this bill becomes law.  They are lying.

SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—
(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary.
(b) PER BENEFICIARY LIMITS.—Subsection (a) 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 beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

Read that again, especially 2711(a)(2).  The word unreasonable is pretty vague, and most definitely contradicts what Reid and his comrades have been telling you.  The Democrats have been preaching that you would have NO ANNUAL LIMITS, while the bill itself says that you will not be subject to unreasonable limits.  It also says that those limits are "within the meaning of section 223 of the Internal Revenue Code of 1986".  In case you want to know what those limits are (and there are quite a few of them, here is 26 USC 223.

Another catch is that 2711(b) says that 2711-a "shall not be construed to prevent... annual or lifetime per beneficiary limits... otherwise permitted under Federal or State law."  In other words, it only applies to benefits mentioned in this bill and can be overridden by other Federal or State laws.  And up until now, you've been told that this was to be the end-all-be-all of limitless benefits.  My friends, around here we call that "gettin' shucked and jived."

By the way, that 1302(b) that is referenced there contains the benefits that are required to be provided in order for a plan to have no lifetime or annual limits.  Skip to page 103 to find it, and continue reading through page 116.  (I sure hope you're reading this as a PDF, and didn't kill half the trees in the Ouachita National Forest printing this thing and adding sticky notes or dog ears...)

Can't Lose Your Insurance, Right?

The next section is supposed to tell us that our insurance can never be rescinded for any reason.  The Democrats say that it is a common practice in the insurance industry to rescind benefits retroactively after an expensive procedure, which is simply untrue.

SEC. 2712. PROHIBITION ON RESCISSIONS.
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).

So basically, this says that you can't lose your coverage unless you commit fraud.  That's a good thing, except for what if you do suddenly become a high risk?  Are the insurers allowed raising your premiums as the only option?  I'm sure you don't want that.  It also references two other sections in the Public Health Services Act.  Now, in order to find those sections, you have too browse the uncodified version of the law and interpret the amendment at the same time.  As in, to find Section 2702(c) of the Public Health Services Act, you will need to go down to page 387 of SA 2786 to find Section 1568(c)(8)(F) to figure out what the bloody hell is supposed to be in Section 2702(c) of the revised Public Health Services Act.

So after following the directions on pages 385-387 in Section 1568(c)(8) of SA 2786, I edited Section 2711 of the Public Health Services Act to read the following:

(c) SPECIAL RULES FOR NETWORK PLANS.—
(1) IN GENERAL.—In the case of a health insurance issuer that offers health insurance coverage in the small group and individual market through a network plan, the issuer may—
(A) limit the employers that may apply for such coverage to those with eligible individuals who live, work, or reside in the service area for such network plan; and
(B) within the service area of such plan, deny such coverage to such employers and individuals if the issuer has demonstrated, if required, to the applicable State authority that—
(i) it will not have the capacity to deliver services adequately to enrollees of any additional groups or any additional individuals because of its obligations to existing group contract holders and enrollees, and
(ii) it is applying this paragraph uniformly to all employers and individuals without regard to the claims experience of those individuals, employers and their employees (and their dependents) or any health status-related factor relating to such individuals, employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—An issuer, upon denying health insurance coverage in any service area in accordance with paragraph (1)(B), may not offer coverage  in the group or individual market within such service area for a period of 180 days after the date such coverage is denied.
(d) APPLICATION OF FINANCIAL CAPACITY LIMITS.—
(1) IN GENERAL.—A health insurance issuer may deny health insurance coverage in the group or individual market if the issuer has demonstrated, if required, to the applicable State authority that—
(A) it does not have the financial reserves necessary to underwrite additional coverage; and
(B) it is applying this paragraph uniformly to all employers and individuals in the group or individual market in the State consistent with applicable State law and without regard to the claims experience of those individuals, employers and their employees (and their dependents) or any health status-related factor relating to such individuals, employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with paragraph (1) in a State may not offer coverage in connection with group health plans in the group or individual market in the State for a period of 180 days after the date such coverage is denied or until the issuer has demonstrated to the applicable State authority, if required under applicable State law, that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. An applicable State authority may provide for the application of this subsection on a service-area specific basis.

So basically, if the insurer can demonstrate to the applicable State authority that it will not be able to provide adequate benefits, they can turn you down and take a "penalty" of not being allowed to provide new coverage for 180 days.  Now, wait a minute...  haven't they been saying that if this passes that you will not be turned down?  Once again... LIES.  This bill has me wanting to put Wilson's  "YOU LIE" outburst in a constant loop, because it would make a great soundtrack for this bill so far.

Now, the 2742(b) was easier to find, since it is a direct reference to something preexisting in the Public Health Services Act.

(b) GENERAL EXCEPTIONS.—A health insurance issuer may nonrenew or discontinue health insurance coverage of an individual in the individual market based only on one or more of the following:
(1) NONPAYMENT OF PREMIUMS.—The individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the issuer has not received timely premium payments.
(2) FRAUD.—The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.
(3) TERMINATION OF PLAN.—The issuer is ceasing to offer coverage in the individual market in accordance with subsection (c) and applicable State law.
(4) MOVEMENT OUTSIDE SERVICE AREA.—In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, the individual no longer resides, lives, or works in the service area (or in an area for which the issuer is authorized to do business) but only if such coverage is terminated under this paragraph uniformly without regard to any health status-related factor of covered individuals.
(5) ASSOCIATION MEMBERSHIP CEASES.—In the case of health insurance coverage that is made available in the individual market only through one or more bona fide associations, the membership of the individual in the association (on the basis of which the coverage is provided) ceases but only if such coverage is terminated under this paragraph uniformly without regard to any health status-related factor of covered individuals.

Basically in that section, we have some common sense reasons why your coverage should be terminated.  Now what about the fines the Republicans keep getting at?  There are so many issues on that front that I will have to save it for my next post.  For now, lets get back on track with how the Democrats are going to improve your healthcare coverage.

Preventive Maintenance

The next section (2713) seems to provide that insurers will be required to provide coverage for preventive care.  They are to be required to provide this coverage without any cost-sharing requirements, also known as copays or deductibles.  In other words, the insurer will be required to pick up 100% of the dime for preventive care.  This will cause you premiums to go up, no question about it.

The covered preventive care, however, is not without its limits.  The first limitation you will run into is that the preventive care you are requesting must be evidence-based and have an "A" or "B" rating in effect from the United States Preventive Services Task Force.  I can see the Task Force suffling around those ratings to move closer to a single-payer system, eventually.

Immunizations will have to be recommended for the individual by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.  So rather than being able to make a choice on getting one of the extra doses of H1N1 vaccine, it will not be available to you if you are not high-risk.

Infants, children, and adolescents will only be able to access the evidence-based preventive care that is provided for in the comprehensive guidelines supported by the Health Resources Services Administration.  So if they decide to not include HPV in those guidelines, your teenage daughter will not be able to be vaccinated against the leading (by far) cause of cervical cancer unless you pay for it out of pocket.  Are you really wanting to leave health decisions up to your government?

The part that will probably get to most people is paragraph (b):

(b) INTERVAL.—
(1) IN GENERAL.—The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline.
(2) MINIMUM.—The interval described in paragraph (1) shall not be less than 1 year.

Read that closely.  The Secretary has the power to establish the intervals that you may have this preventive care, as long as the minimum is one year.  One procedure or vaccination might be available once a year, while another every 10 years, or even every 50 years, depending on the whims of the government.  Read it again.  The ONLY RESTRICTION is that it MUST be at least one year, but the Secretary is not required to subscribe to recommendations of healthcare experts or professionals.  This means that your preventive care schedule will be dictated solely by politics.  This cannot end well.

 Part II contains more information about the penalty for no health insurance.